Profiles in Resilience Episode 6 | featuring Shaleah Jones, MD

Adam Jones 0:00
I do want to recognize Maria and Nick and press. And thank you guys so much for hopping on so far, I’m sure more will be hopping on just a moment. I do want to take a minute to just thank all the community members and people that helped to make these webinars happen that support it with these southeastern Washington Economic Development Association, the Pullman Chamber of Commerce, the Small Business Development Center with Aziz makhani. And of course, the city has been pushing this out and promoting it too. And we’ll begin the recording done as soon as we can, we’re going to do a couple of different things with the recording, that’s going to be higher quality, we’re also looking at doing a transcript. So that if people, hey, maybe I don’t have enough time, or maybe I’m a little bit zoomed out. There’s a transcript that will be available for people to to read through and see. But thank you so much, Dr. Jones, for being willing to come and help and sit with us. And tell us about your incredible business and the business model we were talking about a little bit beforehand, but I’ll have you introduce it. But if you guys haven’t met Dr. Jones, she is absolutely wonderful. I highly encourage you guys to visit her and learn about better care, proper care. And I say proper, just in that communication. My folks have been going through a lot of I mean, they’re getting older. And it’s been hard. And we love the doctors in Pullman overall, sometimes just computers don’t work. And sometimes we just want to talk to a human.

Shaleah Jones MD 1:36
Yeah, well, thank thank you for having me. Thank you for thinking of me, I appreciate all the effort that goes into trying to support our local communities here. So thank you for that. Yeah, so I opened down MD, which is a direct primary care clinic in September of this year. And essentially, it’s the only clinic in our employment that aligns our, our, our profits with outcomes, so rather than aligning our profits with number of patients seen number of volume of services provided, it’s really the only clinic of its ilk in Pullman, that instead trust the patient to choose the product based on the value that they get, rather than us encouraging people to come in to be seen or to have procedures done, etc. So, you know, the cornerstones of stones of the model are accessibility, affordability and value. And with its direct primary care, and all these things sound great is this.

Adam Jones 2:42
Is this new, like, is this new in the way we do medical in America? Or is this something that we just missed?

Shaleah Jones MD 2:49
Yeah, I think it’s growing. I mean, I think practices like this have existed over 100 years ago, kind of went away. And then it’s re emerged, essentially, as a solution for that hamster on a wheel fee fee for service medicine model that we’re also accustomed to. I think the last time I looked, I think there were around 3000 DPC clinics. Oh, wow. Yeah. There might be 3000 DPC providers, but it’s certainly still a minority of clinics that run a DPC model. So it’s still, I think, foreign to most people, but growing.

Adam Jones 3:25
Yeah. And so then. And this is a How can I get to answer a few questions that I’m sure a lot of people will probably have, as they’re learning and hearing this, like, you don’t necessarily need insurance to to come and visit you correct?

Shaleah Jones MD 3:42
Well, I think they’re kind of two separate questions. I mean, I think people should have health insurance, right. I mean, the whole concept behind health insurance at its inception is we want some sort of coverage for catastrophe for the unexpected, the expensive. But I think the reality is the insurance based model doesn’t necessarily provide excellent primary care. And so by actually cutting out insurance billing in my clinic, I’m able to be a lot more accessible to people, I’m able to keep my overhead lower, I’m able to expand my clinic appointment times, we still encourage our members to have insurance, we know that if you end up in the emergency room, or you have a car accident, or you have a cancer diagnosis, I’m not gonna be able to help you with those things, right. But for the 80 to 90% of health services that we do in the primary care clinic, we feel that the insurance actually just adds to overhead, adds to administrative burden and doesn’t actually do anything to help people get better. In fact, it has quite the opposite effect because you’re so focused on bringing people into the clinic so you can build that code or doing that additional procedure so you can get that additional procedure fee, or prescribing that medication because you have an increased level of complexity and you’re able to Bill higher for prescribing that medication. You send the consults are able to Bill higher Because that, that medical decision making is more complicated. So with all these things in our system, they’re aligned with us doing more for patients, but they’re not necessarily aligned with us, preventing people from getting sick, or giving people a little extra time to explain what they’re experiencing, or giving us a little extra time to explain why we want them to do A, B, or C and actually improve that compliance.

Adam Jones 5:22
Yeah, yeah. And I think, as I’m hearing as I’m listening to it, the direct primary care model provides a better conversation for a patient with you directly to because, in my mind, if I go to a doctor for a preventative care visit, the moment I ask a question, it is no longer a preventative care visit. And then I’m billed for the full thing.

Shaleah Jones MD 5:46
Yes, and you don’t have the time to address that thing, right. Because, you know, my previous clinic, we were allotted 45 minutes for our preventative care visits. And, you know, the push was to push him down to 30 minutes, you know, each time we’d have an administrative meeting, I would have to say, Hey, you know, I can’t, I can bring a 30 minute physical, much less address the number of things that people are kind of storing up for you at that one visit that they come to you for that year. So I can’t stress enough how much of a difference it makes to have a 30 to 60 minute office visit. So right now, rather than having a 15 minute office visit at my previous clinic, I have nothing but 30 or 60 minute visits. And that little bit of extra time gives people that little bit of extra time to ask you questions to make sure that they’re confident, they’re confident that you’re confident in your treatment plan. And then when they leave that visit, they’re not feeling like they need to go get a second opinion. They’re not feeling like they don’t understand why that medicine was prescribed. Maybe they go to the pharmacy, and you’ve talked to them about the meds and the side effects that maybe they get a different message from the pharmacist or maybe the medication wasn’t what they expected. That person can call me text me email me asked me clarifying questions. They don’t build them again for that. And because I don’t have to worry about not being able to build them for that time and not worrying about this massive overhead for me to take 10 more minutes to explain to them, why prescribe that medication for them. It really improves their outcome, right? So it allows them to understand what that you know what that treatment plan was about and actually comply with that treatment plan rather than leaving feeling like they weren’t listened to or feeling like they need to go find another doctor to get another opinion from?

Adam Jones 7:21
Yeah, no, absolutely. And I can absolutely see the value in that my my dad’s been kind of on a medical journey, and I cherish the time I get to spend with him. And he recently through doctor’s visits, and everything’s went from like 10 medicines down to two. And it is a night and day difference for him. But he even when he had the 10 medicines, or medications, prescribed he he didn’t know what they were. And he was just like, Why? Why am I taking all this? What was this one supposed to do or how and and it was just really hard for him to understand and be able to work through. But then it was just kind of Here you go, go talk to the Safeway, pharmacy or a Walmart pharmacy to see what’s there. And so then in your mall, you’re able to spend more direct time with individually make sure that they do understand each of those points, and then they are more likely to take the pills, right? Or is that kind of what you see? Or is that? For sure?

Shaleah Jones MD 8:21
Yeah, for sure. I think you know, to your point about going to your physical and having maybe one or two little things that you want to ask the doctor and not realizing that a are gonna get charged for each of those additional questions. But then your doctor is really in a time crunch. Right? So they’ve got to make a decision, do I, you know, do I spend the time I need to address this rash that this person has? And really educate them well and give them handouts and explain to them about the medication? Or do I do the quick thing and write the prescription that I know I can bill for? Or do I send them off to a specialist where they then have to travel wait several months in current 200 $250 office charge. And so it’s really not good for the patient. But it’s also not good for the doctor, right? And so it’s amazing. Now these things that I would have had to have referred or I would have had to just like, okay, I can try to treat this problem, but I only have five minutes to do it or two minutes to do it. And now I can say hey, like, you know, we’re at the end of our 15 minutes, 60 minutes, but it doesn’t cost you anything to come back and ask me about that rash tomorrow or, you know, let me send you some links and some information on this that you can peruse on your own time and then come back to me when you’re ready to start a treatment for that. So yeah, I mean, it just it makes so much more sense. Right?

Adam Jones 9:36
Well, and it does, it does and I can also understand like people with hrs or not with health insurance. I our families all like an HSA. So a health savings account. So then low deductible, but if I do take my kid in for like a 15 minute hospital trip or not hospital, just like a routine, visit. You know, he seems to be lethargic or has a cough or whatever. You know, that’s a 10 Minute. Hey, check him, is he gonna make it? Is he okay? And then I get hit for like, $150. Bill. Yeah. Which your your stuff is pretty affordable? It’s

Shaleah Jones MD 10:19
Yeah, it’s meant to be very affordable. I mean, it’s so, you know, our prices are 100% transparent. So I think right there, most people are going to save money because they’re not going to get that surprise procedure bill or that that surprise, additional fee for that extra question they asked. We, you know, not only do I have very affordable monthly payment prices, but I also couple that with access to discounted labs and medications, so I have several members that easily make the money back from their membership on the medicine prices that they save through our wholesale pharmacy prescriptions. So yeah, it’s very affordable. And I, and I think, you know, I can’t stress enough that just that increased access, like people want me to take care of more things for them, because they don’t have to pay extra for it. So, you know, I just recently opened my Rubicon account, which is an E console service, which is amazing, it’s like the most sensible thing you can do, right? So I can, like I said, I can either, you know, try to treat something quickly in a few minutes, or I can have the person come back and pay an extra office fee, which they almost never do. Or I can refer them somewhere for a lot of time and expense to them. And a lot of time for those specialists. Or I can take a picture of the rash, email it to the specialist say, Hey, this is what I’m thinking for this rash. Does that make sense to you, they email me back within 24 hours, I think this is the diagnosis, these are the three things I would do in the treatment plan. And these are the prescriptions I would give boom, I just saved that person, wow, you know, two to three months of waiting to get into a dermatologist, you know, an hour to two hours of driving to see the dermatologist and I’ve got an excellent treatment plan that I can talk through the patient with the patient. And that’s something I would never be able to do in my previous practice, because it was all volume driven. It was not value driven. So I you know, I pay for that service, but then I’m able to pass that value on to my subscribers.

Adam Jones 12:11
Yeah, yeah, absolutely. So then how, how is I guess medical services, but also your services changed during this whole COVID thing? Because that being able to take a picture of a rash, send it and have a specialist look at it like? Yes, you should have been doing that 10 years ago, like what?

Shaleah Jones MD 12:29
Absolutely. And we’ve always had the technology, right, but we haven’t been able to use it because we’re not able to get reimbursed for it. I mean, people are people are begging for this, right? They’re calling and saying, Hey, I know I just need a receipt, or Hey, I’m pretty sure I don’t need to go to the ER, I’m on vacation. My kids just heard their head, but I’m not sure. Can I talk to my doctor for five minutes? And we’re saying no, because I can’t bill for that. We can’t offer any medical advice over the phone. Right? And so people get pushed into the ER, they get pushed to the urgent care. Muslims love that, because that’s where they make their money. It’s not satisfying as provider, it’s certainly not satisfying as a patient. So yeah, why not use all this technology that we have? Why not use these resources that we have? And, you know, COVID has changed that to some extent, because now insurances do allow for telemedicine visits. But, you know, still, there’s still an incentive there to get people on the schedule to get people on the telemedicine visit. I had a patient over the weekend who texted me and said, Hey, you know, have this thing? Do you have weekend hours? And I said, Well, you know, I don’t have office hours. But if we can do it via telemedicine, or if I can, if you can send me a picture, or if it can wait till Monday, those are your options. Then she said, Oh, I’m just gonna send you a picture. And she sent me a picture. And I said, Oh, that’s, you know, it’s likely A, B, B or C, you might need this test. And she said, Okay, well, can you order that test? I said, I can order that test. You know, if that had been in my previous clinic, that would have all been uncompensated time, right. And as a policy for our clinic, we weren’t allowed to do that, you know, if someone called and said, I have a bladder infection, I know it’s a bladder infection, I just need an antibiotic, I would be giving up my income to treat that person, right. And, of course, there are times when your doctor is going to do that. But more often than not, there’s going to be a policy against it, you know, that system that they work for is going to want you to send that person to the ER the urgent care. So for this patient, you know, as they will say, Oh, you know, that looks like this, I think you need this test, I think you need this prescription, I was able to send that off for her. I still haven’t seen that patient for that problem. But I know that she got equal quality care as she would have gotten if she had to go to the urgent care may be better because she gets to talk to someone that she knows whose opinion she trusts and that she’s likely to follow through with that treatment plan. And her treatment plan ended up being watchful waiting, right, which is often the treatment plan, which is not a very expensive treatment plan. So we make these really simple problems and it’s really expensive processes.

Adam Jones 14:49
Well, yeah, and just to me like the the reduction of stress reduction of anxiety of just Okay, I know I’m okay. Or I know my kid is okay. Or I know. It’s okay.

Shaleah Jones MD 15:06
I mean, I think it helped, I think most people want to see a provider they know and trust, right? Most people would prefer not to go to the urgent care, they don’t necessarily know who they’re going to see their, you know, if they have an option of having an established provider, most people would prefer to see that person. And so this model allows for that you’re always gonna see your doctor.

Adam Jones 15:26
Yeah, yeah, absolutely. And so then, how have you been working with the employees and patients coming in and out of the office? Like, is there a set procedures for that is it I guess, I haven’t been to a doctor during COVID. So I haven’t, I don’t know what new procedures might be there, or if there’s something unique that you’re doing in that process.

Shaleah Jones MD 15:48
But the beauty of a small model is you get to use common sense a lot more than protocols. So, you know, I know all my patients, many of them followed me from my previous practice. I know their family circumstances. I know that works, circumstances, I know whether they’re science minded or more of a conspiracy theorist minded. And so with that, I largely let the patient decide if they want to come in or not, but I but I generally try to say, Hey, you know, if this is something we can do via telemedicine, or via a phone call, let’s do that. And people love, you know, people love that they don’t necessarily want to have to come in, but they like to have the option to be able to come in. So have a lot lower patient volumes, right? Because there’s so many things that we go to the doctor for that you don’t actually have to be in that building to do you know, all the COVID questions. Any other practice? They they’re dying right now, because they’re so inundated with COVID questions and protocol question exposure questions, they don’t get reimbursed for any of that time. And so their answer is to try to turn those into visits, right. And that’s reasonable, because they have to cover their overhead, you know, they’ve got massive overheads, and they need to cover that overhead, they can’t just sit on the phone, putting out fires all day. But for me, I don’t have to worry about that. Because my overhead is not based on how many people I run through my clinic, my overhead is based on my expenses, or my my profits are based on how many people sign up for my practice, right? So for me, you know, feeling COVID questions via text, you know, I’ve filled enough of them now that I have quick texts, you know, macros that I can say, Hey, this is, these are the links to the CDC site, these are the protocols and, and you know, and additionally, I know, like, I know this, this person has her parents living next door to her and she also has kids in daycare. So I kind of know what what their exposures are, and know how likely it is that they can quarantine or how realistic it is they can quarantine. So I’m able to give them really quick advice, and it makes it a lot was painless. But I guess to answer your question, you know, it hasn’t been as much of an issue for me, I have smaller volumes, so I’m able to keep up with my peepee if I needed if I think there’s any suspicion at all that someone’s had an exposure, I do a telemedicine or, you know, I’ve gone and seen people in the car a couple of times, I try not to do that too much. Because I get a lot of sideways looks from people on the sidewalk when I put my peepee on and walk out of the car to swab someone. But and you know, and I will say to that our community has been great in their response of testing. I mean, the hospital is a great resource for getting people in for testing. So I try very hard not to test people in the clinic or bring people into the clinic. If I can at all help that we have lots of other resources that are much more safe in regards to testing.

Adam Jones 18:28
Oh, that’s awesome. That’s awesome. And so then, has there been any government assistance throughout their small business journey? Or has it just been mostly red tape to work with? Or what was that experience been like for especially for medical, like, I always hear medical highly regulated the synonym I hear, in my mind.

Shaleah Jones MD 18:50
Well, so you know, my biggest expenses are my employees in my rent. And so in that I do have several f 225. And Idaho and Washington license, I have my American Board of Family Medicine, I have various fees and dues that I pay. And then I’ve got just a slew of accounts that I’ve opened up for ordering medications and products and whatnot. I mean, I had to purchase a password manager, I have 130 passwords, my password manager now. So there is a lot to juggle, you know, I had to learn how to use spreadsheets for accounting. But for the most part, that’s all been kind of fun. As far as your question about government assistance, I actually haven’t qualified for any government assistance because my business became a business April, and unless you were open in February of last year, you don’t qualify for any of the grants or P PP, pp loans, professional payroll, payroll protection loans. So we haven’t had any government assistance there. We were able to procure a small grant for a vaccine fridge through a private, independent nonprofit organization. So That was helpful because vaccines are very much a big administrative burden and time consuming and do not add much to your practice other than for the greater good, which is very important to me, but, but they really are, you know, time consuming and administrative time time consuming problem or time consuming factor.

Adam Jones 20:20
Yeah, yeah. Interesting. Interesting. And so then Have there been permitting things with your building or licensing things that you’ve had to do with your space at all?

Shaleah Jones MD 20:33
Yes, I mean, I, you know, it’s all like, once it’s done, you don’t think about it anymore. But yeah, there were some painful bumps along the road. I mean, I think I think I gave myself a six month timeline for, you know, from the inception of the business to the opening date, and I kind of had my things lined up that I was going to do at each moment. I think my my space was already at least, you know, the place that I’m leasing was already zoned as a in such a way that I didn’t have to necessarily have a different permit for running a medical practice out of there. You know, have the usual OSHA requirements and that you’ve got no other special vessel special permits.

Adam Jones 21:21
Interesting, interesting. And then, is there anything unique with COVID? that you’re seeing DPC? People are those who ran the miles, including yourself, pivoting into COVID, or pivoting your services? Like it actually sounds like you guys are making all the right medical industry pivots like telehealth and that providing better care better access to specialists. I think your business model is almost perfect in a COVID situation where there’s a high degree of trust needed. So some of you guys are already doing. Amazing. But is there anything specific that you’re seeing other DPC models do really well and COVID?

Shaleah Jones MD 22:06
Well, no, I think, to your point, like a lot of the things that DPC has already figured out. Now, the rest of the medical industry is trying to catch up because of the strain of COVID. Right, I mean, that telemedicine access that trying to figure out ways to get compensated, you know, this has been going on for decades trying to figure out ways to get compensated for preventative services and value rather than procedures performed. There’s just there’s just so many think, against that kind of reimbursement system that it kind of takes these small independent practices that are willing to take the risk to start something new. Yeah. Yeah. I don’t, I don’t think there’s anything else beyond what we’ve already discussed.

Adam Jones 22:52
No, no, that’s great. That’s great. And so then you said that, like, you’ve you’re able to text with your, with your clients? Are you? Like, are you doing a lot of social media, email marketing and text messaging? Like, tell? Tell me about that? Like, because that’s, I mean, we run a market. Kevin, we know that that’s a lot of time and effort. Yeah. What was that communication frequency been like?

Shaleah Jones MD 23:14
Well, you know, essentially, people have my cell phone number, right? So they get to decide how they want to contact me. And it’s a little daunting at first, you know, especially after years of having a full practice a closed practice, and just to say, Hey, you know, anybody that’s in my practice can reach me however they want, whenever they want. But the reality is, people are generally very logical unrespectable about how they use your time, at least so far, I haven’t had any trouble. But you know, the times that people text me it makes perfect sense. Like, you know, I’ve written a prescription they’ve gone to the pharmacy, the prescription isn’t quite what they expected. And they’re like, is this right is essential to be taking this and I say, and they sent me a picture and I say, Oh, you know, the pharmacists maybe made a mistake, we need to fix that prescription. So really, just like, the most efficient way to contact people these days is texting. Like, I don’t know how many people you have to call in your line of work. But when I try to call my patients to give them their lab results, nobody answers their phone. So then I’m leaving them a message and then they’re calling me and they’re getting my front office who may be routed to my nurse, maybe the nurse tries to take the call, maybe the patient feels satisfied, maybe they don’t. And so it’s just much more efficient for people to be able to call or text me most of the time. And, you know, if, if there’s something that maybe isn’t amenable to texting, I could say, hey, let’s turn this into a phone call, or Hey, let me put you on the schedule for a 15 minute phone call, you know, this, this is gonna it’s gonna be more efficient, in this case, just make the call so I’m able to make that determination pretty easily. Hmm,

Adam Jones 24:42
I love that.

I love it. I

our policy is if a email is like more than five sentences long, we try to pick up the phone.

Shaleah Jones MD 24:50
Yeah, absolutely. Just because

Adam Jones 24:52
there’s there can be some context lost. And sometimes it’s just nice to talk to, especially three COVID just to talk and hear somebody’s voice. Yeah, that’s been probably my most used phrase of, of 2020 2021. of, wow, it’s just good to hear your voice. How are you?

Shaleah Jones MD 25:08
Yeah, and same thing with having people come into the clinic. I mean, I feel so fortunate to be in a line of work where I wasn’t shut down, because I wasn’t, you know, I’m an essential worker, essentially. And I feel really privileged that I was able to have people continue to see me in my clinic. And I think people feel that way too, right. I mean, I have several elderly patients who I’m their only the only human they have any contact with. So yeah, so I think the nice thing is to have the freedom though, right? The freedom to say, okay, text makes sense for this problem. It doesn’t make sense for this problem. This, it makes more sense to have this person come in and have that freedom to do that.

Adam Jones 25:43
Yeah, yeah. And then, and this is just for my, I’m curious on it, dude. Do you use a special software for like HIPAA compliance? Or is there like, what was that look like?

Shaleah Jones MD 25:55
We’re sort of HIPAA compliant ish in our clinic, we, because we don’t bill insurance, we don’t technically fall under HIPAA rules. And so we do still strive to use HIPAA, we have HIPAA compliant faxing, and HIPAA compliant communication. But when it comes to texting, in particular, that is not a HIPAA compliant platform. And so we explained that to patients up front, we say, you know, we let you be the driver in this, if you want to send pictures or questions that are medically related, that’s up to your level of comfort, but it is not HIPAA compliant platform. So we just make sure people know that and so far, I haven’t had a single person not want that option of being able to text me. And I think the reality is the risks of that being used against you in some way, or basically nothing. So, you know, that’s kind of one of those areas where it’s nice just to use rational, common sense. And we we want to take every precaution that we can, we want to make sure we’re not sending faxes via non secure format, we want to make sure you know that insurance companies aren’t getting, you know, some diagnosis code that the patient doesn’t want them to have, etc. But if anything, we’re, you know, we are because we don’t build insurances, people actually have more confidential confidentiality in our clinic. So if, you know, if you have a 24 year old who’s on their parents health insurance, and they want to see you for a problem they may not want on their on, you know, do I do you want to see that screening for an internet, venereal disease diagnosis on your insurance, you know, lots of people will opt out of screening for that just because they don’t want to, they don’t want their parents to see that code on their on their insurance bill. And so this allows us to be completely confidential, for all sorts of treatment options.

Adam Jones 27:30
Yeah, yeah. No, that’s, that’s fast. I wouldn’t, I wouldn’t have thought about that. That’s, that’s amazing. So then, how is social media and the the community been like, has that been? a? Has it been warm reception? Or is there still some confusion that that kind of goes with educating people on this newer mode? Because, you know, we’re so programmed to believe, hey, insurance is the way to go? You you get the big job, or the government job to get the insurance? What was that reception been? Like?

Shaleah Jones MD 28:03
Yeah, so this is still the most common misunderstanding that I hear from people or people call and, and they, you know, they see the prices on the website, and they say, that’s pretty great. But I have health insurance, like what, you know, why would I sign up for this clinic? And I don’t often say this to people what I think is great, you have good health insurance, don’t let that get in the way of good health care. And, and I think that’s often what’s happening for people, right, they’re, you know, they’re rationing their care not wanting to use their to use their deductible, or they’re looking for things that are insurance covers, rather than things that might be more effective for them. But the reality is, yes, you know, you should have health insurance, you should have that for those catastrophes. But, you know, I think, I think in 2019, we spend about $12,000 per person per year in the US on health care, so $12,000 per individual. And in my clinic, I charge, you know, anywhere from $20 a month for kids to $100 a month for people 65 and older. So there’s an age range based here. So at most you’re paying 12 $100 a year for your primary health care. And study after study shows that you can do 80 to 90% of your health care in your primary care office. So 80 to 90% of your care can be covered with a 10th of what we’re paying for our overall health expenditure in the United States right now. And there’s all kinds of reasons for that. But, you know, the bottom line is it’s a very affordable way to get a lot of things done in a very practical manner.

Adam Jones 29:35
Yeah, yeah. I just can’t get over how how amazing the model is. And I love what you’re saying about the value of care that is being provided. That is something that just I don’t know that we can always put a money monetary value on having a person Primary care professional that legitimately cares that isn’t just trying to cycle to the next person in 15 minutes. And I that’s the quality of life that I think a lot of us are seeking and looking for.

Shaleah Jones MD 30:13
Well, and I will say, I mean, you actually can put a monetary value on that. I mean, people are doing that. I mean, yeah, right. Right. Right. There is there’s tremendous value in that doctor patient relationship. But there’s also a monetary value in that. And, you know, there are pilot programs que Lyons in Seattle is one there are other other DPC practices who, when they work with employers who have self employed self insured programs, they’re able to show 20 to 40% cost savings in year one, just by using a DPC practice. And the reason is, because people go to that DPC doctor because they can get in and because they trust them, and that DPC doctor is able to explain things, as far as you know why maybe referring to an orthopedic surgeon for a lumbar surgery right now isn’t going to give you a better outcome, you know, showing them that you’re taking the time to showing them the study. And so by giving people better accessibility to a knowledgeable doctor, they’re not gonna end up in the emergency room, they’re not going to end up having an unnecessary back surgery. So time and time. Again, there’s, there’s more and more studies out there that show that people really do save quite a bit of money by coupling DPC practices with the right kind of health insurance plan.

Adam Jones 31:23
Yeah, yeah. And so then, and there, there are a couple of really good questions in the chat. I do want to ask real quick, though, on for businesses, small businesses. Do you see this as a good practical option for small businesses to provide some sort of care for their employees?

Shaleah Jones MD 31:43
For sure, yeah, we have, I think we have for small businesses sign up right now. So we do have a few. And, you know, the issue for us is we’re still relatively small, right? So if it was a really large business, that we’d have to be cautious with that because we don’t want to live and die by a single business. But the the fact that, you know, is this a valuable thing for a business? Absolutely. I mean, my business price right now is it’s 55 to $65 a month, and it’s amazing the value people get for that for that money. You know, I’ve got I trained as a rural physician, that was my, sort of my calling in medical school. I love practicing rural medicine. I worked in Nebraska for about seven years. And as such, I had to do everything right. I mean, I took care of ranchers that didn’t want to drive 75 miles to the next tertiary care facility. There were no other specialists in the town was just family doctors. So I covered the ER nursing home hospital did deliveries, so I can handle a lot of things. So you know, people are sometimes surprised, like, Oh, you can remove this skin thing great. Or, you know, you can solve these lacerations? Or you can split this sprain, of course, yeah, those are kind of basic bread and butter, Family Medicine skills that I think most of us have. But we don’t always have the opportunity to use because we’re so crunched for time.

Adam Jones 32:59
Yeah. And so then, I know we we do live in kind of a transient community. And so one of the questions that was brought up was, you know, what, if a patient relocates or do you? Do you usually retain those clients? Or like, what’s that experience? Like?

Shaleah Jones MD 33:15
Well, I’m only five months into this. And so far, we’ve had very few people leave the practice. And when they have, it’s usually something like, you know, moving. So we don’t have much of a churn rate yet, although we’re still in the growth phase. But I would say so if they’re in Washington State, we’re still able to take care of them as long as they like. But, you know, practically speaking, you probably want to have the option to see your doctor in person, at least from time to time. So you can do telemedicine for a lot of things. But, you know, your annual physical needs to be in person, right? I don’t I haven’t figured out how to do a breast exam virtually. So I think the practical reality is that most people if they relocate are probably going to find a new clinic. Yeah,

Adam Jones 33:55
yeah. But I, I like what you’re saying, though, and having that option of, you know, say someone does relocate to tri cities or something, and, you know, maybe like, one or two months, like, Hey, I still need some telehealth support, while I figure out this new area, like it’s not just an immediate break, it’s just, hey, we’re here to support you.

Shaleah Jones MD 34:15
Right, right.

Adam Jones 34:17
Yeah, yeah. So

then, Maria asked, How I guess how many clients or patients do you currently have? And how many do you think is the limit, especially considering the space that you’re in?

Shaleah Jones MD 34:31
So to give you some bearing on number so my previous clinic I had about 2700 patients and it’s not uncommon for a primary care doctor to have a panel of 20 503,000. I currently have 150 patients with the goal of around 350 total. With the kind of medicine I like to practice and taking a little more time and doing a little more a lot of smaller panel than some other doctors, I think. Other dp succeed doctors, I think they you know, kind of think of themselves as maxing out around 650 750, maybe 100 patients, depending on what kind of ancillary staff they’ve got. So, you know, maybe a third that you might normally see in a traditional model.

Wow.

Adam Jones 35:15
That’s incredible. That’s absolutely incredible. That’s Yeah. And I love your location. Like, I think that’s a down at the armory. I think that’s a beautiful, it’s beautiful space. I really liked that. But I think the renovations have been fantastic. Because I know the building has just changed a lot.

Shaleah Jones MD 35:34
Yeah, it’s a great, yeah, I have about 600 square foot space. And it’s just me, I have one assistant, she currently is working virtually, but she’s actually relocating to Pullman next month, which is really exciting, really bright, really thoughtful, hardworking, you know, great asset to the community. So she’ll be relocating and working with me in the clinic there. So that’ll kind of change the dynamic a little bit as far as it being two people instead of one. But it’s really nice, I don’t, I don’t really have much of a waiting room per se, but the armory itself has a large waiting area. So on those occasions where someone has to wait, there’s a comfortable spot. But the reality is, you don’t have to wait very often, you know, when you’ve got a 30 or 60 minute appointment, and you’re not double booking people, it’s much less common for people to end up waiting. And, you know, I’ll give you another example of kind of the, the blessing of being in this kind of practice. But I did have a patient run long, you know, new patient who, you know, had lots of things that needed to be addressed. And my second patient showed up and she she wanted, you know, she needed a urine test for a bladder infection. And so I was able to sort of excuse myself, get the other person get their urine sample going. And it takes 10 minutes to run a urine sample anyway, and I’ve got to spend it down in the centrifuge. So I said, Hey, you know, you can wait in the lobby, or you can take a walk, you can get a smoothie, I’ll text you and your urine samples done, right. So she was able to go do whatever she did for 15 minutes. And then the timer went off. I texted her and said, hey, it’s time to come back up. She came back up, we finished her visit. And I mean, I can’t really think of a more painless and COVID friendly way to pass your waiting period, then, you know, just be able to go for a walk while you’re waiting for your your blood sample or urine sample to spin.

Adam Jones 37:13
Yeah, yeah, no,

I, I love that. Because that’s that’s a lot of my hesitation like I’ve been, I’ve been a fan of telehealth for years, just because I’m always leery of sitting in a hospital room with a waiting room with other sick people like that. Sure. Even even pre COVID. That just sounds like a not wise idea.

Shaleah Jones MD 37:34
Yeah. Or you’re busy or you don’t want to take the time to travel or you don’t want to miss work, right? So these are all things that again, you can decide, like if you enjoy that office visit environment, or you feel like you need to be seen face to face fine. But there are so many things that you can do on the phone that were kind of forced people to come in for most things mental health I can do on the phone or, or do via telemedicine very easily.

Adam Jones 37:57
Yeah. And so then you said you hit your cabinet run that 150? Mark, what? What kind of things did you do to kind of build up to that? Like, I know, you mentioned before the people had kind of followed you from your previous practice a bit. But were there other things that are initiatives that you did to kind of bolster that?

Shaleah Jones MD 38:16
Um, well, the reality is, I haven’t done much now, as much as I would have if we hadn’t had a pandemic hit, right. I mean, I think, for people to get the value of this model, you really have to explain it to them, it’s very hard for people to look at a monthly membership fee, and feel like they want to pay that on top of what they’re already paying for health care, it really takes some explanation for them to understand, you’re gonna pay a little more, but you’re gonna save a lot on the back end. So it’s really hard to just expect people to come find you in that case. And unfortunately, for me, I have a, you know, had a non compete, I wasn’t able to tell my patients where I was going unless they expressly asked me. And so, you know, that I think that was harmful to me. But, but basically, I, you know, I didn’t tell the patients that asked me and I started a Facebook page, you know, something that I generally try to avoid at all costs, but I admit it has, it has a reach, it has a value. So I’ve maintained my Facebook page, I try to put, you know, various types of information up there, whether it’s motivational or access or COVID related, and really is just word of mouth, like just trying to provide the best level of care that I can to the patients that are saying sign up, and then they tell their friend, it tells their friend and and that’s been our practice has grown. So and I think, you know, I think this is about that volume of patients where I have enough patients where we’re starting to grow a little more quickly, right, that, you know, that patient tells this patient tells that patient it’s starting to grow a little bit quicker. And it’s been about the right pace for us, given that I have three kids at home and I have a husband who is also in health care, he was working, you know, 50% more than he did previously and just all those things are all navigating with COVID. So it’s been it’s been an okay level of growth for us. But But yeah, I think I mean, I do think the ways COVID has affected me, the primary way is just I haven’t really had to have the time or bandwidth to market. Instead, I’m putting all my energy into just providing a good product.