DPC Alliance blog 

Hi! My name is Erin Lassey, I’m the Business Manager at Holton Direct Care in Holton, KS. I also happen to be the wife of the current DPCA President, Vance Lassey.  As I was watching Vance go through his manic daily routine the other day at our clinic, I remarked that I wondered if the DPC community knew what all went on behind the scenes for him, Tiffany Leonard, and the other members of the board of the DPCA. He said “I don’t know...” while making the “thinking emoji face,” and next thing I knew I was being asked to write a blog post!  (Maybe I should keep my big mouth shut!)

As most of you are aware, all of the DPCA board members are busy with their own thriving DPC practices. Squeezed between patient encounters, projects and meetings for the Alliance and DPC movement in-general are taking place every day. I think it’s amazing how DPC is flexible enough to allow them to serve their fellow doctors and the DPC movement while continuing to take excellent care of their patients - not to mention “doing life”. I’m humbled by how selfless DPC docs are, the risks you take, and the Thank you all for doing all you do to serve your patients!

Over the last couple years I’ve seen the long hours and thankless work of the planning committee for the DPC Summit. This year Jeff Davenport is leading the team and is on track to build a more successful event than ever. Jeff’s committee (which consists of numerous volunteers and board members) will have put in an hour to an hour and a half every week for 6 months plus additional work outside the meetings to plan out the event. (Easily over 300 physician hours volunteered–bill that out at locums rates and you’ve got well over $60K donated just to the DPC Summit!)

Giving interviews, writing editorials, speaking at conferences, residencies, and med schools and other means of reaching out to groups around the country (and even other countries!) to spread awareness and understanding about DPC is constant. Not even 20 minutes ago, Vance and Tiffany got off a Zoom call with 5 people representing 4 different organizations who all have a common interest of getting DPC education into medical school curricula, in front of med student interest groups, and into residency programs.

Important for the future of the movement, the DPCA has positioned itself as a DPC authority. The result is that the Alliance’s leadership has become a sought after listening ear for the vetting/testing of ideas. DPC-adjacent entrepreneurs reach out all the time with a myriad of requests. I like to call these the “big idea people.” (Vance calls most of them “middlemen,” which he says is “a longer-than-average-4-letter-word.”) You rebel physicians have built a fantastic idealism-powered locomotive. I would expect no end to the companies and startups who want to latch on to it for a free ride. It’s difficult to estimate the time Vance spends on this kind of communication each week, but it’s enough to be a part-time job, mostly spent urging such entities to keep DPC authentic. There are many flavors to the “big ideas,” but most often their plans devolve into a desire to use employer groups to massively scale up DPC (overnight) using an independent-practice nurse practitioner and PA workforce. DPC doesn’t work when a non-physician workforce practices narrow-spectrum care that fails to reduce referrals and eliminate claims.

Vance puts in SO many hours representing authentic DPC and keeping patients first. He listens to these parties day in and day out, open-mindedly considering what’s good and what’s bad for the movement. I agree that losing sight of foundational ideals and forcing non-organic growth could be detrimental to DPC’s good reputation–one that you’ve all worked so hard to build. 

And when his term expires in December, I want him back. ;-)

Erin Lassey

It’s a Saturday afternoon, and I’m sitting in the cafeteria of a tiny 2A High School in Oskaloosa, Kansas. This cafeteria can’t seat more than 40 students, and that would be packed. I am at my daughter’s volleyball tournament, waiting for the next game, and figured I’d use this exceedingly rare free time to sit down and write my long-overdue first blog post as the newly-elected DPCA president.

The setting is appropriate: As I sit here in this 18 x 40 foot cafeteria just outside the gym of this small rural school, I am currently on-duty. Caring, in one way or another, for over 1,400 patients in my small-corner of the rural Kansas countryside, and representing hundreds of doctors (and growing!) from coast-to-coast who have freed themselves from the tyranny of the unholy American medical system that would dare treat patients and physicians not as human beings to be served, but as commodities to be bought, sold, and traded in an endless pursuit of money from equally greedy third parties. But like them, I am no longer one of those commodities. I will not subserviently bow to the ever-changing will of such parasites. Apart from my patients, I have no boss. I’m getting enough sleep (usually). Like I’m doing today, I get to watch (even coach!) my kids’ ball games, help with homework and a dozen other things I could never do when working day and night inside the system. I love my job, I treasure my extended family of rebel DPC docs coast to coast, and I have a smile on my face.

It’s a bit cliché, but I suppose my “first presidential blog post” should feature my vision for DPC and my vision for the DPCA. But that’s easy, because I am walking a trail that was blazed by pioneers with tremendous work ethic, determination, vision, and sheer force of will. They didn’t just blaze the trail, they practically paved it.

Ryan Neuhofel, DO is the "George Washington" of the DPCA. Without his tireless work in the first 2 years of the DPCA, none of this would be here. I was on the board from day 1 and I’m here to testify to his tireless efforts. Julie Gunther, MD took the helm 2 years ago and was handed the keys right as COVID arrived, and she had the horrible job of figuring out how in the world we could continue to meet and help in-system docs who were drowning, but without DPC conferences at which to do so.

Story after story will attest to the value of DPC conferences. Formerly suffering doctors who felt trapped in very dark places would attend a conference where they saw a light and an extended helping hand. The DPCA wants to be that light-bearing hand, but without conferences, how could we help these docs?

Dr. Gunther came up with the answer and developed the concept, curriculum, and complicated organizational logistics of pulling off numerous DPCA Mastermind Weekends, every one of them a huge success. Her mastermind conference legacy will continue, and plans are looking great for many Mastermind weekends this year, under the excellent organization and leadership of Drs. Kissi Blackwell and Clodagh Ryan.

Numerous other DPC Physician-entrepreneurs helped Ryan and Julie pave this road, I couldn’t possibly list them all here, but Drs. Doug Farrago, Jack Forbush, Amy Walsh, Allison Edwards, Tiffany Leonard, Shane Purcell, Kissi Blackwell, and Mike Ciampi, and so many others all have volunteered huge amounts of their valuable time growing the DPCA (and the DPC movement in general!).

This road leads to a bright horizon, so that’s where I’m headed.

If I pick up where my rock star predecessors left off, I'd say that the next step is to more formally embrace young doctors. I have a goal to build a robust Residents and Medical Students (“RaMS”) department within the DPCA, where we can stockpile and make available the tools and resources to help our members assist young idealistic aspiring primary care physicians to find their way into DPC. We need to be in med schools frequently.

DPC physicians wear a smile that communicates ownership of something rare in medicine: HOPE. The students yearn to know where we get our hope. The development of the RaMS department is already underway under the leadership of Drs.Kenneth Qiu and Jeff Davenport.

I’m happy to report that one of my other goals has already been met, and that is for the DPCA to assume responsibility for organizing the faculty and content for the country’s premier DPC conference, the DPC Summit.

The DPCA has partnered with the AAFP, ACOFP, and FMEC for the last few years in helping plan and pull off the Summit. Because of our membership’s experience and expertise, the DPCA is in a unique position among the co-hosts to singularly focus on building a DPC-relevant agenda that will provide the biggest benefit for the largest number of registrants.

For this year’s summit, not only did the DPCA build the entire agenda with 50 faculty, we also have achieved my secondary summit-related goal, which is adding a third educational track, something for “veteran” DPC docs rather than the “101 and 201” practice-management content that the Summit is known for. So this July, the Summit will feature a full-conference-length 3rd “301” track that is all DPC-relevant CME for established DPC docs who might not necessarily need further practice management education at this point in their DPC practices. The DPC Summit now has content for everybody, those learning, those starting, those who just started, and the veterans.

I am also pleased to announce that after being held virtually in ‘20 and ‘21, the 2022 DPC Summit is planned to be held live, July 15-17, in Kansas City. Of course plans can change, but currently, things are looking good for a fantastic live conference. More exciting details will be available soon, and I am PUMPED! I can hardly wait to see you all there.

Ok, this has been long enough. I’ll call it good. I’m not going to commit to any kind of regular blog posts; we all have work to do, and you probably don’t want to read a bunch of my diatribes any more than I want to write them.

But please be assured that the Board of Directors and I are here building this organization, blessed to have the opportunity to serve you and ultimately, our patients.

Vance Lassey, MD 

Hello wonderful physician colleagues,

I write this two days after my New Year's “hurrah”- the end of more than five years as a founding member, Vice President and President of the Direct Primary Care Alliance.

It has been a privilege.

Dr. Vance Lassey of Holton Direct Care in Holton, Kansas, assumes the President reins for the next two years. I am very excited about where this organization is headed under his strong leadership. In my near-decade of “DPC”, I have encountered few people more passionate or dedicated to authentic physician autonomy and direct primary care. Dr. Lassey’s leadership is complemented by the pragmatism and diplomacy of Mr. Joe Grundy, our Executive Director, the compassion and vision of DPCA Vice President, Dr. Kissi Blackwell, Treasurer Dr. Amy Walsh’s fastidiousness and focus, Dr. Jack Forbush’s (“Special Ops”) technical expertise and willingness to do difficult things and the incredible get-er-done and problem solving ability of newly-nominated Secretary Dr. Tiffany Leonard. In short, this is a stellar group of stubborn, capable, driven physicians. They are going to do (and have already done) many great things.

I believe I became a leader in the Alliance and within the DPC movement, in general, because I demonstrated that a vision for physician independence and for authentic practice can not only be articulated but can be achieved. I have done this personally and have encouraged and mentored others on their own journey. Many of you have, in turn, paid-it-forward and mentored others. We are each paving the way for a brighter future for primary care and medicine, in general.

Dr. Lassey and Joe and I had a thoughtful final conversation on December 30th, my last weekly call as DPC President. We lamented an angry online post written by a home health nurse who asked, ‘what is the point of primary care anymore?’ (not her exact words, but this was her point). She hears, over and over again from the patients that she sees, that primary care physicians are not willing to see their own patients, that they couldn’t get in, that their doctor wasn’t available, that the next visit was too far out to meet the patient’s immediate need and on and on. (Particularly PCPs who won't see sick patients with covid symptoms.) If you have attempted to coordinate any of your own healthcare or that for a family member, I suspect you, too, understand very well how massive the barriers to care have become. Because of these barriers in insurance-based primary care, patients go to an urgent care, or the ER, or a franchise quick-care in a pharmacy or on a street corner and get their care from one of our colleagues or a nurse or someone entirely untrained within traditional healthcare. I have said this before and will say it again: traditional medicine has the *most* to offer patients. But we do it in the worst service-model possible. As such, patients- the consumers of healthcare- really don’t want or can’t access what we have to offer. The pandemic has shone a bright light on this dysfunction. Cohesive systems, under duress, shine. Incohesive systems, under duress, crumble. I believe it is generous of me to say our healthcare system is crumbling. Better would be to call our system exactly what it is: is a steaming pile of poo. We all keep stepping in it and tracking it throughout our daily lives.

Here’s my challenge to the nurse who lamented that primary care physicians stink, too. It’s a challenge to our employed colleagues, nurses, patients, family and the general public. You can hate the player. Physicians are the place where fingers point- from all directions. Administrators say do more, code more, see more, be more compassionate, more available, answer more messages and make sure it’s all done on time and copiously documented in under 48 hours. Patients say: do more, be more available, code/type less, look at me, be available for me, answer my questions (again and again) and do all of this for me while accepting payment from a third party, on time and in a way that is transparent and within my budget. Third parties, aka insurance companies, say, “tell us that again”, do more paperwork, answer another question, submit another form, make sure this is evidence based, talk to our nurses first and on and on. The fingers all blame the player.

But the problem, in healthcare, really isn’t the player. It’s the game.

And it is the game that is broken. Irrevocably.

Direct primary care changes the game. Today, more than ever, we need as many physician-players on the DPC field as we can possibly recruit. And if not DPC, then independent healthcare. Healthcare that answers directly to the patient. Walking away from the game as it is played is the *only* way to shift healthcare back towards serving patients when and how they need served. Not in three months, not after three urgent care visits and not behind layers of scheduling templates, rotating receptionists and off-site triage. Patient care fundamentally requires caring for patients. And patients, as people, simply aren’t ‘template-able’.

Changing the game changes the player. DPC restores the autonomy and integrity of healthcare delivery. DPC has helped me, personally, to reclaim the joy and restoration of the work of being a physician. Sometimes the job itself still stinks. It’s still hard. People can be difficult. And society really isn’t sure what it thinks of physicians anymore. But there is joy in this work. There is value in this work. It requires pausing, reducing, simplifying and being the one who is most available to do the work. I could not do that on the employed-physician playing field. And I really don’t think anyone can, for long.

Direct primary care is about autonomy. It’s about physicians working for themselves and their patients. It’s about being available when a crisis hits, when questions arise, when visits are needed. It's about being able to combine science, training and creative thinking to solve problems, not answer to algorithms. Being available to help people who I know, who have shared their healthcare story with me is enjoyable. Doing my doctor work for the patients I serve feels good. *That’s* what I signed up for.

In eight years with my own DPC I have found that people don’t need all the things RIGHT NOW. They just need to know that their doctor, their medical team, is in their corner and reasonably available when they need them. In primary care, anything that is truly “right now” is an emergency. (And that is what the ER is for, right?). But the rest? That’s what we do as family physicians and internists. DPC docs are here. You can take care of yourself and take care of your patients. There is not a fixed amount of joy or time or happiness such that if a patient’s needs are met a physician’s needs are not. DPC allows for a physician to create a balance for themselves. To say, “I am going to care for you in this way, on these terms, and I am going to solve problems for you and for me.” And there is so much integrity, and sustainability, in that.

So, to my colleagues: I will defend the soul of our profession to my last breath. Being a doctor means something. Being a doctor means something to our families, our communities, our patients and, most of all, it should mean something to OURSELVES. To the person who put in the time. Made the sacrifices. Gave up relationships and visions of other things. We have chosen to give of ourselves to this profession. We have chosen to be the players in this game of healthcare. And you can wake up in this new year, look yourself in the mirror, remember why you set out on this journey in the first place and reclaim your place at the forefront of the healthcare team. On a field of your own choosing and your own creation.

And for the nurse frustrated that primary care physicians don’t even see their own patients: I have a challenge. Perhaps that doctor wasn’t on the golf course drinking a martini. Perhaps she was lying on the floor with her feet up on her desk sobbing because she just can’t do it anymore. Perhaps she was three hours behind and texting her husband, again, to apologize that she wasn’t going to be home for dinner. Perhaps she was forgetting to pick up her kids because she was double booked even though she put a block-hold on her schedule. All of these “perhapses” and more are real experiences from my employed life where I had NO control over my schedule, my time, my life. Perhaps your healthcare colleague was doing her very best and it still stunk.

And to that nurse: the next time someone comes in with something you think their PCP should have handled, give them this email: hello@dpcalliance.org. Even better, tell your patient’s that they have a choice. They can put their feet, their money, their heart and their time where their complaints are. They can move their primary care needs from the ‘3rd-party-insurance-payor-field’ and walk right into the office of an independent, local small-business owned by a hometown doctor. Send every. Single. One. of those urgent care patients to a DPC physician in your region. You won’t see them in your urgent care again. You can find one of over 1500 clinics here: www.dpcfrontier.com/mapper.

If you want the game to change, stop playing it the same way.

Healthcare has a soul. And we are on the front lines of all it can do. This work can be joyful. It can be restorative. It is, perhaps, the most authentic work a person can do. So make it real. Make it yours.

Julie K Gunther, MD, FAAFP
sparkMD (a DPC clinic), Boise, Idaho
Founding Member, DPC Alliance
Vice President, DPC Alliance 2018-2019
President, DPC Alliance, 2020-2021