My name is Brandon Bilyeu and I am an Osteopathic Family Med doc who just opened Ascension Health DPC in Helena, MT this past December and I am the first true DPC practice in this community! My practice focuses on osteopathic wellness and family medicine. Staying true to my osteopathic principles I take into account the health of the whole person; including emotional health, mental health, spiritual health, and physical health. The DPC model allows me to truly be a family doc where the patient/doctor relationship is at the center of care; along with trust, honesty, and transparency all in an affordable manner. My number one priority and the one whom I answer to is my patient, not corporate administration or insurance companies, but just my patient.
I would also like to give a summary of my path to DPC as I think many other physicians had similar struggles and hurdles.
I was born and raised in Montana, where I was lucky to have a couple of great family docs in my nearby small town take care of me and my family. As a high school student, I knew I wanted to become a doctor and I knew I was meant for primary care, where I would be able to build relationships with my patients and their families. I made it through undergraduate school, medical school, and my family medicine residency training, but the further along I got the more I was seeing how difficult it was to create the doctor-patient relationship and to keep the patient as my number one priority. In residency, I was quickly experiencing this thing I was constantly being warned about, which was physician burnout. I had always thought this would afflict those being overworked and under fulfilled, but since I planned on finding fulfillment in the work of primary care it would not affect me. As it turned out, that was exactly my issue. I was finding it harder and harder to find fulfillment in my work.
I felt disillusioned, like the medicine I had been training so hard to be able to practice just wasn’t an option. I felt confused because my favorite parts of the workday were the encounters I had with my patients, so it would seem I should enjoy a full day of seeing patients, yet I dreaded it. I felt frustrated because often I did not have adequate time during a patient visit to understand their thoughts on an issue. I felt guilty asking them to schedule another appointment if they had even one simple question at the end of a visit because I knew for them it often meant another co-pay, more time off work, or the challenge of finding someone to watch the kids. I felt helpless when I worked with a patient to create a workup plan and they asked how much it was going to cost because I had no answer for almost all of them. I felt angry because I studied and trained hard to help people, but most of my day seemed to revolve around typing on a computer, talking to insurers on the phone, and filling out forms. These tasks, along with many more, were taking the top priority spot, the spot designated for my patients. I continued to fight with all I had to do my best for my patients, which usually meant running late in the clinic and not finishing paperwork until 8,9, 10 o’clock at night and many times taking time away from my family on weekends and holidays to catch up on paperwork. It made sense why so many primary care providers were retiring or stepping away from medicine and it became easier to imagine why so many regions in America can’t recruit new primary care physicians. My own mental health was falling apart.
It felt as though my soul was being crushed. Being told to take great care of my patients and then being punished for doing so was taking a toll. My anxiety was becoming uncontrollable and my depression was all-consuming. I was fighting so hard to help others, but in the process I neglected myself and my family. I became suicidal. Fortunately, there were others around me in my residency program who I was able to reach out to and get the help I needed. But, I realized this system of healthcare was not one I could stay in any longer. So, with only about 6 months left of residency training, I told my training program I was done. Apparently, my path to helping people with their health was somewhere else. My residency faculty convinced me to take some time away with the option of returning to complete my training if I so desired. I ended up taking a couple of months off and it was during this time I had a mentor tell me to meet a local physician who had recently transitioned to a model of practice called Direct Primary Care. When I met this physician and he told me about the DPC model I couldn’t believe my ears. He described the type of medicine I had wanted to practice since I was a kid. It was the type of medicine I was convinced was not possible due to all the tasks doctors had to complete in the traditional fee-for-service model that took attention away from patients.
This was when I made the decision to join the direct care movement. As you may have guessed I did indeed finish my residency training and did so with a renewed passion for practicing medicine. I am now in Helena, MT where I was able to “hang up my shingle” (I love being able to say those words) and I have never been more excited to provide health care to my community. I strongly believe the DPC model offers many patients and their families affordable and accessible care given by providers who are allowed the time needed to truly provide patient-centered care. I think we are in a time when patients’ health and wellness needs to be back at the top healthcare to-do list and physicians need to be allowed to practice the medicine they were trained to practice. Currently each year in America an estimated 300-400 doctors die by suicide, a statistic that rings very loudly in my ears. I believe a significant contributor to the physician suicide rate is the consequences of pressuring physicians to provide the best care possible while actively preventing them from doing so.
I cannot express how thankful I am to those who blazed the DPC trail ahead of me. If not for this model I would not be in medicine and the Helena, MT community would not have Ascension Health DPC. Currently, I am just starting to get my name out into the community, which requires a lot of hours and not a lot of income; however, I have never experienced this kind of fulfillment in all my life. I am now doing what I truly believe I was made to do.