E 181 Membership Based Podiatry w Tea Nguyen DPM Direct Care Way 

Can a membership model work for Podiatry? Dr. Tea Nguyen discusses why she left insurance, avoided an early career burnout and is now offering more MIS options and non-surgical treatment in a direct care practice.

181 Membership Based Podiatry Tea Nguyen DPM Direct Care Way a doctors perspective
Dr. Tea Nguyen, DPM talks to Dr. Justin Trosclair, DC on A Doctor's Perspective Podcast

Dr. Tea was first on the podcast episode 28 and we do a quick recap of what was going on 5 years ago and how things have changed since leaving that clinic, having a kid and going to a direct care – cash – membership model of podiatry offering unique minimally invasive procedures.

Once becoming pregnant, she found herself having some peculiar experiences at her insurance based associate positioned job. We discuss those as well as growth, freedom and flexibility issues.

She began to consider opening a solo clinic to accommodate her new to be mother role and the flexibility that would grant her. However, she quickly found out about all the hats one must wear as the clinic owner.

Insurance Headaches and Burnout

Dr. Tea freely discusses the horrors of the insurance pay model, how and why she was losing money hand over fist in 2019, and the pinnacle moments that made her really question to continue and face burnout or make the shift to cash pay and no insurance.

She has a few versions of herself: v1, v2 and now v3.0. These range from a surgery and insurance focus, to minimally invasive procedures, to another clinic and starting a podcast to help more podiatrists (especially women) to become direct care membership model clinics.

Starting a clinic during the pandemic was not easy nor was being overstaffed for a variety of reasons and she explains what she did during this time to pivot and develop professionally and clinically.

Minimally Invasive Surgery

MIS, minimally invasive surgery, has perks like less overhead, patients are happy to not stay in a hospital and when she really critically thought about it all, she was the only one offering these services – so why be at the mercy of insurance.

Dr. Tea, DPM has a pretty simple formula for calculating her hourly rate and cost for procedures.

It’s not her place to judge how someone budgets their money. She puts her prices on her website for transparency reasons and it also helps people make a decision before even calling.

With the insurance model you don’t even get to shop around because it’s usually some line like “we don’t know exactly what your insurance will cover” and then you find out months later that you have a huge bill.

Reasons to do Membership – Direct Care Model

Poor insurance reimbursement, accompanied by heavy patient load can lead one to feel exploited and burnt out much quicker than you would anticipate.

  • Nobody wants a Surprise After The Fact Bill without Freedom To Choose.
  • People Do want, peace of mind and convenience and a direct care doctor provides both.

What services would you offer if insurance would actually reimburse for them that would give superior clinical results? Between needing to be efficient and maximize patient visits and services, how do we do what’s best for the patient but also allow us to not burn out or not even make a living? Is there anything else we can offer (shockwave, PRP etc) instead of surgery?

  • Insurance patients aren’t as attached to the doctor, as the doctor is attached to the patient.
  • Virtual Assistants to answer phones and do tasks are talked about at the end of the interview.

here a few of the direct care rules I have looked over

https://www.dpcare.org/state-level-progress-and-issues https://www.dpcfrontier.com/states https://boomcloudapps.com/2016/08/25/house-membership-program-state-regulations

links to its no secret and her podiatry legends interview

https://www.tysonfranklin.com/news/podiatry-legends/10989-198-dr-tea-nguyen-direct-care

https://adoctorsperspective.net/itsnosecret

link to the podiatry series https://adoctorspective.net/podiatry

Show notes can be found at https://adoctorsperspective.net/181 here you can also find links to things mentioned and the full transcript.
Her podcast can be found here https://drtea.buzzsprout.com/ and her IG is drtea_podiatry and clinic site is https://831feet.com/

181 Membership Based Podiatry a doctors perspective Tea Nguyen DPM Direct Care Way
Full Transcript of the Interview (it will have grammatical errors and mistakes). Just Click to expand. Thanks audioburst!

Awesome, very nice tablet.

You're doing award winning podcast host and best selling author, Dr. Justin, Trosclair, people behind the top doctors and experts about their specialty marketing. All my balance. Let's hear a doctor's perspective. Listen, German. Welcome back to the show. Let's talk a little bit of a break. I moved away from Germany.

I don't, you ever had to liquidate everything you own the move that was tough, but my wife is a trooper who was able to find a way to get rid of everything, was hard to say, goodbye to, some of the people, but do it best for your family. If you didn't come if you're mental health, so it was good, move since then, just setting up a new life and trying to find a house, trying to find a job.

So, I'm working number two, jobs situation, number one, line to five thing, and then building up a membership based travel chiropractic. So, like I go to people's houses and their office or whatever to adjust them. They do also work and all that text stuff certain scratches are slow process.

I'll tell you that. And that's also one of the reasons why we have doctor teeth when on the program she transitioned from your typical podiatry surgery, based clinic into a cash pane membership style, direct care model. And it's gonna run through why she did it. How she did it, how she said her fees, she started a podcast.

Why did she do that? She's just very passionate and super exciting to hear other people doing it, not just incorporating physical therapy, but it's super tidy on insurance. They're tired of the rug around burnout and all those things. So we'll cover it all kind of exciting news. The needle is acupuncture book.

You know. It's about that every episode probably but over one thousand books have been sold. Yes, it's on Amazon and people buy it and super excited about it. It's done a lot of reviews. I don't know how to use my review. Sometimes, please review the show. Please review the book have two variations of something for someone to read over and say yes I like the first one.

Let me just change a couple things here and then they can post it because I just they would like to do it. They just can't write good, they're scared. So you can write for them. Don't prove a copy, paste it over again. I think the nice thing about that is you can highlight different parts of your practice.

What are you looking for? It was painless hours, we're convenient sure the feet might have been higher than normal but the value was so high. Oh he does. This new style is new technique etc. Change of the coaching team a little bit on the show and logo a little bit.

Something more freshman cleans, like definitely got a ream I did. All I was in Germany before I left and I got just it's got all of these story brands that you want, but whether they're like, visually pleasing. So I want to fiber. That's people that I do elementary pro with WordPress, and famous money, actually, two different people.

So the main site and then scallops page at two people do those. And based on the results, I had a couple of little pages that most people frequent and haven't changed it up. Made the foot better in the header better and I was really money. Well, spent I take a look at doctor, Justin for scratch.com, looks a whole lot better again.

If you're in rehab fitness, there's a 11 episodes that cover courses files mindset, anything imagine 11 different episodes. You go to doctor's perspective, like we have to download those. Let's get on with all the shows and the transcript can be found at a doctor's perspective.net/in time. Just got a couple of repeats because you know what she was episode 28 and that is a long time ago because that was 181.

So that's almost like four years and there's been a lot of changes in both of our lives, so we're gonna focus on her. So please welcome Dr. Teague, I'm so excited to be here. We both have kids. We both have changed our practice model over here. Hello, it's amazing.

Like four years for me. Three countries and like a three year old. Now for you from now mistaken, this is gonna be your first second clinic, completely different model that I didn't operate to do is spoil alert memberships and I can't wait to dive deep into that, but I like to take us back to a quick recap of the show before and then sort of how you never mind.

Tell us. That sounds great. So I really listen to the episode. You were super about the the practice that you had and you're doing not trying to have amputations. That was your focus. It seemed like preventative IVs, very happy with the people that were there but you know, things happen over here, too are three or whatever.

So what happened there and made you turn into your own practice and if I'm mistaken, you got out of insurance and you're like a cash practice. Yeah. So I my husband according to my husband says, I've been reinventing myself like every six months. So the last time I was happy, I joined a group.

I had left, Michigan, came to California, with voltage, and job here, in separate offices, in Santa Cruz, and a year, and a half, in our little bit more, I got pregnant. And when I got pregnant, I let my employers know, I want to continue working and just pregnant. No big deal but things.

Maybe. Reposition, where I wanted to see my future in 2018 of January. I made it. I made a decision that in order to have the freedom that I wanted to be a mom or to do whatever else in my practice that I would have to go into a private practice solo.

I would have to run my own business because in my mind, I'm thinking who is going to accommodate my schedule the way I need it. And no idea what it's like to be mother. I don't know what's going to be demanded of me, my body in mind, so who's better to make that decision than me?

So, I quickly had to decide how to open a solo practice and I did that in 2018. I saw my first patient on my own at August with, they not have been flexible. Say like, I'm just worth half days or four days. Three days a week. They really wanted somebody that was gonna be there non-stop, what hours a week.

So, some of, that's a little bit of a blur. Because I living at the whole situation because what had happened was I had surgeries scheduled. And then all of a sudden one day I showed up to work. And my surgery said it was clear. Nobody had told me, they were canceled, their surgery, scheduler would not even talk to me.

She just said, I'm just doing what I'm told to do, which was to clear your schedule. So I had, I had both one of my bosses aside and I said can you explain to me why I only in January but I'm doing and by being stopped to do surgery and it was kind of like a very indirect conversation about how I became a liability to surgery.

So it was just a lot back and forth and at the time it would it just wasn't really worth talking more about. I said you know what, he's got no interest in making me a better person in the practice, they just want me to do what I'm with. They're gonna tell me to do and that's just reality of being associate.

You're just there to do somebody else's job basically and so I came to. Yeah. And there was no growth for me. There was no freedom. There was no way that I did really grow in this position. So that's kind of how it turned around. So I try not to leave better although I was for a little bit because I had really invested myself in this practice and trying to make it work but in the end it didn't but it was a good move for me.

Because having gone into solo practice, I really learned the value of being a business owner and how much freedom I do get right in my own business by myself. You know, it's hard but having a daughter it's like what's gonna manage your time better than yourself. Have to doctors that, I'm sure you've built up but someone's going on where you still able to do the fancy surgeries and everything that you trained for.

Yeah. So from story how I was trained and residency that just laid the foundation of what's to come. But what I actually do? Now, I'm gonna mean basic surgery in the office. Was that was an additional skill. I learned during practice. So version one of me in 2018, I did exactly what everybody else was doing.

I got contracted with all of the insurance, the private insurance, the government insurance is the state insurance thinking, that, that's what everyone's doing and the end of 2019, I was financially thinking faster than I knew how to get outside a consultant because I had to pay for overhead a biller, an EMR system that had daily software.

I had to pay for the manual labor for someone to evaluate my AR, and see who didn't pay it, follow up on that. So that in itself was just anything, enormous amount of energy suck that costed a lot. So, the end of 2019, it's like, what the heck is happening?

I had not envisioned this to be happening, so I got professional help and by a 20 January 2020, I started to learn minimally face of surgery. Did my practice how to do it in the office. So I didn't have to rely on the middle people and facilities and staff.

May or may not show up in my community right now we have a hard time retaining and seeing just services. So without any future it was really hard to do surgery at the facility problem. I had to deal with other people like I just want to do the work and my patient is there.

So me, patient, well-wise is difficult to do. I've already want to switch off the joint aesthetic. That was version 2 of me but was incorporating office by 30,000 people today. Everything I still have potentially hospitals and facilities. And so if I had to figure surgery that required for staff services and that door was open, that's good.

And then depending on kids, which very interestingly though, 2020 was my best financial year in other way. It just wasn't because of any skill, but it didn't hurt me as bad, as I thought it would. When you say that on the invasive tends to be more profitable because you don't have all of the extra overhead.

Nothing like a PRP injection, we're like you know these guys get their side joint blocking those. They just put that up all day long because at least it's still like you can do in house. You're not. Yeah. All these other people in the hospital? Yes, beautiful because I can just do it right.

Then it there and everyone's happy I get paid. The patient is fixed, they don't have to be hospitalized. The bill is not exceeding orbiting is really nice, but I was still tethering insurance at the time. So I was still billion insurance for that service and then it just got really painful and I said you know what?

No one else in town is doing what I'm doing. So why do I, why am I competing insurance with insurance? When I really could compete on cash face, practice minimally basic surgery and what else has been doing it? That was kind of the way I was looking at it.

My brother has everything. So is it kind of one of those things where I don't know the fees or let's just say six $6? Or if you break around the same, it doesn't how it turned out. Yeah. So I'm trying to think of my old cases, the reason people pay my prices because no one else is doing it.

That's where I get my leverage. So regardless of their insurance or not, I mean people insurance is deductible all the $10,000. It's kind of ridiculous. You have to pay that in order for your benefits to getting a smile. But I like $5,000 short about you or it's $2,000 for a total you know those rates change with time depends on the circumstances in the complexity but that's kind of my base rate, that's pretty normal throughout.

I don't know what other people charge. I just know what I want to charge. I know what I want to make her hour or year and that's how I make the calculation. I don't feel that I can compete with other people with icing because I don't want to be the Walmart of medicine.

I don't want to be the dollar store so I know, I give really excellent care. So I'm very high price thing. It doesn't bother me one way or another because don't again, no one else is doing it. What I'm doing within 80, mile radius. I can also essentially unusual because I would think if it's good money and it's a little training.

I don't regardless of other people want to put in there. Hi, yeah it's just it takes personally investment. So if one is lucky to have learned this and residency, then yeah, you have to do it. I didn't learn any residency. So I had to get my head to seek out.

Professional people to teach me so that was okay, young alternate, and that's a benefit of having kind of. See what I need to do, back to training, I didn't have that training, I didn't learn as a resident yet. I've learned as a fellowship, I had to learn this when I was already in practice, and it took me a year to kind of figure out how to do the technical part because it did because it is a year to see the follow up to see if there's recurrence that.

There's other things that need to be modified, what was my own success rate, because there is a huge learning curve. I took the time because I had the time I took the time to train with other people who are doing it and that is another investment in education. That's probably why people are doing again, okay?

Well, then I definitely wanted to come up as a physical son, as we learn a new technique, but it's not over the time. But yeah, yeah. That's not the weekend and then someone buys and they use it. That's not what this is. Okay, this is like a real deal.

This was again, I want people to do it something investment time and resources. Everything. Also, the reason why people are doing is because they're so used to the modern day way of doing surgery which involves screws and fixation, which is ind did. So in order to get that type of training, the industry pays for the doctors to have that experience with their equipment, whereas mainly basis surgery, there's no real equipment funded industries so we have to get a pocket for that knowledge following.

Yeah, it's really funny. So once I was version two of me in 2020 and now we're in version. Three in 2022, where I am already cash now and by July just my birthday, I will be 100% cash and in a different, those are the changes coming up. And so the second office is the first one.

Yeah, I'm just gonna like with the chameleon like I'm just gonna change. I'm gonna, I'm moving on to a place that's closer to my home. So I saw the feast, they're not a like I said, it's not a dollar store prices for sure. But at the same time, you're gonna get quality of patient.

And so has your clientele have yet to market differently, to go from insurance based or make your base to people who have. I don't know if you call this question because I don't have deep problems yet so I don't know major priority. So these kids part of my budget now because I have a problem and so you just have to come up with money.

Yeah. Thank you. So I have people way too very high income, see me, so it's not really the dollar amount, that's the concern, it's the priority of the person and how they want to spend their dollar. So my that's why I'm very transparent about my prices. So people know in advance what the cost of the service is and can budget for that.

And I have no place to judge how they send their money. Though, it's just there for people, if they want my service, they can find me and if they end, and that's okay. The problem with the insurance based medicine, is that people don't have that freedom or opportunity to shop around for services.

It's not transparent. It's not like you can go to one doctor and say, what's the fee going to be? What's my responsibility going to be and then you go to the next office and ask the same question. You can sit there and compare you can. It's just not easing, you're not like going to a restaurant and you're picking one of the others.

They don't even want to. They're gonna give you the run around like, oh, it depends on what insurance you have. Oh, it depends on this whatever. And I found it to be so frustrating and so unthinkable. And there was no freedom to choose. You really did not get that opportunity to pick what was in your budget.

This was interesting, the callus removal thing and even like the diabetes think there's a fee per month with a commitment. Does that actually include a visit? Or is it the mission fee is the privilege. The concierge part to actually access me on a easier scale. How's that feeling? So version, me version three, I'm evolving.

And how I'm designed this member, so I have not met the doctor who have created the membership model, that would work for me. But I'm kind of just reballing it. If you will, I created a membership where it's a 12 month commitment, and they just pay a friend and these are just a visit, they can have a visit per month and it can include very basic things.

If it's whatever I can cover with 30 minutes of it's now trimming the mild wind debridement, that was nice. It's all inclusive. I try not to like pick up any hair. There is just like okay security that they can rely on me. They can access me. Shall they have?

Do they have to go to the, ER, for example, I'm trying to prevent those definition and just contact me for that even though a lot of things that I can do out patients. I'm trying to educate patients in that the model as well. So cool, a couple things we find people are signing up in and doing like, you happy, with the numbers there.

Or do you like to go if you want, 200? People could even see, five people really good questions. So, I'm divided between the membership model and the fee for service research, I have a very amount of memberships. I have two different membership. I have one is just ship model for people who have more product conditions or amputation in our at risk additional loans.

Those are the two models that I currently have people are interested, but they it takes a bit of, they have to know how I'm different from other people. But these are well, established patients who knew what I had to offer and was willing to buy into that membership. So that has worked really well because I'm doing memberships as well.

And as you build, you have to get inflation and instead up. And yeah, I think I'm gonna say what is you? I'll try one thing but like I'm curious about trying different ways. There's a different price and range of how many visits and I found my wife. This is really good.

Alex, he's on the kind of starting we cut her hair that's always like, you only have the IP and you pay this auto money and you get this much off. But they did right after this party like it was all set up and so just trying to tag with her and some of her business minded friends to find like, what would be the most beneficial?

Because you want all your time, you want to make it where they are gonna see value in the benefit. But he said, wherever you can't handle five people months and that's probably you know what the price and workload. If this thing explodes over the next year and a half I don't hire more people.

I got to the problem to have I personally would love to have an associate or a partner with the next five years. I'm still kind of ignoring the model for my particular community so I really like the membership model because it makes them, it gives them. Peace of mind.

People will pay for peace of mind and convenience my surgery prices for my surgery prices. It also all inclusive. So it's not like I do the surgery and you have to worth of service. They can perceive the value in that and it's an easier spell than to say, well it causes much, you know, to do the surgery and then you'll still have to pay it off.

Because that a family history of some more problems. Like you know what? I'm about to hit 40% out and unfortunately to get prescription to get these services, they start making calls. And like, this was a December early December. Like I said, February, like February, maybe March, like, oh, about a long time, have to wait, and then do a great financial guy who would do it for you, like, or five hundred euros, cash and didn't get me in.

And I can, we can have and sounds like me already paying for it, but I'm not going to be in the country anymore, but I really like it over America, we will know. It's gonna be a way more than 500 euros to get any of these tests done. If they even do it for you, I was like, all right, here's my money.

Just taking it, you will pay for that convenience and that's where I cash back is really place because it all because the insurance based model. All the doctors are tired. They want to push it out. They may not necessarily get to see you today. I saw patients yesterday, he complained of being a lot and I was like, well, maybe it's a GTI.

I don't know about the ER but I usually go to the go to your primary care doctor and he goes, I can't get into see that doctor for two weeks or so, which is not that bad. But when you have a burning UTI, that two weeks is a very long time.

One hour urgently at least we have those around here. Yeah. Because I was like, well I guess that makes my thing is the ER which I obviously wanted to prevent but I'm not his primary doctor and I don't have the utilities to help the diagnosis, the lab work and all that sounds like I guess that's your best.

But see if his primary care access to care. And a lot of the direct care, doctors the PPC, doctors primary care, doctors have low membership fees, and so maybe they're paying, they're having patients, pay $100 a month or the year for 12 months and they have a patient panel of three, four hundred people just really depends on what they want to make.

Now patients have a quicker access to their to the doctors. And that's kind of what I wanted to do with my membership, is that, I knew people who had chronic a problem. They're gonna eat my services on. I need to find a way to make that work and I imagine or what you do chiropractic.

I see my chiropractor for a long time. You probably have patients having to see you for a long time as well. So I just think the membership knowledge just makes sense, like, just pay up front and then you're good for the year. Whatever happens exactly as a podiatrist Are you allowed to regulate professional medicine and things because you do with diabetes or you kind of stay away from that and refer back to the PCP?

I do what's in my school within my scope. So if I'm treating infections, I don't manage blood pressure. I don't manage their diabetes. Any that that's medical management website because it might be confusing. Everyone over here. Don't have the experience for that. Yeah, I don't know how far, how deep it goes.

You know, you said something direct primary care PC. I was thinking something else. I know when we were or membership like contracts, I don't know if contracts are you can't, you can't call the discount plane, you can call it insurance man for a certain legal terms and others a couple of way things.

They don't link them to their children's page today where they have access. This is what questions to have this concierge thing. This is how they word it, and it's in a lot of statues due to correctly. Yeah. So I actually lawyer who's well versed in the direct primary care.

So she knows what's happening on the legal standpoint and in California. I don't know exactly what's happening in California, but the verbiage is, it has to be very clear that this is not a type of insurance. It has to say that this is not insurance, it's another discount plan because it's just a whatever it is.

And your terms if I'm mistaken. You have your podcast. What's going on? I just started a podcast. Yeah, I feel kind of silly talking about on the one hand because all of the world does direct care. If cash or cash practice or socialize medicine, you know, but in the US there's definitely a move towards direct care.

So the podcast name is the direct care way and it's really geared towards pediatrics and private practice. So we want to just exit the insurance model because I was burned out and it was costing me a lot of money to run in insurance based practice. Yeah quick. So I got busy really fast thinking I was doing a service but I was not doing the service.

If I could make profit I let go of that had like little patience because I said, there's just no way I'm gonna except 18 dollars for my time. Just can't do it. I have three stop members feel like almost breaking when I go to school for. Now this everything for 18 bucks in any field, very avoided.

I was so willing to help and the system has no issues in making you work and then people make you feel guilty about that. Like, oh, you should be asking for money. You should be happy that you're helping, but you have the privilege to help people and I'm like, oh, are you absolutely not?

Would you like to pay my bills? Would you do like to look at the dead? I took out myself to know. Would you like to help me with that? Can you give me more money as a Costco manager is, a problem is like $15 an hour and you get discounts, I mean there's so many things I would have been able to make money off of and insurance name.

It was one of them, really, I thought you were on Franklin's podcast allegiance here. But I thought I was on it too comanch. How did it go? How do you feel? I like this show. You're so good. I love talking about the dietary. I think they're used to be more people within the speak about what it is and he started doing that.

I'm trying to do that in the director's space. So I spoke a lot on his podcast. Not right here in detail. Of course, he's looking at the US like, well, you guys got it all wrong, of course, like, I know, but there's parts of the world where they're looking into privatize health insurance.

And I'm trying to discourage that because you lose a lot of economy as a doctor, when you let someone else manage those bills and you definitely keep in touch with him. There's a Dave, James from the UK, and then, you know, doctors perspective on this last pediatric. They're on there.

That's three or four guys that are in the circuit in the UK and Australia. They do lots of like talking and coaching and seminars, all that kind of stuff, I don't know. That's one route that you're investigating. Yeah, it might be a wealth of knowledge especially if you end up niching down on this and get a name for yourself with that, like me more.

Tell me more. Yeah, like chiropractors physical therapy. Acupuncture have all been doing this for cash for the longest time and it didn't pretty solid as a well-oiled machine. We got out of it. We've been doing insurance like you, I was getting paid there was one insurance company. You get an exam based on their copays how much exam you get so the max you get $94 and that's all you would get the rest of the year after that.

It was their $10 coping. I'm supposed to treat. You crack your back and do some exercises but 10 bucks. Please don't come back to often any chair anymore. Practice insurance, just something not going right? Yeah you should be happy. One second. How many patients are there style? That you got a nice check up and it was a 10 or 15 or $5 coupon.

Like what are we doing? What is this? And then another one is either flashing or how many services do you have slightly or it was you do up to you can do at least three services to reach that slightly and thinking somehow, to four or five services. Now, you're actually finally breaking, you know, that's even because good morning, you know, I want to talk about that because this is what the server.

If you're an insurance based practice, you're offering insurance based care, which means you have to have volume to make money between your, you're not going to offer innovative treatment. If insurance doesn't pay for it because you come with a judgment that patients won't pay for it. So automatically you've narrowed your soap offering because you'd rather spend your time wisely which is no false of your own but to get paid for that time.

You spend with the patient and that's just we get, we have a good heart. We are good, doctors, but we get tied up in the system to making it work for us. That at the end of the day, when you go gambling, who always win the house? Always, so I didn't recognize this and how I exited the insurance things practice.

And I was like, why aren't we offering other modalities that can actually help patients before we offer surgery? I love doing surgery. I did all day long, but the way I've been trained, we skip the whole pocket of opportunity to help patients not have surgery. And that's because those things don't get paid by insurance no longer practice.

This is what there was to relax things that we can do that. Don't cost that much. But there's a machine that 20 to 35,000. I've got must discoverable, maybe you do, but I guess people probably charge 50 bucks for that in a carpeting ground for a few minutes sessions, but it has to be cash.

And so even a thousand dollar payment a month, that's a lot of visits to meet that payment and you're starting to overcome like, all right, so I got this copay and I'm adoptable. And what's another 50 on top of that? I feel we really need it. Now start selling packages of six and ten up front, otherwise you're not gonna use it and then, yeah, so much to involve even this massive salesperson for taking a daily but, you know, that's a big price.

Again, you like it. You use it for years, you sell as a package. I like it as an alternative. I don't think, I think there's any one thing I offer that is the end all not scary injection. Not PRP not surgery. So chocolate theory. Therapy is just another tool for another type of patient who's like, is there something else besides surgery?

And that is the thing and I found that it's helped probably 70 to 80% of people like, for it to and so. So I that's how I sell it. I say this is an alternative way to help yourself to two problems. That is non-steroidal and it's not surgical and if you want to pay for it, it's there for you.

And if you don't I don't try to push it. I'm not Mars sales. I have the tool and you're welcome to use it and that's all there is to it. Yeah, I'm gonna go with my cold laser. I use that a good bit for different things, I like it, you know, I could probably, I would like, to upgrade to the, like 15,000 hour one because you can do a lot more with it and it's like faster, but I have works well and just takes a little bit more time than my guys, little tips where you can come and get focus like, acupuncture almost, and you can force focus, the beams deeper into being more concentrated so you don't have with it.

Just be nice to a little bit faster with it. But again you've got another big old computer size piece of machine that you're trying to drive around with this one has more portable, so I'm okay with it. Yeah. And you had the direct care days, you do have to market different because the mentality of people who you marketed to have, originally they found you because you were gonna refer to network or on dated internally.

That's actually found to and maybe they looked you up online on Google or something. But as soon as they change insurance or you don't contract with their insurance, they're gonna let you go, they're not attached to the doctor, as doctors are attached to the patient, but that's something that I had to overcome for a long time.

And now that I'm market how normally market, you know, this is a solution for the things that you need. Also, I don't bill insurance. There's gonna be a pocket of people who don't really care. And those are the people that weren't really marketed to previously. So there's a whole window of opportunity for people to find you.

You just have to really put yourself out there doing Instagram. I know it's really good hers to handle to be on the show notes page, but she really has good stuff before. And after is the surgeries that's about drew me into the very beginning and she still doing it.

It looks like I hope I all get in plans. Yeah, Instagram is, it's kind of funny, you know, it's age dependent is generation. So it's like one is the 30s, maybe 40s or on Instagram and they're usually friends who refer themselves or they refer their family member, which has been really nice.

It's nice to connect with people. I used to know from high school and drive all the way in town to see me. So it does have a little bit of some weight but it's really meant to be educational so that they can say I got this information from an actual doctor and it wasn't like a Google.com search and they have questions.

I have, you know like free 15 minutes consultation, put a social connection in the education. What are some of the ways people can get in contact with you? The best way to contact me is on my Instagram, Dr. Teddy. And you can find the links and how to get in contact with my office or myself directly through the DM.

And I really hope this was interesting because I love talking about photography and I love talking about dry care and private practice. I hope you got something from this too. I'm gonna create like a house call slash direct care type of PDF like I've done for all the other series that I've done because now I have enough episodes where if you really interested in this stuff, read them all.

And remember listen to more about pricing about the mentality shifts because it's not just about money, even though we can't focus on that, it's all the mental part behind it. Yeah, you're good. You're worth it. There's value. You how to present it so that people understand. Yeah, you are being premium price.

I'm not hiding the fact that you're paying more than you could down the street, but this is the reason you didn't get results. I don't know, maybe that's something you get with experience for some kind of school. Probably not make sure sometimes be powerful for a lot of people in person.

Think I step out, you did get out of insurance which whatever, don't just drop on my cupcakes. So take your time, you will be trapped in there for 30 60 90 days. You might start with the worst ones and they don't like a year or 18 months period so slowly start dropping all of them.

So like you don't just have this massive hit in your income too because you still have all that same overhead for a while. Before you can kind of skip this, you can't scale back some of your staff and probably different things. We like to take insurance after. Yeah, source their staff.

So I've had hello reached from the Philippines and I traveling from Mexico for the answer phones. Are they doing? They do answer the phone, they do. Scheduling, follow up, calls insurance verification for the one insurance. Like I have left, whatever. Needs to be done by phone. They'll do it.

My personal calls, you know, they have a lot of stuff. Yeah, they're very like this. I'm hired, my first VA to do all of the blog in the content. Like, I probably have about 100 different things. I need to put on there that I just haven't done and then I want to convert my top podcast episodes into something that's useful for my clinic site, for SEO and everything, and some in the process of hiring someone right now to do all that for me with like three months period, but they'll give me content, like, for years.

I'm like, this is totally worth it. And it's so affordable. How where did you find this person? Was it a company? Yes. Online jobs not pH. Yes. They're really good. One too pay for the heads. Like they don't take a cut from your salary for their salary. Is just you paid a poster.

Ad is a monthly money sponsored by this, maybe they should but you guys like one time fee or one monthly fee to find person you need. And at that point all of them salary goes directly to them. But I like because I'm sometimes you might call paying 500 bucks.

They might only like 275 of it and I'm like, that's not cool. And I have to I have to say these virtual assistants are out of the country. They're making a lot of money with what we're paying them because they're waiting. Their cost of living is way different from the US.

I make more as a VA, you're gonna do as a nurse. So she was happy. So there's nothing unethical about outsourcing and paying less for really good care, really good quality service and something that's speaking with us first week. So we have to worry about some really bad lookingness and they're really the easier.

They're like hard work is just part of their DNA. They're just really good at using the other strong as a Catholic. I think deeply rooted in my Christianity, in their culture as well. So, it's like in South where I'm from there's like, an underweaving of being, I don't know.

Yeah. A little bit more like the right thing. Yeah. They're very good at your job. Yes, I'm going with this. Thank you so much. Any other parting words for people? Of course, if you decide to go into a direct care practice, it's really easy to do is it's not hard.

The only thing you need to get over, is your insurance based practice mindset. And there's by podcast and tell you more about how I pivoted from insurance may see direct care. You mentioned Tyson Franklin but I do legends is another source. A lot of resource out there just to kind of let your whistle on what it's like to have a direct care practice.

And you just have your own character practice and traveling chiropractor with anything, incredible. And that's also another good resource how to have the cash practice, free of insurance. All right, thank you so much. Our show will be doctor, perspective.net / 181, all the show notes and the transcript will be on there as well.

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About the Author
Dr. Justin Trosclair, D.C., an expert in Chiropractic Care, has been focusing on back and neck pain relief for over 12 years and has delivered treatment to more than 6000 patients. With advanced training in treating disc derangement conditions, you can count on him to keep up to date with the latest research in physical medicine for spinal pain. He has 5 years of hospital experience in China, is currently working in Germany, and had a private practice in Colorado for 6 years. Dr. Trosclair hosts a doctor to doctor interview podcast called ‘A Doctor’s Perspective‘ with over 220 episodes. During his free time he wrote 3 books. Today’s Choices Tomorrow’s Health (rebooting health in 4 categories), a Do-It- Yourself acupressure book for 40 common conditions called Needle-less Acupuncture, and a step by step guide to look like a local for Chinese dinner culture called Chinese Business Dinner Culture. If you have kids, you may be interested in his 6 series tri-lingual animal coloring book series (english, spanish and chinese).