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Dec '25 •
Why We Built This — And Why We Never Quit
What pushed us to build something different wasn’t a business idea. It was what we were seeing every day in the emergency department. A huge number of patients who come through the ER are there for one simple reason: they don’t have access to primary care. Not because they made poor decisions. Not because they didn’t care. Simply because access didn’t exist. Some arrive poorly treated—not from neglect, but from delay. Others wait four, five, sometimes six hours in an emergency department for minor illnesses that could have been handled safely and efficiently through telemedicine if access were available. That stayed with us. We weren’t trying to replace emergency medicine. We were trying to protect it—by keeping patients out of the ER when they didn’t need to be there, and by creating an economical, accessible way for people to get care earlier. From the beginning, we knew Direct Primary Care was the direction we wanted to go. But we also knew access alone wasn’t enough. Telemedicine had to be part of the solution. Not as a shortcut. Not as a replacement for real care. But as a way to remove unnecessary friction. We don’t believe doctors are “getting it wrong.” Most are overwhelmed—buried under red tape, documentation, and systems that make meaningful care harder every year. The intent is there. The time is not. At the same time, both of us were still working roughly 150 hours a month in the emergency department. We were very intentional about keeping those worlds separate. As tempting as it might have been from a business standpoint, we never pitched our clinic to patients in the ER. That line mattered to us. We wanted this built the right way—or not at all. There are plenty of colleagues who think we’re crazy for taking this path. That’s fine. What’s driven us hasn’t changed: an undying drive not just to be successful, but to create something better. Staying clinically grounded has always mattered. Emergency medicine keeps you honest. It also makes it clear that better access and longer appointments create space—for conversation, for prevention, and for alternatives before defaulting to the usual pharmaceutical path.
Pinned
Dec '25 •
Total Healthcare Replacement Model
Why we stopped trying to “fix” healthcare—and built something better. For years, healthcare has been optimized around billing, not patients. Higher premiums. Narrow networks. More friction. Employers pay more every year. Patients delay care. And the ER becomes the default access point. This post outlines how we built a true healthcare replacement model—not a theory, not a pilot—while still working full-time as emergency medicine physicians. Where This Started (The ER Truth) A massive percentage of patients we see in the emergency department are there because: - They can’t access primary care - They don’t understand their benefits - They’re “covered” but afraid of the cost - Or they’ve been bounced around a broken system Insurance wasn’t failing catastrophically. It was failing quietly—through delay, confusion, and avoidance. That’s when we realized: Insurance is a poor tool for delivering everyday healthcare. So we stopped trying to optimize insurance—and built around it. The Architecture of a Real Replacement Model This only works if every layer is intentional. 1️⃣ Direct Primary Care (The Foundation) FirstCall DPC became the front door: - Same-day access - Longer visits - No billing friction - No visit limits - No prior authorization for basic care DPC handles 70–80% of healthcare needs when done correctly. But DPC alone isn’t enough. 2️⃣ Community Concierge Navigation (The Missing Layer) Most healthcare failures aren’t clinical—they’re navigational. This is where PatientPAL became critical. PatientPAL functions as the human guidance layer, helping members: - Understand benefits - Navigate imaging and specialty care - Resolve billing confusion - Coordinate follow-ups - Avoid unnecessary ER visits This isn’t a call center. It’s advocacy + continuity. When combined with DPC, this layer alone demonstrated ~$1,000 per employee per year in modeled savings, while improving outcomes 3️⃣ Claims Intelligence & Network Optimization
13d •
The Shift from Employed to Owner
One of the hardest things for me when going from an employed doctor to a DPC owner was changing my mindset. As an employed physician, you're kind of spoiled! Yes, the system sucks, but you also don't have to deal with all of the back end stuff like marketing, hiring, firing, billing, phones, making big decisions. At least now, I realize I was "spoiled". Sometimes it's amazing how many things you have to do as a DPC owner! Not only do you learn all of the business parts of HOW to run a practice, but you have to THINK like an owner. You have to value your time. You need to learn how to price your services appropriately so that it's fair to your patients and also sustainable for you. You need to set and keep your boundaries to protect your time, both at work and at home. These are the intangibles, things that you can't learn in a book. You can open a DPC using a checklist, no problem. But learning how to think as an Entrepreneur is a whole process. I talk about these shifts on my podcast, DPC Life. In my interviews with new DPC doctors, we talk about things that are hardest for them--marketing, nailing down their ideal client, fine tuning their elevator pitch. Many of these issues seem very personal, which makes them truly universal. Just about all new DPC doctors have these mindset blocks. Take a listen to the coaching calls on the podcast, they may be helpful for you if you're just starting out. I'm also hosting an in-person event in February called DPC Women Connect, at my office in Hickory NC. It's a 1/2 day event for women starting their DPC or just opened in the past 6 months, where we work on that mindset shift from employed physician to entrepreneur. 4 other established DPC founders will join me in sharing experiences and tips on how to make that adjustment and how to avoid the mistakes that we made. We'll also have a DPC focused accountant to walk us through best practices on setting your membership prices. It's a short event, just enough to get you started thinking differently and also to connect you with other DPC doctors in your same stage of growth. The event is filling up quickly, we only have room for 12-15 docs. I would love to see you there!
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Dec '25 •
Why DPC—and What’s Holding You Back?
What first made you consider DPC—and what is your biggest concern right now? If you’re early: - What’s pulling you toward DPC? - What’s holding you back? If you’re already practicing: - What did you not expect to be as hard as it is? - What do you wish someone had told you sooner? There’s no “right” stage to be in here.Just real people, real decisions, and real conversations. Jump in wherever you are.
Dec '25 •
The Real Product of FirstCall DPC Isn’t Medicine
This Costs $0 to Implement — and It’s Costing Clinics Millions Not To This is not about an awkward script your staff has to memorize. It’s not about SEO hacks. It’s not about some magical unicorn platform promising “innovation.” In the next 7 minutes, you can implement something today: - with the team you already have - with your current pay structure - with your existing software - without buying anything But first, a true story. The $1,800 Phone Call That Exposed Everything A woman named Victoria on our team needed blood work. So did her partner. She asked where to go. I referred her to two clinics—both existing clients. - Clinic #1: ~$250 for consult + labs - Clinic #2: ~$900 for essentially the same thing Naturally, she called the cheaper clinic first. Call #1: put on hold Call #2: put on hold Call #3: “Hey, you’ve put me on hold twice and hung up twice.” Obligatory apology. Placed on hold again. She hung up. You would too. Then she called the $900 clinic. Her call was answered on the second ring. Warm greeting. Focused attention. Genuine interest in helping. They talked for 15–20 minutes. She scheduled labs for both people on that call. 💳 $1,800 paid over the phone, across the country, to a stranger. Not because of price. Because of experience. What the $250 Clinic Actually Lost (Without Knowing) They didn’t just lose $500 in initial revenue. They lost: - two long-term patients - future memberships - referrals - goodwill - and possibly their reputation In today’s world, bad experiences ripple outward. Any friend who asks Victoria for a recommendation will be told: 👉 “Go to the $900 clinic.” 👉 “Avoid the cheaper one.” This couple is affluent and influential. That goodwill damage compounds quietly—and brutally. And if she wanted to? She could’ve left a negative review saying: “They don’t answer the phone. They’re rude.” She’d be telling the truth. “They Were Just Shopping Around” — Exactly Yes. They were shopping around.
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