For those who don’t know, I had written about the University of Houston medical school opening a DPC clinic twice in 2021. Here are my articles:

The University of Houston College of Medicine is Actually Opening a DPC Clinic. Is It A DINO?

I Have Communicated With the University Of Houston College of Medicine About Their DPC Clinic and They Do NOT Want It To Be a DINO!

After that last article above in DPC News I decided to reach out to the school to see if I could help. I offered to consult for FREE. Yes, you read that right. I did, however, want my expenses paid if I flew down to Houston. I had a meeting via ZOOM with the dean and the medical director. It went well and it seemed like their hearts were in the right place. Here was my follow-up email from that call:

Steve and Omar,

I truly enjoyed our discussion this morning. I want to formalize a consultant agreement to move forward.  Being retired from clinical medicine has allowed me to do this kind of stuff but it is bigger than that.  What you are doing is a big swing that can’t miss.  Other than my massive network of connections,  I bring a lot to this table and I think I can help with:

1. Recruiting – I will push hard on DPC News and elsewhere to find someone
2. Retention – the key here is building in the right perks BEFORE you start and continuing them so the doc stays!
3. Purity – you do not want to be DINO
4. Marketing – I know this very well and need to work intimately with your marketing team
5. Leanness – you want this to last and build that network.  I know what isn’t needed and what is. 
6. Reputation – See DINO thoughts. This should be the model to other schools to do this and the country (including DPC docs) should be proud of it.
7. Other:  EMR advice, workflow, subscription management, doctor agency, etc. 

Your timeline is fast approaching.  We (I) have to get moving.  I am fully aware how I would start that clinic as I have done that before.  Yours is different, however.  I need to learn how to work with you so that I don’t step on your toes while also feel that I am being heard.  You have shown you do the latter already. 

With your permission, I will get a VERY simple consultant template and boiler agreement sent to you.  Before I do that, I want you to think about this some more and let me hear some of what you would expect of me in this consulting role. That way we are on the same page.  My asks are simple: all expenses paid (I don’t foresee 5-star hotels and first-class tickets).  I am not looking to gouge anyone.  I would also like an official role and announcement so that I can use that on my resume in the event other schools come asking.

You are on the precipice of something great here. It really could change the system.  We don’t often get opportunities to put a dent in the universe.  This is one of them.

I was excited for them and to help them. Then I heard back from the dean who stated they could not let me consult for free but would have to pay me at a rate of $200/hr. I was blown away. All I had to do was work with their lawyer on the contract. That’s where it ended. It became a mess and I had to email the dean back to try and square things:

Steve, I need your help in facilitating this.  You have to love bureaucracy and lawyers.  

As I told you, I have no problem doing this consultation gratis.  As it turns out, the contract seems to be doing that. I am attaching the contracts sent to me.  Here are the problems I am having:

1. The contract has a total cap of $4K.  That’s 20 hours of work.  As I said, I can do this gratis because I will be doing more than 20 hours of work.  That would be eaten up just by coming down there. 

2. They do not put coverage for expenses.  That’s a problem. 

3. They want to OWN all work I do.  Well, I have written 3 books on DPC and much that I will be recommending is from my work.  I have an issue with their claim of ownership. 

4. They want me to purchase insurance and I am not going to do this. 

5. They are not allowing me to publicize, in any way, that I am working with your medical school which is what I would like to do to show the work we are doing. 

So, my question to you is where do we go from here?  I want to start helping ASAP.   The people that send me emails (Paule, Liz, and one other) never email me back with my questions.  I can send those 5 rebuttals above but it will take forever, if they respond at all. 

Any thoughts?

The result? NOTHING. NADA. They ghosted me. Everyone, even the dean. WTF?

I tried a few more times to contact them but nothing. I had to give up. Remember, no good deed goes unpunished. And I kept this whole experience to myself because I still wanted them to succeed.

A few months later I heard they found a great doc to start at their clinic. Awesome. But then, out of the blue, I got emails from this physician. Interestingly, she didn’t even know that I had been trying to work with the school. This doc found me on FB due to DPC News and she was having trouble at the clinic with such things as:

• I had asked if appointments were going to be extended/longer. I was told yes. But I am now seeing patients every 20 minutes and running behind an hour. I have brought this up and they use the excuse of the waiting list that started in Nov 2021. They launched the clinic then with big publicity, but no doctor to staff it, thus I came into a problem. Their solution lets hire more MAs and call you at 745 am for a huddle. I have 3 exam rooms and for multiple reasons, there is no good flow, one of them being they have not translated documents to multiple languages, not even Spanish.
• I had tried to make sure this was a DPC model: extended visits, low patient panel (I have heard from 700-800 but nobody gives me an exact number), price transparency, voice and leadership guiding the clinic, be able to make the schedule, taking time to build the panel (currently they want 500 by summer) and low overhead…but I feel like this is a fee-for-service model with the operation team making all decisions, not listening to the doc and working in assembly line medicine. 
• The dean says that the other DPC clinics in the area are not doing it right, because DPC was developed by Dr. Garrison Bliss to serve poor people w/o insurance. And they spoke with Erica Bliss on how to provide care to the poor…this came as a surprise to me…I have yet to find this anywhere.
• I was told we could not do some of the things of private practice, but it was not clear that what they meant was operational team making all decisions, leading this like a FQHC/fee for service model and billing a monthly membership and therefore calling it a DPC.
• Am I missing something here? I feel like I missed something, said yes and all is blowing up…I am also concerned that they are calling this DPC and with all the publicity they will ruin the model.

Uh oh. I reassured her as best as I could and told her to voice her concerns and work through this. I still believed we need a medical school DPC model. And she did try but to no avail. She left a few months later.

I tried to follow what was going on at the clinic online as best I could and it seemed they never found another doc. They just used the medical school faculty, including the dean, to see patients. Was it even a DPC clinic? Who knows.

And now it is over in about 13 months. 13 months! They had a $1 million grant to work with and they couldn’t do it right. Could my consulting have helped them? I have no idea as I wasn’t given a chance. Now I am glad they ghosted me like a petty little teenager.

Overall, it is sad that they couldn’t pull this off. If you look at my seven points of concern I initially gave them you would see how relevant they were.

This massive failure by the University of Houston Medical School also begs the question of whether academia (like corporations) can do DPC right.

Answer: probably not, especially when bureaucracy gets in the way.

How many of you could have made this clinic work with a $1 million grant at your disposal? Stop laughing.