Ask Me MD: Medical School for the real world
Ask Me MD: Medical School for the real world
Manvinder Kainth, MD - Direct Primary Care
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Dr. Manvinder Kainth of Maple Primary Care discusses her path after residency that took her to opening her own direct primary care practice.
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Ask Me MD, medical school for the real world with the MD, Dr. D.J. Verret.
D.J. Verret, MD, FACS:Greetings and welcome to another edition of Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret, and today we're talking with Dr. Manvinder Kainth about her transition into direct Primary Care Medicine. We'll talk to Manvinder right after this
Commercial:Commercial inserted here
D.J. Verret, MD, FACS:Welcome back to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret. And today I have the great pleasure of talking with Dr. Manvinder Kainth, a direct primary care physician here in the Plano area about her experience in alternative primary care delivery models. Doctor, thanks for joining me.
Manvinder Kainth, MD:Thank you so much for the opportunity DJ,
D.J. Verret, MD, FACS:Can you tell us a little bit about yourself and your background?
Commercial:Sure. You know, going back to the beginning, I grew up in Canada, that's where my childhood was. So I kind of grew up with national health care. And then my family moved to the Houston area when I started high school, and I was there for high school, college medical school, ended up in Seattle for residency and then started my career. And, you know, I was it was a, it's been an interesting journey. So far, I've been with three different major health organizations. And after the third, I decided to start my own practice.
D.J. Verret, MD, FACS:So and that kind of brings us to why we're here in our discussion. Can you talk a little bit about the differences in direct primary care, concierge medicine, cash pay practices? And why you settled on the model that you have?
Commercial:Yes, it's a very good question. So I am, I did my residency in family medicine. So I knew fairly early on that I wanted to do primary care. And I wanted to get to know my patients have a relationship with my patients and actually make some meaningful changes. You know, as you get to know them, what I found in the typical traditional insurance model is that it was really difficult to do that. And so I really didn't feel fulfilled. In my career. As a physician, it's really hard to make an impact when you only have about five minutes to actually talk to a patient per visit. And, and then the other 10 minutes are spent usually with documentation. And so my thoughts after, you know, the three different healthcare organizations, I finally learned with a third that they're all pretty much the same. They all have kind of the same rules, regulations, goals, and none of them really met. What I wanted to do. And what I wanted to do was have the time to actually talk to my patients, and to talk about lifestyle, behavioral changes, in order to make some meaningful change, which you and I both know, takes a lot of time. It takes time to do it. And then it takes time to actually put those things in action. And so that's kind of how I came to To DPC or direct primary care, as far as the differences in the models, so direct primary care, or DPC is fairly simple. I always say it's not the typical insurance model. And it's not the concierge model, it's kind of somewhere in between. It works very similar to a gym membership, where you pay a low cost monthly fee, and that covers all your office visits, all your in office procedures, all telemedicine and there's no question or thought about co insurances or co pays, or what is covered what is not covered. And so obviously, that's a huge difference from the typical insurance world. The concierge model, the way that's different is that most concierge doctors bill a high dollar membership fee, often the average is about 2000 to 2500 per year. And they will also bill insurance on top of it. So that is the big difference. So people who have deductibles or co pays, they still have to pay those bills, but they have to pay the membership fee on top of that.
D.J. Verret, MD, FACS:How did you when you were you were with a couple of large health systems? That sounds like I'm assuming integrated delivery systems as they're called correct?
Manvinder Kainth, MD:Oh, I guess so.
D.J. Verret, MD, FACS:How did you settle on the DPC model? Like what thoughts went through your head? And in? What fears did you have in making that kind of a leap? And how did you overcome those?
Manvinder Kainth, MD:Sure. So it all kind of fell in my lap. So when I was getting towards the end of my third year, with my last healthcare organization, I knew that I wanted to make a change. I was not happy, the way things were running. So the biggest challenges that I had, as I mentioned before, is time with patients. The other challenges were that it was difficult for my patients to get in. The other challenge was it was difficult for my patients to actually reach me, they had to go through the endless phone chain to actually get a human being on the phone. So those are and then of course, the wait time, you know, when you double book, you know, and have six appointments in one hour in primary care. To me, that's a pretty busy schedule. And I'm always going to be running at least 15 to 20 minutes behind. And so patients having to wait in the waiting room was also frustrating. So those are all the patients frustrations. For me as a physician, you know, I wasn't being fulfilled with basically throwing medications at patients, you know, when I only have five minutes, and I am being measured on performance. And somebody has a like, let's say it's a diabetic and they have an LDL of 120. I'm just upping their SAT. And I'm not talking to them about their exercise, their nutrition, the very nitty gritty stuff, because I don't have time to do it. And so that was a big thing that I did not like so I wanted to make a change. The other thing is the cost model with different health organizations, obviously, they're different depending on where you go. But I'll tell you in the end, in my opinion, it's it's always going to benefit the organization, it's never going to benefit the physician. And almost always the physician will get slighted when it comes to their pay. So I was getting to that point, I happened to see that the TMA was basically sponsoring a DPC conference. And it was just one day it was almost free. The conference, I needed some CMA, I decided to go and when I attended that conference, it really opened my eyes to the DPC model or direct primary care model. I honestly had never even heard of it. But it was after that conference that I decided, you know what I'm going to, I'm gonna take the leap, and I'm gonna, I'm gonna go for it.
D.J. Verret, MD, FACS:The thoughts you're putting out there about why you were unhappy are ones that I see echoed quite a bit on physician messageboards. With that in mind, let's talk about how what it took to actually start the practice. Let Did you So as many of our listeners know, I was was in a little bit different situation finishing residency, I actually took out a loan and opened my practice. So I didn't have any of the real clinical experience behind me. But so there was a whole lot of things to learn. In your case, after having that bit of clinical experience. What did you have to learn to actually get your practice off the ground?
Commercial:Sure. So great question. I mean, really, in the end, the biggest thing to learn is, how to own your own business, and how to start your own business and all of the things that go with that, honestly, the clinical care, that's the easy part. That's the part that I enjoy. It's the other parts that are challenging. So I was fortunate that the DPC, physicians around the country, most of us are, most of them are very open, and they want to mentor other physicians who want to do this model. And there is no fee to that. There's none of that it's literally just physicians helping physicians. So I connected with one of the physicians who kind of started this model. And he really helped me Walk, walk me through it and make decisions. You know, the very first step is, what do you want your name to be? And filing it with the state, getting your ID number. These kind of simple things. I think, as physicians, we don't know, that process. So getting that done. And then, you know, my next step was, I need to build a website. And before I can build a website, I really need to know a location and find the right setting for my practice. And then with all of that being said, when you're starting your own practice, and especially with the DPC model, you have to keep your overhead low. So finding a spot where I could sublease one room is what I was looking for, to keep my overhead down. And I made the decision not to hire any staff. So it was me, my desk, my exam table in one room. Yep. And I was the scheduler. I was my EKG tech. So I learned how to you know, did I remember where to put the leads for medical school? Nope, I had no clue. But you learn it. And it's those kind of things that I had to learn along the way is how to be a scheduler, how to be an accountant, how to be a medical assistant, and then knowing my limits and asking for help when I needed it.
D.J. Verret, MD, FACS:Enough, that's, that's interesting. I run a similar smaller practice. We do do insurance, I'm as a specialist, but I don't have medical assistance. I have a receptionist I do my own bandage changes, my own suture removals, all that kind of stuff in order to keep the overhead low and, and to stay nimble. And it really helped during the time of COVID. I didn't have a large overhead to worry about when when things just turned South all of a sudden.
Commercial:Absolutely. That's definitely the case. You know, and I, I was fortunate that after a year and a half of doing the DPC model, I had enough traction that I was able to hire a clinical assistant. So now we are a team of two. Me and a clinical assistant. So it's been great.
D.J. Verret, MD, FACS:Let's talk a little bit about some specifics there. You mentioned choosing a name of the practice in your practice is Maple primary care not Dr. Kane's practice. Yeah. What went into your thought process and choosing that name?
Commercial:It's a good question. You know, I wanted something that was simple, something that people could remember. And in the end, I kind of go back to my childhood in that healthcare was easy in Canada. It was never a concern for us. And I just feel like our system here in America is much too complicated. And so I kind of went back to you, I want something a little bit Canadian. And that's how I came up with the name and then and checking with the state of course to make sure nobody else has that name. And that was a that was one of the rate limiting steps. And when, when the nice lady on the phone said, Oh, that's nobody has that name. I was like, perfect. That's the one.
D.J. Verret, MD, FACS:So you got a name you get a EIN number.
Manvinder Kainth, MD:Yeah.
D.J. Verret, MD, FACS:How did you come to your practice location? What did you look for? You said you were subleasing a space, obviously somebody with a sublease. But, but I mean, the area obviously, we're in the DFW area, a lot of square a lot of square mileage around here, you could have set up shop and why did you choose where you get
Commercial:So number of different reasons. Number one is the thing we all hate about healthcare organizations is the non compete clause. So I knew that I didn't want to fight that clause. So I was gonna go, you know, outside of my mileage. So that took out, you know, a decent amount of the Metroplex. And I came to Plano and settled on Plano for a number of reasons. I feel like Plano is now is fairly Central, in the DFW Metroplex. It was a location that was very close to North Dallas right off of the highway. And it was a place where there was a clinic who was willing to sublease a room to me, I was surprised to find that it is actually fairly challenging to find a clinic that's willing to sublease one or two rooms for a very reasonable price. You know, obviously, I was looking for very low rent. And so that's that's really how I, I came to, to that area.
D.J. Verret, MD, FACS:What was your biggest fear in switching over to the DPC model, obviously, working for large health system, you have a fairly reasonably guaranteed paycheck at the end of the month? Obviously, we've seen that's it's not completely guaranteed with
Manvinder Kainth, MD:I was gonna say sometimes, yeah, exactly. sometimes that's the case.
D.J. Verret, MD, FACS:But But now you're going from getting a paycheck on a regular basis to starting from scratch all over again. What was that like? And how did you kind of overcome those, those concerns?
Commercial:Sure. So towards the end of being employed, honestly, the company was decreasing my base salary significantly. And this goes back to all the problems with, in my opinion, those organizations and how they do accounting, and if they make a mistake in accounting, they're not held accountable. So in essence, my resignation letter got turned in when my administrator handed me my salary to be, which was $14 and 14 cents an hour. So that's obviously
D.J. Verret, MD, FACS:You could have gone to Hobby Lobby, I just saw they increased base pay to$14. at Hobby Lobby.
Commercial:Exactly. I mean, I'm sorry, but you know, as a physician getting presented, that was just a slap in the face. So you know, when I saw taking the leap, I mean, my biggest concerns were, am I going to be able to do this? Am I going to go bankrupt doing this? How am I going to get health insurance or any type of benefits? And there's just so many unknowns, but those were the big things that came to my mind initially.
D.J. Verret, MD, FACS:And how did you? I mean, obviously, those are real concerns, especially in the benefit department. How did you overcome those? I mean, initially, obviously, logistically, how did you do it? But But more importantly, how did you get your mind passed? This is this is a huge mountain to go climb. I how did you get past that to say, Okay, one step at a time. Let's go. What did it take? How did you do that?
Commercial:So I tried to think logically about it. You know, my, I asked myself, What are my choices? My choices at the time, I felt like was continue to work with healthcare organizations and maybe find another one, a different one. But in my heart, and in my brain, I knew they were all the same and they all have the same challenges. And then I thought, What is my other option, my other option is To open my own practice and do the traditional insurance model. And then my other option was open my own practice and do the DPC model. And then the last option, which I put last was doing, you know locums or urgent care. So, for all the reasons I told you that I liked DPC, that's how I came to that conclusion of this is what I want to do. Because I don't enjoy urgent care or you know locums type of, of jobs. And then I chose DPC over the traditional insurance model. Because honestly, DPC felt easier to me not having to hire multiple staff members to, you know, process insurance and verify insurance and deal with all the coding and the billing and the that stuff. It actually sounded much more doable for me to just do most of the jobs that were needed. And so I had some comfort in that. So that's how I came to it.
D.J. Verret, MD, FACS:Now that you've, you found your spot, you opened your office, how did you get patients?
Commercial:Great question. So initially, I let all of my patients know where my practice was going to be. And so I put in the effort and the money to send them letters so that they knew where I was. Because obviously, the health care organization is not going to do that. For me. They always send out the generic letter of it's with mixed feelings that we announced that Dr. Manvinder Kainth will no longer be working with health, blah, blah. So that's how I initially got some of my patients to follow me. Even though I was in a different location. A number of patients wanted to follow me and it wasn't a large amount of patience, but it was enough to get me started.
D.J. Verret, MD, FACS:Did you did you see a hesitancy especially in those patients, but even after that, for patients to adopt the DPC model over the classical insurance model?
Manvinder Kainth, MD:Absolutely. It takes a lot of time and education to explain the model to patients and to other people. And they do often. Mistake DPC for concierge medicine. And I tried to explain the difference to my patients and all of that just took time. But once patients were in the practice, and they understood the model, and you know, they were used to it, it just made a lot more sense to them. And it makes more sense to everybody.
D.J. Verret, MD, FACS:What is one thing you learned since starting your practice in a row? And if it's more than one we'll we'll go down that road but but maybe the biggest thing you've learned that you wish someone would have told you before starting your DPC practice either in a good or bad way either way.
Manvinder Kainth, MD:Oh, let's see here. It's not necessarily something I learned but something I listened to. I really listened to my mentors saying keep your overhead low. Remember that your your biggest asset is being a physician and being a good physician. So never let that lapse. Don't think that you have to have a fancy office with like a cool water fountain and a modern this and a modern that and you know a serving bar with coffee and teas and things like that. Concentrate on the patient care and the patient will come and they will stay with you. So I would say that was the biggest thing that I took from those mentors is reminding myself that patients don't care if you have a fancy exam room or a fancy this or that. They just want you know quality care for an affordable cost.
D.J. Verret, MD, FACS:We're talking with Dr. Manvinder Kainth about her experience starting a primary direct primary care practice. We'll take a quick break and we'll ask Dr. Kainth what her top three is right after this.
Commercial:Commerical inserted here
D.J. Verret, MD, FACS:Welcome back to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret and today we're talking with Dr. Manvinder Kainth, about her experience starting a direct primary care practice. As we do with most of our interviewees. We're going to ask Dr. Kainth , what her top three are. And Manvinder, what I'm going to ask you is what are the top three things you would tell a physician who was thinking about starting a direct primary care practice.
Commercial:So the top three things I would tell a physician colleague who wanted to start a DPC practice is, number one, have a mentor or if you mentors, and listen to their advice and see what works best for you. Number two, is keep your overhead low. And don't be ashamed to do all wear all the hats at the office. Don't go fancy because you don't need it. patients don't really care about that stuff. They want good care, and they want it at an affordable cost. Number three would be remember why you went into medicine. I really think that the majority of physicians went into medicine to help people. And unfortunately, the way medicine has gone is nobody in the system is happy as far as physicians or patients or staff. And remember why you chose to do medicine in the first place. And remember that on days that you think you're going to go bankrupt, or that you think this was the biggest mistake of your life. Just remember why you're doing it and keep pushing through.
D.J. Verret, MD, FACS:And on that front. I think I know the answer to this. But do you regret making the change?
Commercial:Absolutely not, I am a much happier physician. And I actually can say that I enjoy going to work on most days. And I couldn't say that before when I was working for other people when I was an employed physician. So now I can say that I I tell people all the time. I really love being a family medicine physician.
D.J. Verret, MD, FACS:One kind of we're approaching our half hour here. But one other thing just to give people a sense for this isn't an overnight process. How long do you think it kind of took to set when you start after you started your practice? How long did it take to get to a comfortable spot for you?
Commercial:That's a good question. I don't know if I am even at that comfortable spot yet. I don't know how long it's gonna take for me to feel comfortable. And some of that is my personality. But what I can say is by keeping overhead really low, I was profitable within three months of opening my practice. And that alone really helped me along the way. And so I would say that comfort maybe at year three, and really, really comfortable, like fairly close to smooth sailing, I would say would be your five but I'm I'm not at either of those points yet.
D.J. Verret, MD, FACS:I appreciate the numbers I've heard generally it takes five years to develop a medical practice and personally. That's what it took me to get to kind of a as smooth of a sailing as you can in any practice. But to get to that point took about five years.
Manvinder Kainth, MD:Absolutely. I would completely agree with that.
D.J. Verret, MD, FACS:We've been talking with Dr. Manv nder Kainth, about her xperience and directness. rimary Care. Manvinder, thanks o much for joining us some some reat thoughts and hopefully, we ere able to give some insight. o for folks thinking about aking the switch, they'll at east reach out to somebody in he DPC space and learn some ore about it.
Manvinder Kainth, MD:Absolutely. Thank you so much for the opportunity DJ. I'm always happy to talk to colleagues who are considering DPC or are just curious about the model.
D.J. Verret, MD, FACS:And I'll put a link to your practice in the in the show's description. So if folks have questions, they can reach out to you through there.
Manvinder Kainth, MD:Sounds great.
D.J. Verret, MD, FACS:You're listening to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret. Until next time, make it an awesome week.
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