Hello Students and Residents, 

I hope this is an enjoyable and useful read for you.

It seems like only yesterday when I was so nervous to start my own practice. I had everything setup for my clinic to open its virtual doors. The ship was ready to sail yet I was afraid to leave the dock. 

It has been close to one and a half years since my husband encouraged me to set sail with “myhappydoctor”. Today I am reflecting on the experience as a solo direct primary care physician and I have to say I am loving the feeling of being on my own…

Direct Primary Care was never the plan. 

My professional reality today was not even the back up plan. 

To have my own clinic where I make my own workflow decisions, create my own logo, create my own brand, create a personalized experience for my patients… was nothing but a starry-eyed dream. A dream where I was a well-respected and a dearly loved personal doctor to a wonderful community of people. A dream that seemed too good to be true… and out of reach.

You may ask me why I say ‘out of reach’. 

maybe because I was an immigrant in a new country, 

maybe because I spoke with an Indian accent, and 

maybe because I was scared to dream in a city full of towering concrete structures we call the “modern healthcare industry”.

When did I stop chasing my dream? 

I did chase my dream up until I started medical school training but I lost momentum along the way somewhere. Life happens! And when life happens during medical school and residency training, our priorities get blurry. Did you know that the word ‘priority’ was meant to be ‘the single most important purpose in our life’. The word ‘priority’ did not have a plural form for many years. 

That’s how significant a “priority” is meant to be. Our priorities during medical school and residency start to look like the priorities of people surrounding us everyday. 

Let’s explore what shapes our priorities… 

Of course some of us yearn for money and fame to varied degrees while helping people heal. 

We are often inspired by amazing professors and excellent doctors who train us. 

We enjoy some rotations, and some we clearly don’t. 

We watch colleagues chasing a dream in a particular specialty and experience peer-pressure to pursue the same.

Yet, for some of us – choosing one specific specialty as a career can be so daunting when we have so many options to choose from. 

To define my ‘priority’ I thought hard during my early years of schooling. I always wanted to serve my community and I loved biology. But soon the confusion began when I was in medical school training…

Sometimes I liked Ophthalmology 

Sometimes I liked Surgery

Sometimes I liked Internal Medicine

Sometimes I liked Academic Medicine

Sometimes I wanted to rest and take a break

Sometimes I enjoyed the thrill of working late hours in the Emergency Room

Eventually I chose Internal Medicine because I enjoyed the rotations thoroughly and was inspired by my professors.The confusion around pursuing subspecialty training or choosing outpatient versus inpatient medicine careers persisted through the first one and a half years of residency training.

Eventually, I chose Primary Care, which thankfully was the best decision for me, and I am so glad I chose primary care despite the complaints from practicing primary care doctors about billing/coding, rushed visits and insurance hurdles in clinics. I am so glad I chose primary care despite the dwindling interest of residents in primary care. Primary care was not in fashion anymore. And still isn’t.

Here is how I narrowed it down to primary care.

I worked backwards. First I imagined a day at my blissful job – A job where I could chat for hours with my patients in a leisurely manner while diagnosing diseases and planning their treatment as a doctor-patient team. In fact I love talking to people; I love listening to people’s stories. I like to know their pets’ names, their everyday troubles and everyday victories.I like to help alleviate multiple symptoms single-handedly so as to simplify my patient’s experience instead of having them see another doctor, unless of course it is beyond my expertise. This is also the reason I pursued a Primary Care Psychiatry fellowship since the body and mind are truly inseparable. 

Ultimately, I want my patients to have the best experience without excuses. 

So during residency training, I had a clear picture of what a typical day at my dream job would look like. I knew there were flaws with the insurance based model since I was quite familiar with the paperwork involved with it. Yet, I believed I made a small compromise with my dreams and  imagined that joining any existing primary care practice would be the closest I would get to achieving my dream job. Boy, was I wrong!

I quit insurance-based private practice within 6 months of my first job becauseI couldn’t spend enough time with patients for a detailed history and exam, I would have to interrupt my patients when they were speaking to me because of rushed appointments, I found myself referring patients to specialists often because 15 minutes was too less to address all their health issues, and I was assuming the worst possible clinical outcome for all patients since the rushed appointments did not instill confidence about my diagnosis and also because of the uncertainty of follow-up if the patient couldn’t afford another appointment. Fear of uncertainty leads to unnecessary tests and imaging – which leads to higher expenses and stress for patients.

I quit my job feeling frustrated and let down by the healthcare system. I felt let down by my training which never focused on how to work outside of the insurance model. I considered working in urgent care because it seemed like a less stressful job with less paperwork but that wasn’t my dream.

So now I had to pause – regroup – strategize in order to achieve my dream that could not be fulfilled by big-box clinics. 

This is when I learned about Direct Primary Care from a stellar community of self-motivated and “patient health results”-driven doctors, and shortly after I created “myhappydoctor”.

I am glad I worked in the insurance model because it pushed me to fight for a better experience for my patients. My motto is to provide a high-quality, consistent and personalized patient experience with compassionate, timely, and efficient communication throughout the doctor-patient relationship. 

Direct Primary Care is a model of practice that helps me achieve my motto. The most important part of my practice is to be a good doctor and to provide a pleasant experience with peace of mind for patients while saving them money. In contrast, the current insurance based healthcare system prevents us from being good doctors due to lack of time per patient. Further, patients’ experience turns sour right from the beginning, whether that’s the phone tree when they dial their doctor’s office or the 60 minute wait-time in the waiting room. Insurance bills with explanations of benefits keep showing up in the mail once the patient steps into the clinic a few times. In essence – patients have a bad experience in the insurance model. I made a list of all these unwanted patient experiences and found solutions for my patients to avoid them. I am still looking for solutions and this is going to be a dynamic journey but I am already seeing excellent results.

For 2022, I am learning about evidence-based lifestyle medicine and having a healthy quality of life is my new priority. I want to practice what I preach. I want to lead a healthy lifestyle at home and at work in order to help my patients do the same so they can stay healthy.

Hoping for a better tomorrow. Wishing you all the very best in your careers! Happy Holidays!

Dr.Deepti Mundkur is an Internal Medicine graduate from the University of California San Francisco School of Medicine Fresno Medical Education Program. She hails from a small coastal town in India. Her medical schooling was at Manipal University in India. In the second year of her residency, she found that primary care was her passion. Psychiatric conditions being a very common comorbidity encountered in primary care, she pursued a fellowship in Primary care Psychiatry from the University of California Irvine School of Medicine to provide comprehensive care for her patients. She has a Masters in Clinical Research from the University of California San Diego and has won accolades for various Quality Improvement Projects. She worked at a big box clinic in San Diego right out of residency and soon realized the many hurdles to provide primary care in the insurance-based healthcare system in the United States. To meet her personal and professional goals in the chosen career path of Primary Care, she has now begun her journey in Direct Primary Care.