Lessons I Learned from Farrago: The Art & Importance of the Meet & Greet (Part I)
After a grueling, multi-phase interview process, I purchased Forest Direct Primary Care from Dr. Doug Farrago in October 2020. In the month before that transition, Doug was kind enough to “show me the ropes”. He had set up several systems and policies that yielded success for his practice of six years at the time. As I have been mentoring resident physicians, medical students, and pre-med students, I find myself sharing these pearls and tidbits often. I offer them up for the DPC community. This is the second installment in this series of lessons.
When I purchased the practice, it was almost “full” by DPC standards, just dozens of patients shy of 600. I was eager to fill it as quickly as possible. However, Doug shared with me the importance of mandating a no cost, no obligation “meet and greet” appointment before allowing folks to join the practice. It’s important that potential patients understand that these are also no pressure. Some have PTSD from no cost, no obligation time share meetings, which were high pressured sales pitches! I literally tell patients this is not the intention of the meeting when we start. For these meetings he would block 30 minutes to share about the DPC model and learn about the patient. I had the opportunity to be “the fly on the wall”.
This “Part I” is about the importance of sharing about the DPC model in general and your DPC practice in particular. It’s important to remember that the vast majority of patients are unfamiliar with DPC. It’s also important to remember the maxim, “When you’ve seen one DPC, you’ve seen one DPC!” So, even if a patient has heard of “DPC”, they may have expectations different than what you can (or want) to deliver at your practice. But relax, DPC literally sells itself!
It’s important to share with patients your “why” for choosing to leave the fee for service system and switch to DPC. I share the three main interests that drew me to Family Medicine: the opportunity to solve undifferentiated medical problem, the variety (patients, problems, some thinking, some hands-on), and the opportunity to build relationships with patients and their families. I share how the fee for service model undermines those three key interests, especially focusing on the ability to build relationship with its push for “production”; I make it clear that I’m interested in getting to know them, and what is drawing them to consider joining a DPC practice. More on that in “Part II”.
Explaining the variety more, I point out that most times I am a “consultant”: helping to diagnose, make recommendations for treatment, or direct further care. A small amount of the time I’m the “mechanic”: removing the bead from a child’s nose, biopsying a changing skin lesion or performing a no-scalpel vasectomy.
I share about the unparalleled access and savings of DPC: almost always same day appointments for acute issues, unlimited visits, no cost for telehealth or emails, that patients will have my direct cell number and email, the savings of pass-through billing for labs and pathology, etc. For my practice, I don’t charge extra for most clinic procedures (dermatologic, orthopedic, gynecologic, etc.). I do have a fee for circumcision and no-scalpel vasectomy. Many of these amazing things should generate clarifying questions and discussion. It’s often enjoyable to see the looks on folks faces, especially when one spouse gives a knowing nod to another and smiles (they’re hooked!).
Although patients have unparalleled access to me as their DPC physician, I clarify the boundaries. It’s extremely important to share what you are and are not willing to do. I personally don’t do home visits because it would kill way too much of my day with travel time in central Virginia (where there are no straight roads). I also make clear that my practice is not an urgent care. If something happens in the evening or on the weekend, patients are welcome to contact me about it, but I may or may not be able to assist them. I make clear that part of my switching to DPC is restoring work/life balance with my family. I’m married and have four kids, and recently a first grandkid. There are sometimes that I have family obligations in the evening or I’m visiting kids in college on the weekend, so I may not be available. I’ve certainly come in the evening or weekend to staple a head or stitch laceration, but sometimes I’m out of town and I will have to direct my patients to an urgent care. I explain that I’m a solo doc. The handful of other DPC docs in community and I have a Gentlemen’s handshake agreement to help cover each other when away, if possible. None of us are on call for the others. If our schedule is jam packed, it just won’t work out. It’s guaranteed that all of us will be with our families on Christmas Eve, etc. and the potential patient will need to go to the urgent care or emergency department if necessary.
Regarding that unparalleled access, I share Doug’s story of three different “bins” of reasons why patients contact the physician. I explain the first bin being something routine or more of a curiosity question. These are things like requesting a medication refill or wondering if that hair supplement they saw on the late-night infomercial actually helps grow hair. I instruct them to email me about those things and not call me in the middle of the night. The third bin (relax – I intentionally skipped bin 2 for the moment) includes obvious emergencies for most reasonable people. I say things like if you have a bone sticking out of your flesh or blood squirting out of your eyeball or you’re having crushing chest pain. Don’t call me, go to the emergency room, do not pass, go! Most patients get this. Back to the second bin. This is where something seems quite urgent, but not clearly an emergency. I tell patients that most things fall into bin 1 or 3, and bin 2 is rare. Nonetheless, not having gone to medical school, exactly what qualifies for bin 2 is varied.
One of my favorite stories that falls into this bin 2 category is a very well-educated mother, who called me on a Saturday afternoon to share that her three-year-old girl was peeing blood. I needed to think about this for a minute. On one hand, this is well educated woman who menstruates monthly and had given birth twice, so one would think she would know what blood in the toilet looked like. However, when I asked how her three-year-old was doing, she replied that she was tearing around the house, playing tag with her sibling. After another moment of thinking, I asked if they had eaten beets recently. Mom reported that they had eaten beets last night. I reassured her that this was not blood but beet-uria. On one hand, I understand that some of you reading this would be frustrated to think that your Saturday afternoon was interrupted. However, we all know that if she went to the local emergency room, and she couldn’t give a urine sample, someone would put a catheter into this little girl, incurring a significant amount of medical trauma and a large bill. I didn’t mind heading that off at the pass. With the way I saw Doug frame this for patients, I have found the bin 2 contacts to be quite manageable.
Lastly, discuss the money. It’s a membership. You can’t join and quit, wash, rinse, and repeat. Explain clearly the registration fee and the monthly membership fee. Ask if they have any other questions about the DPC model or you practice. Transparency and clarity is key.
More about learning about your potential patient in the next installment.
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