Guest article by Kylie Vannaman M.D.
Why I Gave Up a Good Job
Some would say it was a good job. Maybe even a GREAT job. After all, I had my own private office and a whole team of support staff including a medical assistant, triage nurse, medical coders, referral specialists, front desk receptionists, phlebotomists and lab techs.
I never had to clean my own exam room, take out the trash or worry about inventory.
No need to market my practice or attend networking breakfasts.
In fact, I was so busy most days that I didn’t even have time to eat lunch, or go to the bathroom, or spend time with my patients.
Wait…what was the whole point of this job again?
When I first decided to go into medicine, I went as a bright, optimistic young woman. I was determined to change the lives of my patients through my skills as a diagnostician and with my compassion as a fellow human being. It didn’t take long to realize that neither of these ideas was practical in the current world of medicine in this country.
As a family doctor, I had learned how important it is to spend time with my patient. Time to listen. Time to think. Time to build trust and allow a story to unfurl on its own without interruption and constant checking of the clock. In my years of training and practice, I learned that the “chief complaint” listed on the schedule was often not the most important thing that would be discussed at that visit.
I learned that patients don’t care how much you know, until they know how much you care.
This quest to be understood, to be heard and cared for is not just important for patients. It is imperative for doctors and caregivers as well.
The Frustration … and Worse
While I grew more and more frustrated at the way the system encouraged us to see more patients each day with ever-shorter visits, more inane boxes to check in the name of “patient centered medical home” designations, more referrals and more testing (that brought in more money for the system), I saw my once-compassionate primary care colleagues burning out all around me.
Some dealt with it by developing a thick skin, putting their head down and plowing through their day.
Some moved on to administrative positions that involved lots of meetings and greatly limited or even eliminated their time spent in clinic with patients at all.
Some retired early or left medicine all together.
Some turned to drinking or drugs.
Some committed suicide.
So I quit. I quit because my patients deserved better, and so did I.
Time To Be A Little Crazy
While I had never had the intention or desire to open my own clinic, I had come to the realization that it was time to be brave. And creative. And a bit crazy.
Luckily, I was not the first to come to this realization and had a number of role models to learn from, including an innovative clinic I had read about back in 2008 as I was finishing up medical school, coined “The Robin Hood Practice”. In this practice, half of the patients (Benefactors) paid a flat, annual fee and the other half (Recipients) received free care*. I thought this was amazing and had even saved the original article as a “some day” inspiration. Now that I had reached my “some day” moment, I wondered if there were any other membership-based clinic models out there that I could learn more from.
Enter, Direct Primary Care (DPC) and a whole new world.
As I learned more about DPC, I soon realized that it wasn’t just the patient care that I was craving to change, but the whole clinic environment.
In medical school, residency, and while practicing abroad, I was blessed to be surrounded by energetic, curious, happy colleagues. Once I entered the world of traditional medical practice, particularly a hospital-owned clinic, this collegial atmosphere evaporated right into the PCMH/ACO/CPC/MIPS/MACRA alphabet-soup of managed care.
My colleagues were too busy and too burnt out to engage, and it was surprisingly lonely.
Fortunately, DPC provided both the model to practice medicine in a way that was fulfilling and introduced me to a group of passionate non-conformists that were all too happy to challenge the status quo for the sake of their patients and their own hard-earned careers. These were doctors who were willing to walk away from an abusive environment despite the steady paycheck. Willing to take huge pay cuts and work second jobs. Willing to learn a whole new set of business skills and take out new loans. Willing to convince their families that it would all be worth it in the end. Every DPC doc I reached out to for mentorship was so gracious and generous with their advice – these were my people and it was good to be home.
I Was Not Alone!
While I originally thought I would be starting off on my own, luck and serendipitous timing led me to Dr. Haseeb Ahmed, a brilliant internist who would be my passionate co-founder of our Health Suite 110. Together with our incredibly dedicated spouses, we took out loans, purchased and fully renovated an office space, assembled furniture, painted walls, hung cabinets, ordered supplies and pounded the pavement telling anyone who would listen about our new clinic.
On July 1, 2015, with high hopes and about 20 pre-enrolled patients, we opened our doors. We worked hard that first year in getting the word out through various networking and chamber events, but eventually word of mouth from our current patients began to help us grow.
At about 6 months in, we hired an outstanding young RN to join our team and shortly after that, were even able to afford a weekly cleaner.
At 7 months in, I had a baby (!) and took 6 weeks maternity leave thanks to the love and support of my Health Suite 110 family and local DPC colleagues who helped cover for me during my absence.**
Now, nearly 3 years in, I couldn’t be more proud of what we’ve built. Health Suite 110 has grown to three physicians, two nurses and nearly 1,000 patients.
Our incredible spouses continue to handle many of the thankless jobs behind the scenes and help to manage the day-to-day business operations.
We continue to expand our primary care services for all ages, including free in-house procedures, direct access to us through email/text/phone as well as wholesale medications and greatly discounted imaging and labs – all for a membership fee that is less than the cost of a daily latte.
What’s The Catch?
The most common question we get from potential patients is, “What’s the catch?” and we happily roll up our sleeves to show there are no tricks.
People, ourselves included, are continuously amazed at the cost of things, the REAL costs when all the middlemen are removed. When medicines cost pennies per pill and lab tests cost a few dollars each, people who were unable to afford care are finally able to take control of their health again.
Instead of having to bring someone into the clinic every time they have a simple question or issue to address, we can manage them by email or phone and save them a half-day of missed work. Since our income does not rely on face-to-face office visits, our priority is helping people stay healthy – and out of our office – rather than sick and constantly returning for visits. And since we aren’t relying on all the ancillary testing and medications to pay our bills, there’s no ulterior motive when we do need to order something.
EKG? Breathing treatment? Stitches? All free. With patients having direct access to us and available after hours visits, we are able to avoid unnecessary ER and urgent cares, saving them thousands of dollars.
We even do house calls.
‘Cause It’s All About The Relationships
But beyond the access and cost-savings we provide, it’s all about the relationships we build – that’s our secret sauce. These relationships are what sustain not only the business model, but also the people involved.
I finally have my energetic, curious, happy colleagues back and we use this enthusiasm to promote further growth both professionally and personally, for all of us. We meet weekly as a team to discuss ideas and issues that have come up and together make decisions about any changes that need to be made. We often host students and love sharing the DPC experience with them.
We even take all staff on a clinic retreat each year to get into nature and allow some out-of-the-box thinking and time for bonding. Clearly, we love what we do.
What Primary Care Should Be
When a patient chooses to establish care with us, we are always in it for the long haul. In return, we hope that they value the service we are offering and see it for what it is: a vote for what primary care should be in this country and an investment in the clinics that are willing to take the leap to provide it.
We encourage everyone to shop local – Join a DPC practice and spread the good word to others.
*A New Model of Charitable Care: The Robin Hood Practice (American Academy of Family Physicians), Robert A. Forester, MD, Fam Pract Manag. 2008 Feb;15(2):12-16.
**I had suffered two miscarriages during my 20 months of traditional employment and learned that return of fertility seems to be a DPC hazard as we heard of many babies arriving among our new DPC colleagues.
Kylie Vannaman MD
Dr. Kylie Vannaman is a family physician and co-founder of Health Suite 110, a DPC practice in Overland Park that opened in 2015. She grew up in the Kansas City area, graduated Summa Cum Laude from Truman State University and attended medical school and residency at the University of Missouri-Columbia, where she served as chief resident. Dr. Vannaman loves being a family doc and has enjoyed practicing in a wide range of environments including: the Navajo Indian Reservation in New Mexico, a birthing center in rural Haiti and as a locum tenens doctor in New Zealand. She firmly believes in the transformative power of primary care and is grateful to be practicing meaningful medicine again. In her spare time, she loves hiking, gardening and spending time with her husband and two young children.