Do you have a MO(E)?

In my opinion, every DPC practice needs a MOE. 

For about two years, I sustained the practice by myself, without needing any additional help, and able to do it all. This was starkly different from my previous role before I started the practice, as a Chief Medical Officer of a 14 site health center, with six directors reporting to me along with multiple other individuals. Delegating was something I did on a very regular basis.

When I started the practice, I had to learn how to do everything. I took care of patients, I marketed, I ran the social media, I cleaned the floors, I organized inventory, and I made the schedules.

But then, we grew.  Initially, I started looking for virtual assistants.  This came with multiple issues and questions, including pushback from my lawyers, encouraging me not to sign any contracts with indemnification from virtual assistants who may be international, as there’s no way to control their compliance to privacy and security.

But I loved the idea of having a virtual assistant. This led me to start with bringing on two part-time virtual assistants, people who I had worked with and had known before, and had done very similar roles from previous work lives that I had had with them. This turned out to be very fruitful, but was still challenging because after a while we needed in person work. I often debate the world of remote working versus in person working, and I came to the conclusion that the hybrid world is probably the best.

I brought on my brother, who was looking for part-time opportunities as he was completing his education. This gave us a chance to work together and created both in-person and remote hybrid opportunities. But as we grew, I had to strategize what to do. I tried thinking of the idea of a traditional medical assistant but soon found that it was very limited for what DPC needed.  I needed someone versatile.

Shortly afterward, I had three international medical school graduates approach me for observerships since it was COVID.  All three had entered my world by accident, as has been the case for everyone who has joined our team, though one can debate whether it was an accident or divine intervention.  

What started off as an Observership turned into the creation of the MOE position – Medical Operations Externpreneur – a hybrid role of the Medical Assistant, Front Desk, Phlebotomist, Care Coordinator, while learning business operations and how to navigate the US healthcare system.  Initially, this role was targeted toward International Medical Graduates and Pre-Medical Students, the purpose of this role was temporary.  The goal was to have someone perhaps 1-2 years to gain a skill set and either move to other roles in the practice or pursue higher education.  I had gained some inspiration for this role from my time at Iora Health, particularly at the Dartmouth Health Connect practice where a premed student was brought into a role for a year to help mentor and groom for medical school.  It was about fostering the social mission of encouraging future physicians and grooming them to show them what primary care is about and could be in all facets of the Physician’s life.

While two of our initial MOEs have gone on to pursue residency (one of whom wants to do DPC), one of my MOEs was actually someone named Moe (divine intervention?  Accident?  Who knows).  Moe was an International Medical Graduate, with an MPH.  And fell in love with Direct Primary Care.  He decided not to pursue residency and has since become our manager, running various facets of the practice, and together we are finishing our MBAs, sponsored by our practice.  I learn from him daily, and I realized we all need that right hand person in the office.  We need that person who believes, who has our back, who has lived the various roles of the practice in addition to us.  And our responsibility?  To keep pushing their learning, to keep educating them, to give them opportunities to grow and gain skill sets.  I never expected to have created the MOE role or someone with that name to exemplify what I needed. 

So here’s the lesson I learned: I learned that dedicated roles don’t necessarily work in DPC, and we need a lot of cross-training and a lean staffing model to help keep overhead low.  I also learned that we should approach hiring with teaching.  We are inherently teachers.  We need to keep teaching our patients, our team, and let them grow into their careers and paths. 

As one of my supervisors once told me, “I need to have bigger dreams for you than you have for yourself.”  And together, we need bigger dreams for our practice, and for our team members, and while we hope they remain with us, we should be equally proud if they decide to pursue opportunities greater, knowing that as we do for our patients, we made an impact in their paths.