Healthcare Without Permission: How Direct Primary Care Puts Patients First

Dan (00:06)

Welcome to another episode of Uninsured by Choice, the podcast where we help you navigate the healthcare system without insurance. I’m your host, Dan, and as always, we are brought to you by our sponsor, Zion HealthShare, a nonprofit health sharing community. Today we are joined by Dr. Marielle Conception, who is a board certified family medicine physician practicing in Arnold, California, where she runs Big Trees MD, a direct primary care clinic. After years in corporate insurance-driven medicine, she discovered DPC and never looked back. She’s the host of the award-winning My DPC Story Podcast, founder of the DPC director directory, and creator of the DPC Toolkit, a digital magazine for the DPC community. She’s one of the most recognized connectors and advocates in the DPC movement. So, Marielle, welcome to the show.

Maryal Concepcion, MD (00:52)

Thank you so much, Dan, for having me. This is an honor.

Dan (00:55)

Absolutely. No, honor’s all ours. I’d love for you to just take a few minutes to kind of give everyone your your background, all the many things you’re involved in, you know, in that whole DPC ecosystem so people can get a little introduction to all the stuff that you’ve got going on.

Maryal Concepcion, MD (01:12)

Yeah, absolutely. So I, like you mentioned, was in corporate about a month shy of six years. And those of you who have not heard the the nidus of my story, husband and I were 28 weeks pregnant with our second child when our employer that we would either need to sign the contract that had ridiculous terms to it. And if we didn’t sign it, we would be fired basically in 30 days. And so having gone through so much training to be a rural family physician, my husband and I remain the only full scope primary care physicians in the entire county that run an independent practice, not in the emergency room. It was quite shocking be on the side of things where the corporation was showing its colors as as to they don’t actually care about quality of the physicians serving this community. Always been an advocate for things I believe in and stand for, but this pushed me into advocating and standing for the protection of the physician patient relationship.

Dan (02:13)

Yeah, that’s great. And and that’s kind of what got you into the D P C movement that’s still I’d say fairly new, but it’s it’s gaining more mainstream is is probably safe to say. But a lot a large part of that is driven by your podcast, my D P C So why don’t you give us a little background on when did that start in this journey of yours into D P C.

Maryal Concepcion, MD (02:32)

Yeah, I actually started the right after the traumatic experience of being told I was going to be fired and being worried that I was gonna lose, you know, access to a place to deliver my baby safely, access to my OB, all of those things that you you can only get with insurance and especially with insurance through your employer. So I started the podcast because for me, what I needed to do. To focus and move forward was to hear who had done it before going out on your own was actually in 2021. And so the podcast really started as a journey in being able to fill my righteous rage time with something that was actually something that helped me heal. And it continues to help me heal to this day. And I’m extremely honored to be able to highlight the and the presence and the individuals who are my colleagues opening direct primary care practices all over the nation and who are serving their communities in rural settings and urban meant so much to me that my advocacy has resulted in so many people being able to hear fears that they have themselves as physicians. Hear about patients that, you know, they’re afraid that they couldn’t take care of if they left the insurance people are able to listen to an episode of my DPC story, whether they’re a patient or a physician, and they’re able to say, Hey, you know what? Is actually something I could do in my community. I could see happening in my community, I could see transitioning I could see my patients joining me in.

Dan (04:05)

It’s a great podcast in case anyone has not is unaware, go look up my DPC story, speaking to those audiences that are that are doctors and patients, I think you hit on two things that that are really at the core of what we do on our one, view insurance as a necessary evil, and two insurance or or healthcare is only accessible via some sort of employer DPC really strikes at at both of those misconceptions, I guess you’d say, because neither of them is true, but they are largely believed, maybe the doctors who are maybe in this ill informed state right now of, I need to be insurance, I need to accept insurance, I do everything through D PC might sound foreign, scary, not sure if I can do this. What would you say to those people? Or what do you what are you saying to those people? Cause you run into them all the time.

Maryal Concepcion, MD (04:51)

It is true. And sadly, a conversation that I’ve been having more recently this year compared to prior years is since the quote unquote one big beautiful bill we’ve had a lot of physicians who have lost their insurance because they’ve been let go from their jobs a colleague of ours in California worked for Planned Parenthood and money was no longer available. And so she to open DPC for I think it was 1,300 patients within three months. have who are now not having the option to think I do DPC? Could I know, health coverage for myself? They’re just being told you’re being let go and you have to figure it out like everybody else who is in that boat or you know in a similar feeling boat. So what I would say is that there are those physicians who, like my my husband was another physician. He got let go from his physician because locally the corporation went to a non-physician model. So the corporation denied access to our community to see a physician who’s actually trained in full scope medicine it’s not cheaper. Even in our own home, we’ve had to pivot. And that’s where I I can really empathize with these doctors, no matter how they’re coming to the table to learn how can I get health care, not how can I get health insurance. There’s a lot of education that needs to happen whether or not we are under an employer’s an insurance plan we’ve bought on the marketplace, or if we’re for what state or area of the country are you living in? Is there a mandate on having health insurance? Is there not? What’s the minimally acceptable type of insurance that you are there catastrophic plans? If you have an employer less than 50 employees, what are your options? So I think there’s a lot of education that needs to happen overall, especially the from the physician side of things, because so many patients, our colleagues, who are coming to us and asking, like, what are my options? So I think that being educated in general is a very common thing that I will root my conversations in these days with with my colleagues, especially. Like what what are you doing if a patient comes to you with this? What are you doing for your own health insurance? Those are two common questions that I’m asking people a it comes to the patient side of things, I would say have a lot of people who are scrambling because health insurance costs so much more than it used to. And in most of the country where health insurance is not required, are really getting quickly educated how can I access health care through. A direct primary care health shares like Zion Health Share, you have an option for catastrophic coverage. You have an option for help if you’re in a catastrophic situation, I should say, that’s not only locked into the the big corporate insurance models. The education of what is healthcare is happening globally, whether you’re talking to patients or physicians. But I think how people are coming to the table to get educated is just, it’s devastating right now, but it’s also on a positive spin, it needs to happen sooner than later because our healthcare system under the insurance-driven is continuing to tank whether we like it or not.

Dan (08:03)

Was talking to someone the other day who it shouldn’t be called health care, it should be called profit care, because it seems to be that powers that be who oversee this big health care industry are not really concerned about caring for health, but caring for the bottom line. And so many decisions driven by And not necessarily you know, when you’re a small business owner, there’s there’s certain money considerations. If you are not making money, you might just have to close your business. And if you’re choosing between staying open and the the math, the economics are what they are. You might not be able to stay a lot of these decisions we see being made at hospitals and clinics and with physicians and and different things is not, boy, we have to do this or we can’t continue to operate. It’s, we’re doing fine, but we could do more money, we could make more if we do this way. And they’re benefits, they’re cutting access just for the sake of making a little more. Not to stay open, but to just make that little more, take care of those shareholders. And that’s where I think people are really this almost revolution against traditional options is that, hey, I love DPC because it’s helping me back against the the, like you said, the big I envision that like Monopoly Man with the the big top hat monocle or something like that. These these big big wigs that are that are controlling it. You don’t have to be subject to that. You talk about options. I think the first step is people understanding are options before we even look at what they are. You have to understand you do have options. And so DPC is is a really good one. What what else would you say? And you mentioned Zion Health Share, obviously the sponsor of the show as well. Health sharing memberships are a great way. Any other feedback or advice you might give to someone navigating this healthcare world without insurance?

Maryal Concepcion, MD (09:40)

As a preventative focused family physician what are your medical needs now and what are your medical needs going to be in the future? Clearly nobody can look at a crystal ball and tell exactly what they’re gonna you’re having prediabetes, if you had hypertension when you were pregnant, if you have a family where everybody has breast cancer, you know, there there’s certain things that to me, I would look into, if something were to happen where I would need access to care, what are the things that happen in a person’s health the most common things are the commons, the common things that happen in our household in the past two weeks, like empatygo and hand foot mouth disease, colds and coughs and irritable diarrhea, those types of things, most of us are going to go through at some But if you have a primary care doctor who you can access who actually knows you, and it’s literally you talking to your primary care doctor, if you are a member of a clinic like mine and my husband’s, where there’s not 2,000 people, 4,000 people where you’re trying to fight for the limited number of spots available in a year to see your primary care physician or non-physician provider. I think about if if you talk about rolling the dice and you think about how many times am I gonna unquote sick a year I have to see a doctor I need help for, that I shouldn’t go on to Dr. Google and how many times do I go to the emergency room? And if you think about it like you’re already with a diagnosis of hypertension and your medication is $30 a month for your insured plan, then all of a sudden you lose that, how do you your medication? How much does it cost wholesale? There’s things like good RX. There’s things like talking to your DPC doctor to much is this and so I think that when it comes to looking into the future, most commonly with my patients who are about to transition to Medicare and they’re like, Do I choose Medicare, Medicare Advantage? And I’m like, how many minutes do you have to talk about this? Because they’re so focused on. I need to have insurance. I need to have coverage. And it’s like you need to have healthcare access and you need to have someone who you can access when you need them. To me, those are much more important than I need health insurance you can find options that are going to give you a higher deductible for catastrophic nothing would happen. But if you did end up in a car accident or needing a surgery or having an emergency C those types of things. I think really help put an objective lens on the fear of what do I do if I’ve gotten fired? What do I do if I’ve lost my health insurance? So I to me what is helpful to look people, estimating what’s going to happen to them in the future. You are in a state where insurance is not required, like California, where you get a is a position that a lot of people found themselves in. And so I would say even just asking friends and neighbors like, what are you doing for healthcare, especially those friends and neighbors who are self employed or who recently got let go from their employed positions.

Dan (12:40)

It’s interesting when you say not just having access to care, but access when you need I remember when our oldest, she’s thirteen now, but she was maybe seven. Seemed like in the springtime she’d have typical allergies. And I’m a I’m a big green thumb guy, like to work around the yard and plant stuff and all I thought, boy, if I just knew what’s kind of triggering these allergies for her every spring, I w I could maybe rip that out of the yard or or do something to try to we looked it up and there were, and where I live, it’s about 200,000 people in the there were two required referrals. So now we had to go see a doctor first just to get referred to them within that network in were three and four months out we’re gonna miss the whole allergy season before we even get in And so, yeah, there’s care. It exists. It’s sort of accessible, but it’s not there when you need And that’s why I think so many people just go to urgent care or emergency room for things that aren’t that urgent or real I just need something that’s why DPC, I think, is such a really exciting option out there, is that. So many things that people think are urgent or emergencies really And you can you you you just feel like you need to know something now because you don’t want to go on like said vomiting, diarrhea, something like that. You want you wanna get an answer. I get that. And having access to someone who knows you and you know them is such an empowering thing because these DPC practices often only are limited to what, several hundred at a time, is my

Maryal Concepcion, MD (14:05)

It’s fair to say in a full panel, a doctor who’s working eight to five in a DPC practice, you know, 600 to 800 patients is is a typical number that we will see. I do think the number of patients is definitely more in the hundreds range than the thousands. The reason I say that is because you have people who when they become an entrepreneur in DPC, they also find, just like myself, that like clinical medicine is great, but there’s also all of these other things that I never got to in the insurance-driven world that I have time to do now. And so you have people who are working for nonprofits for foster children who have grown out of foster care, homes and and resp and care slash responsibility, whatever that you also have people who are I have a cooking show now. Like, I so you doctors who are human beings. And I think that with transition to owning your own practice, what comes with it is reclaiming autonomy of your own way of doing medicine. And the way of doing medicine is not limited to the time that you are face to face with a patient. The way of doing medicine is the way that you need to be. The physician in the room, and that includes taking care of yourself.

Dan (15:16)

What’s a day looking like for a for someone who’s practicing D PC or for a a patient who’s who’s walking in, you know, to to join a DPC? What does that just kind of look like on a on a routine sort of basis?

Maryal Concepcion, MD (15:28)

So we have a really unique arrangement here in Calaveras County where Big Trees MD is. So for the regular patient who is like, Hey, I’m interested in membership, they’ll call our clinic. My husband, whose practice is open right now, will do a meet and greet with them. And then they’ll still usually not really understand what DPC is, and then they sign up and then they’re my gosh, my doctor just talked to me for an hour and a half on the and now we have another visit next week to do my physical and personal. And like, what is And so it’s really different when you’re looking at DPC versus when you cross over as a patient and become a DPC patient, really understand value of access to a physician who actually knows you when you need them. Four-year-old who fell on the fireplace needed stitches in their chin. You have, you know, the people who are 45 minutes away from the emergency room and they’re am I having an acute heart attack issue or not? And helping them figure out, you can we do to triage and to help diagnose if you need to go to the emergency room or one of the things I’m very proud of is that. We have partnered with our public health department. So we basically have a grant funding the services for uninsured patients in Calaveras County. So for example, if you’re a person who’s moving into the county and you haven’t yet established your insurance, you haven’t yet completed your application for different state-run programs that take time to join, unless you’re under emergency medical in the state. And there’s gaps of care. And so for our county, what we are super proud to be a part of is that the patients who are be able to contact the county. And then the county basically we work together to get that patient seen. Their access to care has not been high quality in a lot of the patients’ lives who’ve who we take who we’ve taken care of already. And so it’s been so empowering to say, like, hey, I’m Dr. C, how can I help you today? And I speak the exact same to the patients who are members of my practice. This was a way that our clinic could quickly get into without having to go down the nonprofit rabbit hole spend the time to do that, we could quickly get into the care access points for people of this community who needed it and who were uninsured. And so I I just love that however people are finding us, they find the same doctors and they find the same level of care.

Dan (17:58)

That’s really cool. I didn’t know that about the about the clinic. I think what that speaks to is the broader implication of when you are a doctor with your own clinic and your own practice, you now have the independence and the freedom to pursue something like a joint partnership with your county’s Department of Health. Justin Forrest in Arkansas. He’s a D that we talked to that is a volunteer at at the local airport. And he, you know, kind of negotiates contracts to get other, you know, airport, smaller, smaller flights to And I thought, boy, if you were in in your run-of-the-mill medicine practice, you wouldn’t have the freedom or the time to pursue those kinds of things. So, like you said, doctors are humans. They want to be able to live their lives and practice in a way that’s fulfilling to them. And so would you say that DPC is probably a pretty effective route for being able to do that?

Maryal Concepcion, MD (18:47)

Would definitely say so, but also we see that in the physicians who are coming into their medical careers, the younger physicians in training, in residency. They’ve seen so much of the last 10 years of medicine, whether that be through their own lens as a or their family members’ lenses as patients or hearing stories from attendings that they’ve been working with. So many younger physicians are choosing this model earlier. We see people choosing this model while they’re in pre-med, while they’re in medical school. And then you see people who are licensed in residency choosing to do this model while in Again, it’s just been such an honor to highlight multiple people, even on my podcast, who have opened while in And so I think that, it’s such a gift, I think, to the future of primary care to be able to stand for this model earlier on in your career before you caught up in the care is just for referring. Like you don’t actually do anything in primary care. That really, that really is such a travesty that a lot of people believe that a primary care doctor is the place you go to to get your referral, just as you did for the allergist. It’s no, we can actually do medicine because actually are real

Dan (20:04)

That’s so cool. So what do you think about this new DSC, direct specialty that’s starting to gain steam? I’ve come across a place in Oklahoma, Colorado. Even just going to my allergist example. If you are an allergist, could you just go direct the direct care route? Is this is this kind of a a a path that’s open to just about anybody?

Maryal Concepcion, MD (20:27)

Arguably I would say yes, because you have people who are doing direct care who are surgical specialists, you have people who are quaternary specialists that Mayo and Cleveland send their people to who are doing literally cash payments for their so what I will say is that direct primary care, even though it is a legal term, I think about it for the specialists as a business model. If you are not taking insurance and you’re literally working for your patients, whatever you’re calling yourself, you know, direct primary care is definitely something to consider if you’re doing already. Especially for people in psychiatry, that’s a very common one where insurance is always the friendliest when it comes to covering mental I will say though that there is a difference between direct primary care and concierge medicine. Where concierge medicine is usually for higher income earners. Know, in California, you could get a concierge doctor for 40K a year. And also you’re still billing the person’s and the patient’s insurance. And so direct primary care is breaking free from that insurance model completely. And the typical cost per member per month for primary care is $75 to $100 per member per And with the changes in HR1. Are higher allowances than that average. So it’s something that a lot of people in the DPC community are educating themselves on. And I definitely would say it’s important for specialists to understand, however, the HR1 focus was on primary care options and not on specialty care. So there’s in California, there’s cardiologists, rheumatologists, gastroenterologists, psychiatrists, allergists, sleep medicine physicians. There’s so many specialists who are saying. This is way more peaceful of a way of practicing medicine. And I can actually earn more by seeing fewer patients if I do this model and I still am able to give people access. And so you have that same infectious when you become an entrepreneur, what can’t you do, spirit, to that that’s going to direct specialty care doctors as well as direct primary care physicians.

Dan (22:36)

That’s great. Yeah. It’s great to hear that there’s more people headed in that direction, regardless of what they want to call it. Eliminating that that middleman of insurance really is a powerful way to do that. I recall I was at the D P C summit last year in New Orleans and I would say half the people we talked to were either in residency or had just gotten started s were getting their feet wet in in the industry and thinking, I don’t know if I like this so much. I’m I’m kind of exp experimenting with this or or seeing if I can do that. There are a lot of people that are certainly looking into that. The DPC summits probably a a good resource to go check out. Obviously your podcast are there other resources you’d recommend to people who are kind of on the fence, maybe looking at, hey, maybe how do I break from this insurance and and try a different route?

Maryal Concepcion, MD (23:18)

Yeah, definitely. So I will say that in the in the world of my DPC story, we also have multiple events coming up this year. What we found was that it’s really in the savannah where you get water like once a season and then it goes away. Like that’s the feeling of DPC Summit, and then everybody parts ways and you’re like, there’s something missing here. So we were very very much focused on how do we keep connecting people between these, you know, larger events. And so what I will say there is also what we’re finding is state state specific DPCs are coming together to make their own like you know DPC organization or DPC collab CaliDPC.com is where a bunch of California are putting their information so that it’s a place where, you know, if somebody’s asking what is DPC from a policy perspective or a patient perspective, there’s one unified place that we’ve created for people to go to to educate themselves about DPC and connect with people in the state of California. You have people doing this in North Carolina, in even cities like Houston or Austin. So there’s definitely ways that if you are interested in DPC as a patient or as a person looking to this model, I definitely would say that absolutely places like the Summit are great places to go to. But even if you, you know, Google direct primary care or DPC and you know, your zip code, there’s ways to find people even just from cold searches on the then what I would say also is don’t discount the the healthcare experiences of your friends and neighbors. It’s so crazy that in a world of of marketing everywhere, way that DPC practices grow is by word of I think that that is such a powerful testament to what people want on the physician side of things and the patient side of things. And so you have people who they’ll come to this practice and they’ll be like, yeah. I didn’t even know that you existed, but like somebody was telling me that you, you know, did this bandage change at their house. And I was like, how did you get that? And they’re like, you could sign up to be a member too. So don’t discount asking your friends and neighbors about how are they accessing health and definitely if you are DPC practice or drug specialty care practice, make sure that you’re connecting with other DPCs in your area or drug specialty cares, because then more people will know about you.

Dan (25:49)

Way I found health sharing was from a neighbor. When my marketplace plan was twenty one hundred dollars a month premium, told me it was gonna go up to thirty five hundred the next year. I said, I okay, can’t do that. I was talking to a neighbor about it. They said they were with one of the Christian ministries and said and suggested I look into that and I started looking and found Zion Health Share, which I’ve been able to join and and and loved it and don’t discount it. Just t just talk to people. I know it’s it sounds old fashioned, you know, with this screen first digital world that we’re all living in now and trying to navigate, is you can still go outside and and just talk to someone and ask them what they’re doing and how they’re doing it. And I think that’s how these kind of movements really do grow and and catch on and hit that critical mass where they become the mainstream. You know, right now it’s this offshoot, this this fringe alternative thing that people a lot of people see it as, but it’s rapidly starting to move towards mainstream and I think it would be awesome if if that’s where we get to. We’re members of a D P C here in where we live and there’s I three or four in this little area that we’re at. So there’s more D P C doctors than there are allergists. That’s just great. So if someone wants to connect with you, reach out to you in s in some way, what is the best way since you have so many, avenues out there in this media ecosystem of the DPC world, what’s the best way for someone to get in touch with you?

Maryal Concepcion, MD (27:08)

I definitely would say that my dpcstory.com is the easiest place to get started. There’s education, there’s free tools, there’s your first 90-day checklist for patients. There’s lots and lots of stories that are being shared by physicians who could potentially be in your neck of the woods. And so if you’re listening to how physicians are really approaching healthcare, to me, it also helps break down medical trauma for patients in terms of like they’re actually hearing the doctors themselves what experiences they’ve gone to that led them to opening a practice and working directly for patients. So I think that whether you’re a patient or a physician, going to mydpcstory.com is a great place to get started. But I definitely am biased in that.

Dan (27:48)

No, that’s great. So if anyone wants to connect, go to my DPC story dot com. Thank you, Marielle, for being on the show today. It was great to have you. Sure if you’re looking to subscribe, we’re on Spotify, Apple, all the major platforms. Come give us a listen and we’ll see you next time.

Maryal Concepcion, MD (28:03)

Thank you for having me.