Last month I checked off one of those proverbial “bucket list” items, hiking on the Camino Trail in Spain. I actually dislike that term, preferring instead “enhancing and challenging geriatric-appropriate opportunities.” That list is endless, at least in my mind.
My friend, Dr. Kari Uusinarkaus from Colorado, and I have talked about this trip for a number of years, but COVID got in our way. Finally, this year, we were able to pull it off.
I spent 2 days in Barcelona where I sampled the tapas and studied the genius of Gaudi, including a tour of the almost finished Sagrada Familia. After a high speed train to Madrid, I met up with my friend, and we went north to Sarria to begin our trek on The Camino.
In case you are not familiar with it, the Camino de Santiago is a network of “ways” which all (except one) lead to the Cathedral in Santiago de Compostela in northwestern Spain, the burial place of St James. Pilgrimages on the Camino are thought to date back to as early as the 9th century. The most popular one is called “The French Way,” which begins in Saint-Pied-de-Port in France and extends about 800 km (nearly 500 miles) to Santiago. The “Camino de Finisterre” actually begins in Santiago and ends about 80 km (50 miles) away on a point which at one time was thought to be “the end of the world.” Along the trail, fellow travelers offer each other greetings of “Buen Camino!”, wishing each other a “good way.” Pilgrims carry a small booklet, which is stamped along the way at chapels, restaurants, and hostels to prove the pilgrim’s time on the trail. Upon arrival at the Cathedral in Santiago, each pilgrim who has traveled at least 100 km receives their coveted “Compostela” certificate.
The trail from Sarria is not difficult (nothing like the Appalachian Trail if you are familiar with it), but challenging enough, and very picturesque. We walked 12 to 16 miles a day (over 300,000 steps during the entire trip according to the device on my wrist). Each night we bedded down in small simple but clean hotels. We found the “locals” to be friendly and proud of their traditions and history. The food was amazing. I am currently trying to grow padron peppers in my own little garden back home here in NC. Sweet when picked small. Delicious sautéed in olive oil in a skillet. Whether octopus tastes good again, anywhere, is another story.
Tradition says the Camino “provides what you need,” whether that be essentials for the trip, the making of new friends, the introduction to new foods, or simply the opportunity to think and reflect. For me, all those were delivered.
I split my time between hiking with my close friend and my new friends, but much of the time I chose to go it alone. After turning 69 in April, the experience was much needed and much appreciated. It gave me the space to think about many things, where my life has been, and where it is going. Of course, I thought about our profession, the specialty of Family Medicine, and, yes, DPC.
Here are 3 reflections on DPC from my time on the Camino:
- Group benefits are valuable. My friend and I went as part of a small tour group, with a guide. For one’s first time on the Camino, I recommend it. The trails are worn from the boots of thousands and well-marked. It would be difficult to get lost. But so many advantages. You arrive at the trail better prepared. Your guide’s initial orientation session answers many questions. Your heavier luggage can be transported ahead of you from village to village, freeing you up to hike with only a light backpack. You generally know where the inclines are, and the downhills. What the weather will do. And where to order the best peppers, and yes, the most trustworthy octopus too.
I met some very interesting individuals in my group. A business entrepreneur, a retired financial planner, two (friendly!) attorneys, a palliative care physician, a teacher, a nurse. Many experiences to share. Much wisdom to impart. We all shared similar goals: finish The trail each day, not get injured, finish at the Cathedral.
True with DPC as well. There is strength in numbers. Facebook groups. Colleagues with expertise and experience in certain areas you can call or email with questions. The DPC Alliance. Of course, the Summit, just held in Minneapolis. Masterminds. Nuts and Bolts. The Hint Summit. Excellent books. Blogs. Many resources, many guides to starting one’s practice, and making it successful.
2. Many routes will get you there. The iconic symbol of the Camino is the clamshell, shown in the photograph above. You see this symbol everywhere on the trail . On directional signage. On shirts and hats. And real ones dangling from backpacks. There are many versions as to how this came to symbolize the Camino. The most popular seems to be that spines or ridges of the shell represent the many different trails of the Camino, each one converging at a common point, the Cathedral in Santiago.
When I began to plan my DPC practice in 2014, and opened in early 2015, it seemed that the DPC practices I became familiar with were all rather similar. Prices. Staffing. Strategy. Even EHRs, with only a couple out there suitable for DPC. Websites even looked and read alike. Only a few “ways” it seemed to reach the nirvana of independent, personalized, membership-based practice.
Fast forward, and I see DPC today as a very diverse and changing model, with a variety of different paths. Many have adhered to the lower monthly price point, while others have upped their charges or opened with pricing which looks “concierge-like.” Contracting with employers has become popular, and there are now (thankfully) a number of user-friendly EHRs to choose from, including ones actually designed by real doctors. Side gigs, like addiction medicine, aesthetics, or weight management are not uncommon.
There is, and will continue to be, criticism and concern as “DPC-like” practices emerge. Personally, I am not simply OK with the diversity I see, I applaud it. I think more physicians will choose a pilgrimage to DPC if they can find a path that best fits their style, values, and location. For me, DPC is not about meeting a definition or fitting in a box. It is a means to an end: a happier physician and a better served patient.
On the other hand, there is valid reason for concern. Not all paths are guaranteed to end up in Santiago, much less at a cathedral. Some DPC practices struggle. Some fail. Certain DPC pioneers have issued warnings, such as the dangers of setting fees too low, or too high. We very much need to know which trails are most dependable, which can provide the income and lifestyle we desire, and which ones are more likely to simply lead to an empty barn in the country. Dr Doug Farrago has recently begun to seek more data and details on those DPC practices which have not thrived. I encourage you to assist him if you have stories and insights.
Again, the power of the group, and the value of experience!
3. Plan well, and expect surprises. Thanks to our guide, we generally had a good idea of where we were going on the Camino. But if you have never been on the trail yourself, you really cannot be totally sure of what exactly lies around the next curve, what the view will be when you crest that next hill.
During my time on the Camino, I had many miles to myself, lots of time to think. If you know me, you know I am a planner, maybe an over planner. For the past few years I have devoted much time and effort, not to mention investment of money, to prepare for my winding down and eventual retirement. I suspect most DPC physicians, being much younger than me, have not spent as much time thinking about that. They are more likely in their thirties, forties, or fifties, and working hard to build their practice, pay off loans, make ends meet. You know, the churn, the hustle. (By the way, I do think we need some sessions devoted to planning at future DPC meetings. I do not mean creating a business plan; I am referring to succession and retirement planning.)
In my case, this trip to Spain was a milestone of sorts. I knew what I was coming back to, a new phase of life. I had 2 young excellent partners. I could see the future I had worked for. More time managing the business. More time to possibly expand to other locations. Less (or no) time doing the day-to-day primary care work. More time to write, to podcast, to fish, to travel, to spend time with family, enjoy the grandchildren. I had it all planned out. I knew every curve, every hill ahead of me.
Little did I know what awaited me when I returned home. Unexpectedly, I am back practicing full-time. The details of what all happened are not as important as perhaps the lessons I have learned. That even the best made plans can go awry. And, as much as I thought I was ready to step away from practice, I have learned that I, my staff, and my patients were maybe not so ready. I am enjoying myself again. I am revising my time tables and my plans. And doing my best to appreciate the privilege every time I step foot in the exam room.
My conclusions: If you are considering hiking the Camino, do it. You will not be disappointed. If you are contemplating DPC, do that as well. And if you are already in a DPC practice, great! Keep going.
As you proceed on your DPC Trail, take advantage of the group benefits. Listen to your guides. But also to your inner voice. You know where you want to go and what you want to be. Explore the many options and examples, but be sure to follow a safe and reliable trail, one which maximizes your chance of success, however you define it. Plan well. Embrace the surprises. Enjoy the ride.
Hopefully, we all get to our own version of the Cathedral one day. Weary legs and all!
So, “Buen Camino” fellow pilgrims! And “Buen DPC” my colleagues!