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What do you do when pregnant patients need care they can't afford? For Dr. Esther Katibi, the answer was to build a way to help them.
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Welcome to Physicians Taking Back Medicine. I'm Dr. Rebecca Bernard, and today I'm speaking with Dr. Esther Katibi, a family physician in Corpus Christi, Texas, who practices obstetrics and founded New Life Direct Primary Care. When she saw women falling through the gaps in maternity care, she created My Doc, My Direct Obstetrics Care, a nonprofit offering free obstetric delivery and postpartum care,
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but turning that mission into a sustainable organization has meant navigating hospital politics, securing physician backup, raising money, and learning just how difficult starting a nonprofit can be.
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Now she wants to make that path easier for other physicians, including family doctors who want to combine DPC with delivering babies, we'll talk about putting patients first, pushing through resistance, and why taking back medicine sometimes starts with deciding that a problem in your community is one you can help solve.
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My name is Esther Kativi. I am a family medicine physician that does OB.
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I started my DPC practice, which is called New Life Direct Primary Care, in 2020. Right before the COVID hit, I initially started doing my clinic as full spoke peds adults and OB,
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and I saw a huge need for women who did not have insurance, who were pregnant. So,
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in 2022, I started MyDoc, which stands for My Direct obstetrics care. It's a nonprofit clinic, and it is a completely free clinic. We do offer OB care delivery and postpartum care to anybody who is either high risk or uninsured or underinsured. And the reason I say high risk is because we are also trying to treat those patients who are either African American who have an increased risk of morbidity and mortality in pregnancy, people who may be pending insurance but cannot get into a physician. They're trying to fill that gap of not just uninsured, but also people who aren't getting the care that they need, which is making their
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pregnancy higher risk for both them and babies. It's absolutely incredible. I'm so inspired by your story because so many times we're thinking there's so many problems in medicine in our communities, but somebody else can do that, or I can't make a difference, or you know that's what government entities are for, and you're like you know what? No, I'm gonna do what I can do, and you're making a huge difference. Yeah, I hope so. Looking back, I always tell people like, if I knew how much work it was to start a nonprofit, I might not have done it. But at the time, I was like, oh, these people really need help, and I also,
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in creating it, wanted to help family medicine doctors because there's just not a lot of options for people who want to do OB
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that are family medicine because it's either you go into academics or you go into a high call practice with a lot of people, and you really don't get the same kind of care that we believe in direct primary care that you want to give your patients, and that's future goals for my doc. And extend this to other places so that
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physicians who want to do direct primary care and continue to do their OB that that would still be an option for them.
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Where are you located?
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I am in Corpus Christi, Texas, which is way south. What is the political climate there for a family doctor practicing obstetrics?
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So at our hospital, it's actually pretty good because we have an OB hospitalist group
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that will help with the call for the family medicine physicians, but that's pretty much only because of the residency program.
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So I
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did have a lot of
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opposition towards starting my doc and just pressure to be on call 24/7,
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and that they were not going to back me up. And I think it was
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maybe a miscommunication that a lot of times people think direct primary care is concierge,
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that your patients are paying you tons of money
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to get that cell phone number and.
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To have access to you,
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and just because they all know you and like you because you're in their lives and present doesn't mean that they're paying you a ton of money. There was probably some anxiety on their end as far as like, what does this look like, and is this going to turn into some kind of a power struggle, and where is the liability, and and then I guess there's the whole payment issue, as far as how everybody's getting paid, like for the deliveries, how did you navigate all of that? Yeah, so
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many of them did not have insurance. So
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when I originally started and I didn't have the nonprofit, my patients were just paying $150 a month if they were pregnant,
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but many of them would be like, "Oh, I can't pay, but I'm like, "I can't desert the patient either. So I'm like, "Okay, just whatever. Like, I'll just deliver you and continue the care, or, or
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you know, make sure that the patient is being taken care of. But then I had a patient come in that was,
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like, I want to say, 24 weeks,
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and ruptured, and I was like, "Oh my goodness! And they wanted to keep her in the hospital until she delivered, and I was like, "Oh my goodness, I'm in so much trouble, because that means I need to round on her every single day until she delivers, and it's just me
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and a clinic, and I have my own kids. She ended up delivering like
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a week or two later, and not good for the patient, obviously, or the baby. But it was just like an eye opener of like, oh, I did not consider this with this model, and not having the backup
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of like the OB/GYN group or the residency program or something like that. So,
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so that would be advice to somebody who is considering doing this kind of model. You really have to have that support and that buy-in from colleagues. Yes,
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direct primary care by itself, you don't have to do a lot of necessarily networking. You could do a lot on your own, but when you add OB to it,
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you have to.
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And a lot of hospitals have a lot of politics about
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family medicine and OB/GYNs and working together. So if that is not a strong
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Relationship there, it can really affect whether
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you one you can do OB in in that area, and then two, how successful you are going to be, or how drained you're going to be because of the call that you're going to be on. In the last year,
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I have put a pause on doing OB mostly just because of
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one, I have volunteer physicians who are willing to deliver the patients, and they're great. So that makes me feel comfortable about the patient care. And then two, just trying to run the. Nobody wants to do the grant writing. Nobody wants to do all the board meetings and all that logistics. So my dog kind of became my baby, and so I didn't want it to bail. So I started doing more of the administrative stuff, hiring people and trying to get more physician volunteers, trying to raise money, fundraisers, all that.
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And so I had backed off of doing a lot of the OB,
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but I think my goal is still to
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create a job that a family physician would want when they come out of residency. Unfortunately, we don't have the money yet to offer these positions
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as a paid position, but that is my goal in the future is to have branches of MyDoc places where people can say, "Hey, I want to do direct primary care, but I want to continue to do OB. So I'll start my own direct primary care, and then I will join a branch of MyDoc.
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I love that. So you're really looking at building a platform, all kind of based on your nonprofit, and talk to me a little bit about the nuts and bolts of starting a nonprofit. We
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opened on paper, I say, in 2022, and it's a lot like running or opening a direct primary care or your own business. It's all the same stuff, but a little bit different. I did
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get a lawyer to open it because
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just the logistics of opening a for-profit and a nonprofit in the same location
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and trying to run them both as the owner of both. I was like, I think I need some legal advice on this, which was very helpful, it's a lot of liability and the risk that goes with it, and wanting to do it right. If I can keep other people from having to recreate this and redo
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it, that's my goal. As far as monetary gains from it, no, I don't. Every state has different rules, and
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most states.
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Require that you have to have a board with at least three people on it. So you recruit your people, and you go to a lawyer, and you have to form your bylaws, and you have to apply for what kind of nonprofit you want to be, whether it's medical or religious, and then you have to apply for your
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501 c3 status, which is what gives people the ability to donate and have it tax deductible,
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and then
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it was a matter of kind of recruiting patients. So a lot of meetings with
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the pregnancy center. We also have an FQHC here, so I went to them and told them if you have anybody who's undocumented or
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does not have any form of insurance, you can send them to
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us. We have a Catholic hospital here. Approached them for both for funding. We went to the ER and gave flyers out. September of 2023 is when
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we officially opened our doors
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to my doc. How have you been fundraising? Sounds like a lot of it is self-funded. Sounds like this is a labor of love. Where else are you getting money? Yeah. So in the beginning, I would say my direct primary care was funding
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the nonprofit completely, and then about a year in,
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I was like, "Oh my goodness, I'm going to tank my business.
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And part of the reason why I did this was to not tank my business with the OB already. So I was like, "I need help. I think that
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a lot of us as physicians, we love the patient care.
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Maybe not as strong. A lot of times in the business side of things,
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and with my direct primary care, I was like, okay, I got the business side being down. I had gone to the Goldman Sachs program. I had learned a lot, but then the nonprofit-it's so much about
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networking,
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and I was not prepared for that. I was like, I need a new wardrobe because you know we're used to our scrubs, but that doesn't go over very well. And also, when you say you're a physician, everybody thinks you have money,
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and so being a physician running a nonprofit, they're all like, "Well, why don't you give to it? And I'm like, "Oh my goodness, I'm like dying over here. Like,
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all the money is going to the nonprofit. Like, I need help. And then the other thing is, as a physician, we're always like, and I think family medicine, especially, a lot of times we're like, "Oh, I can do everything. I got this. I'll figure it out. I'll Google it. I'll be the accountant. I'll be this. I'll be that. You know, but
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I really realized with the nonprofit, like you cannot do this all. And the sooner you start asking for help, the better.
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And it was a few people that really came on board in the beginning that were like, okay, I used to work with donor relationships in the pregnancy center, and I do ultrasound, and I'm willing to help recruit people, and I'm gonna go talk to the. And I was like, yes, yes, yes, just them recruiting other people, and then little by little, God just brought people into this circle that helped me because I was like, I was trying to do it all on my own, and it was not working. And
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then we did a fundraiser. It was kind of like a clinic opening,
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and we raised a whopping, I think, $3,500. And I was like, okay, like that's good, but
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I think we're gonna need more than this for this. And then
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you apply for grants, but if you don't know them,
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you are not going to get it. Within the first three years, nobody trusts you,
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and that was a thing too that I also did not know when I opened my nonprofit. I remember I went somewhere and they were like, "Oh, everybody opens a nonprofit, and I was like oh they do. I also didn't realize the
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abuse that goes on within a lot of nonprofits, and that the transparency piece is so important. I remember we didn't get one grant because we were
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in the same building in the same office space as New Life, which is for profit, and they were worried that that would be taking
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something from the money from the nonprofit, just little by little. And honestly, we don't bring in a ton of money right now. Something that we are still working on. We have got a few grants recently, which helped us pay for an ultrasound machine. These have pretty much been local or community
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grants, rather than you know there's big ones. But when you apply for the big grants, they also want all the the details and all the paperwork, and you almost.
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Have to have somebody who's in a paid position full time to either be a grant writer or the accounting part of it. When you apply for the big grants, they want a lot of details. They want a lot of follow up,
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and for the one doc trying to run two businesses, it can be very difficult. And I think that's why I
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feel like if we can recreate this, and we've already paved the path, we could just say, "Here, we've done all the work. Here's a branch you want to deliver.
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OB patients, you want to help people who need help.
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Let us help you, and you help us, and kind of form this relationship, so people don't have to go through this whole process. I do know there's a lot of interest within the
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physician community to help other people. I mean,
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a lot of us, yes, we donate a lot of free memberships within direct primary care, or we give a lot, so we find ways to get them what they need, and that's really good. I just feel like
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if somebody can
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pave the way and everyone else can kind of follow, it saves everybody time without the corporate
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thing that we're all trying to avoid of someone controlling you or telling you what you can and can't do.
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So I haven't completely figured it out, but I also would in the future like to have a portion of
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our nonprofit helping physicians who just want to
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provide
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free or charitable care to both women or men, any kind of primary care. But I have a passion myself for women's health and OB, so those have kind of been my focus, and I feel like
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they have been somewhat ignored for a while within the
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primary care scope and media and those kinds of things. I think it's improving, maybe within the past few years. But,
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but yeah, I would like to help physicians who want to,
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who just need some basic resources. And I know it sounds crazy, but a lot of us are trying to do things without proper tools, and I think it can work. But I've been a big promoter of quality care.
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It drives me crazy. Like, I think you should have a pat with a light that works. I think you should have speculum. Yes, a lot of people are using the metal ones, but if it's just a matter of
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a few dollars or a cost for the comfort of the patient, or or for me, what's more important is can you see better with a plastic speculum and a light that goes in, which means you won't miss things, which means
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you are giving better quality care. One of the focuses, you know, a lot of the federal programs for the morbidity and mortality with pregnant women has focused on access to care, and I do believe access to care is important. But I also highly believe that quality care is just as important because so many of these patients have Medicaid and they get two minutes with their doctor.
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And how are you going
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to hear or know what's going on in their life or what the problems are in those two minutes? No, you're going to listen to feel heart tones. You're going to ask about five so questions, and yes, those are important. And then you turn everything over to a nurse, you may or may not get that information back. And
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I, I think with quality care comes more time with the physician. And I know myself just
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10 minutes in the room with the patient, and a lot of times that 10 minutes
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is when they start to open up, and then you start to hear what's going on, and that's when you hear about domestic abuse. That's when you hear about you know a rape case or us living close to the border. Sometimes women are pregnant because they were raped on the way, or and they don't want to tell their family and they don't want to tell their spouse. Or you know you get to the complicated part of medicine. The longer you're in the room, most of the time, sometimes yes, it's the chatting, but it's the chatting that leads to the
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deeper stuff a lot of times. So,
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yes, access to care is important, but quality care is just as important. You're so speaking my language because you know I'm a scope of practice you know maniac and because what I always hear
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is access access access and I say exactly what you do actually access to poor quality care has been shown to be worse than no access at all people always kind of like look at me like.
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I'm crazy when I say that because it's kind of counterintuitive. But if you're getting care from somebody that's not providing it properly, you might have been better off just not going anywhere at all. So I I totally agree with you, and I so respect and admire the work that you're doing and your passion. And so I'm excited to share this story. And is there a website link that I can share in case so people can check it out. Yeah, so it's just my doc like
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doc.org.org. I've gotten a lot of criticism, a lot of opposition about this nonprofit, and so many people even as talking to an OB hospitalist, and she's like, "Well, your foundation and your patients and I was like, this is not my foundation. Like, this is not my patients. These are our patients. These are people in our community. Like, I do not get paid by this nonprofit. I feel like a lot of people feel like somehow I am benefiting from this.
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I'm like I am not. I don't get paid. I probably work 30 hours a week for the nonprofit. All of our physicians are volunteer. Like
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there is nobody benefiting from this other than the patient.
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But I I feel like the more
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the more you're like that, the less people trust you, and so I'm like, okay, we gotta get money so we can start paying people, so that people can trust us, so we can get more money to take care of the patients. Like, actually, what you're saying makes sense. I remember when I was moonlighting at a hospice, and the medical director, I said, well, you know, I can probably volunteer, and he said, no. He said, "Actually, it's very, very important. We think for our professional, you know, integrity and value that you do get payment. You're not going to get, you know, top dollar, but you need to get fair compensation for your work. And that always kind of sat with me because I'm, I'm like you. I'm always like, well, we can just do it for free, and we can do it altruistically, but then there's that double-edged sword where then you're looked upon as not providing quality or not doing you know doing it right because you're doing it for free. Yeah, and the other thing with it was
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the like just the the credibility. I don't know why. And like when we started,
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we were charging, I think, $25 a month
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until we were considered a charitable clinic.
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And I will tell you, it was a night and day difference from going from
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any paid amount to completely free,
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because it was again, it was a trust issue. People are like, "Oh, you're making money off of these patients, and I was like, $25 is not even keeping the electricity
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on for these patients, or you know, or providing any medical supplies or anything. Like, so, so you're saying that you got more funding or a better response when you told people that it was free versus charging $25? Yes, in fact, I went for
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Arnoises County Medical Society something, and I had just made the decision like a month ago, like we're gonna move to free.
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And
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they had a photographer. We were supposed to be doing our professional photos for
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the directory, and the photographer asked me, "Oh, what do you do? And I said, oh, I have a direct primary care, and I have this nonprofit, and we offer free. And I was like, kind of trying out my, you know, like, oh, we offer free care for women. And he was like, oh, I'm gonna give you
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free extra professional photos to use for your website and everything. And I was like, no way, like just changing it to free like I just start people started being like oh okay I'll give you this I'll give you that and I was like oh my goodness why did we spend nine months of charging $25 and not getting anything from anybody
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and
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then changing it to being free and
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it was just so different I don't know it opened doors that's so interesting! Wow.
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Yep, and you know, I had when I came up with the C for doing that, I was like, oh, let's you know do something that's minimal, but that makes people want to come because I, you know, we always have this idea that if you offer something for free, people are going to no show and they're not going to take it seriously, and you know, nobody's gonna want to fund it, but I was like, my thinking was
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completely different than what the nonprofit world sees
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as being transparent. So I was like,
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or credible, I guess. So I guess that's just part of this trial and error. You know, you you make your best guess, and you you know based on research and you know what other people are doing, and then you try it out, and then sometimes you pivot. And I think that's what is so amazing is you know being able to say like do it your way, say like this isn't working, let's try it this way and see if that works, and if that works, great. If not, we'll try it a different way. Yeah, and I think you know that's part.
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Part of the DPC community is we really want to help other people, so I really hope that this podcast will help people, you know, who are considering either starting a nonprofit or
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wanting to provide care for patients in need who won't be able to afford it. That it would, you know, they wouldn't have to go through all these trial and error, and they can just take from this and build on it. I drank the Kool-Aid. I 100% believe in direct primary care, but I know a lot of us also want to,
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you know, go beyond direct primary care and offers either free or reduced pricing for things for patients that really need it. And I think we're on the we're at the forefront. We know which patients really need it. You know, I have a patient who's diabetic. Every month, he does not pay his membership, but he will at some point,
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and I know that. And so, you know,
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I don't fire him. I just say okay, just pay whenever you can.
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I don't have a very high fee for my direct primary care.
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Honestly, if he didn't pay, I probably wouldn't do anything anyway. So,
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but yes, I mean, I think there's a lot of us. We have a heart, and that's why we went into this profession. I think a lot of times people don't know that physicians have such a deep heart
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because we are known as the decision maker and
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in direct primary care the business owner and this and that, and we don't always get that
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painted picture
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of the sympathetic, caring, empathetic person who's going to be there, and we don't want to take money from people who don't have it. We do want to help them, but we also have a business and we need to run
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it. But I just I don't think we're often painted
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as the empathetic physician. You know,
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that's kind of the point of this podcast in this small way to try to show, you know,
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it's of course made for physicians, but also just to feature like the hard work and the dedication and the caring that so many doctors have, and you really epitomize that.
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Thank you so much. I I I'm very
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proud to be a part of the direct primary community, and I'm very proud to be on this podcast because I do believe there's a lot of us trying to improve things for physicians, and then also for our patients. Thank you so much for listening to this episode of Physicians Taking Back Medicine. I'm your host, Dr. Rebecca Bernard, bringing you true stories of day-to-day physicians just like you, who are working to improve the healthcare system. Thanks again, and we'll see you on the next episode.
What do you do when pregnant patients need care they can't afford? For Dr. Esther Katibi, the answer was to build a way to help them.
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Welcome to Physicians Taking Back Medicine. I'm Dr. Rebecca Bernard, and today I'm speaking with Dr. Esther Katibi, a family physician in Corpus Christi, Texas, who practices obstetrics and founded New Life Direct Primary Care. When she saw women falling through the gaps in maternity care, she created My Doc, My Direct Obstetrics Care, a nonprofit offering free obstetric delivery and postpartum care,
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but turning that mission into a sustainable organization has meant navigating hospital politics, securing physician backup, raising money, and learning just how difficult starting a nonprofit can be.
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Now she wants to make that path easier for other physicians, including family doctors who want to combine DPC with delivering babies, we'll talk about putting patients first, pushing through resistance, and why taking back medicine sometimes starts with deciding that a problem in your community is one you can help solve.
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My name is Esther Kativi. I am a family medicine physician that does OB.
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I started my DPC practice, which is called New Life Direct Primary Care, in 2020. Right before the COVID hit, I initially started doing my clinic as full spoke peds adults and OB,
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and I saw a huge need for women who did not have insurance, who were pregnant. So,
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in 2022, I started MyDoc, which stands for My Direct obstetrics care. It's a nonprofit clinic, and it is a completely free clinic. We do offer OB care delivery and postpartum care to anybody who is either high risk or uninsured or underinsured. And the reason I say high risk is because we are also trying to treat those patients who are either African American who have an increased risk of morbidity and mortality in pregnancy, people who may be pending insurance but cannot get into a physician. They're trying to fill that gap of not just uninsured, but also people who aren't getting the care that they need, which is making their
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pregnancy higher risk for both them and babies. It's absolutely incredible. I'm so inspired by your story because so many times we're thinking there's so many problems in medicine in our communities, but somebody else can do that, or I can't make a difference, or you know that's what government entities are for, and you're like you know what? No, I'm gonna do what I can do, and you're making a huge difference. Yeah, I hope so. Looking back, I always tell people like, if I knew how much work it was to start a nonprofit, I might not have done it. But at the time, I was like, oh, these people really need help, and I also,
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in creating it, wanted to help family medicine doctors because there's just not a lot of options for people who want to do OB
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that are family medicine because it's either you go into academics or you go into a high call practice with a lot of people, and you really don't get the same kind of care that we believe in direct primary care that you want to give your patients, and that's future goals for my doc. And extend this to other places so that
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physicians who want to do direct primary care and continue to do their OB that that would still be an option for them.
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Where are you located?
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I am in Corpus Christi, Texas, which is way south. What is the political climate there for a family doctor practicing obstetrics?
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So at our hospital, it's actually pretty good because we have an OB hospitalist group
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that will help with the call for the family medicine physicians, but that's pretty much only because of the residency program.
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So I
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did have a lot of
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opposition towards starting my doc and just pressure to be on call 24/7,
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and that they were not going to back me up. And I think it was
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maybe a miscommunication that a lot of times people think direct primary care is concierge,
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that your patients are paying you tons of money
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to get that cell phone number and.
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To have access to you,
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and just because they all know you and like you because you're in their lives and present doesn't mean that they're paying you a ton of money. There was probably some anxiety on their end as far as like, what does this look like, and is this going to turn into some kind of a power struggle, and where is the liability, and and then I guess there's the whole payment issue, as far as how everybody's getting paid, like for the deliveries, how did you navigate all of that? Yeah, so
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many of them did not have insurance. So
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when I originally started and I didn't have the nonprofit, my patients were just paying $150 a month if they were pregnant,
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but many of them would be like, "Oh, I can't pay, but I'm like, "I can't desert the patient either. So I'm like, "Okay, just whatever. Like, I'll just deliver you and continue the care, or, or
Unknown Speaker 5:52
you know, make sure that the patient is being taken care of. But then I had a patient come in that was,
Unknown Speaker 6:00
like, I want to say, 24 weeks,
Unknown Speaker 6:04
and ruptured, and I was like, "Oh my goodness! And they wanted to keep her in the hospital until she delivered, and I was like, "Oh my goodness, I'm in so much trouble, because that means I need to round on her every single day until she delivers, and it's just me
Unknown Speaker 6:20
and a clinic, and I have my own kids. She ended up delivering like
Unknown Speaker 6:26
a week or two later, and not good for the patient, obviously, or the baby. But it was just like an eye opener of like, oh, I did not consider this with this model, and not having the backup
Unknown Speaker 6:40
of like the OB/GYN group or the residency program or something like that. So,
Unknown Speaker 6:46
so that would be advice to somebody who is considering doing this kind of model. You really have to have that support and that buy-in from colleagues. Yes,
Unknown Speaker 6:56
direct primary care by itself, you don't have to do a lot of necessarily networking. You could do a lot on your own, but when you add OB to it,
Unknown Speaker 7:07
you have to.
Unknown Speaker 7:08
And a lot of hospitals have a lot of politics about
Unknown Speaker 7:12
family medicine and OB/GYNs and working together. So if that is not a strong
Unknown Speaker 7:21
Relationship there, it can really affect whether
Unknown Speaker 7:26
you one you can do OB in in that area, and then two, how successful you are going to be, or how drained you're going to be because of the call that you're going to be on. In the last year,
Unknown Speaker 7:38
I have put a pause on doing OB mostly just because of
Unknown Speaker 7:44
one, I have volunteer physicians who are willing to deliver the patients, and they're great. So that makes me feel comfortable about the patient care. And then two, just trying to run the. Nobody wants to do the grant writing. Nobody wants to do all the board meetings and all that logistics. So my dog kind of became my baby, and so I didn't want it to bail. So I started doing more of the administrative stuff, hiring people and trying to get more physician volunteers, trying to raise money, fundraisers, all that.
Unknown Speaker 8:16
And so I had backed off of doing a lot of the OB,
Unknown Speaker 8:21
but I think my goal is still to
Unknown Speaker 8:26
create a job that a family physician would want when they come out of residency. Unfortunately, we don't have the money yet to offer these positions
Unknown Speaker 8:38
as a paid position, but that is my goal in the future is to have branches of MyDoc places where people can say, "Hey, I want to do direct primary care, but I want to continue to do OB. So I'll start my own direct primary care, and then I will join a branch of MyDoc.
Unknown Speaker 8:56
I love that. So you're really looking at building a platform, all kind of based on your nonprofit, and talk to me a little bit about the nuts and bolts of starting a nonprofit. We
Unknown Speaker 9:08
opened on paper, I say, in 2022, and it's a lot like running or opening a direct primary care or your own business. It's all the same stuff, but a little bit different. I did
Unknown Speaker 9:23
get a lawyer to open it because
Unknown Speaker 9:25
just the logistics of opening a for-profit and a nonprofit in the same location
Unknown Speaker 9:34
and trying to run them both as the owner of both. I was like, I think I need some legal advice on this, which was very helpful, it's a lot of liability and the risk that goes with it, and wanting to do it right. If I can keep other people from having to recreate this and redo
Unknown Speaker 9:51
it, that's my goal. As far as monetary gains from it, no, I don't. Every state has different rules, and
Unknown Speaker 9:59
most states.
Unknown Speaker 10:00
Require that you have to have a board with at least three people on it. So you recruit your people, and you go to a lawyer, and you have to form your bylaws, and you have to apply for what kind of nonprofit you want to be, whether it's medical or religious, and then you have to apply for your
Unknown Speaker 10:19
501 c3 status, which is what gives people the ability to donate and have it tax deductible,
Unknown Speaker 10:25
and then
Unknown Speaker 10:27
it was a matter of kind of recruiting patients. So a lot of meetings with
Unknown Speaker 10:36
the pregnancy center. We also have an FQHC here, so I went to them and told them if you have anybody who's undocumented or
Unknown Speaker 10:46
does not have any form of insurance, you can send them to
Unknown Speaker 10:49
us. We have a Catholic hospital here. Approached them for both for funding. We went to the ER and gave flyers out. September of 2023 is when
Unknown Speaker 11:01
we officially opened our doors
Unknown Speaker 11:04
to my doc. How have you been fundraising? Sounds like a lot of it is self-funded. Sounds like this is a labor of love. Where else are you getting money? Yeah. So in the beginning, I would say my direct primary care was funding
Unknown Speaker 11:21
the nonprofit completely, and then about a year in,
Unknown Speaker 11:27
I was like, "Oh my goodness, I'm going to tank my business.
Unknown Speaker 11:31
And part of the reason why I did this was to not tank my business with the OB already. So I was like, "I need help. I think that
Unknown Speaker 11:40
a lot of us as physicians, we love the patient care.
Unknown Speaker 11:44
Maybe not as strong. A lot of times in the business side of things,
Unknown Speaker 11:49
and with my direct primary care, I was like, okay, I got the business side being down. I had gone to the Goldman Sachs program. I had learned a lot, but then the nonprofit-it's so much about
Unknown Speaker 12:01
networking,
Unknown Speaker 12:03
and I was not prepared for that. I was like, I need a new wardrobe because you know we're used to our scrubs, but that doesn't go over very well. And also, when you say you're a physician, everybody thinks you have money,
Unknown Speaker 12:18
and so being a physician running a nonprofit, they're all like, "Well, why don't you give to it? And I'm like, "Oh my goodness, I'm like dying over here. Like,
Unknown Speaker 12:27
all the money is going to the nonprofit. Like, I need help. And then the other thing is, as a physician, we're always like, and I think family medicine, especially, a lot of times we're like, "Oh, I can do everything. I got this. I'll figure it out. I'll Google it. I'll be the accountant. I'll be this. I'll be that. You know, but
Unknown Speaker 12:45
I really realized with the nonprofit, like you cannot do this all. And the sooner you start asking for help, the better.
Unknown Speaker 12:52
And it was a few people that really came on board in the beginning that were like, okay, I used to work with donor relationships in the pregnancy center, and I do ultrasound, and I'm willing to help recruit people, and I'm gonna go talk to the. And I was like, yes, yes, yes, just them recruiting other people, and then little by little, God just brought people into this circle that helped me because I was like, I was trying to do it all on my own, and it was not working. And
Unknown Speaker 13:24
then we did a fundraiser. It was kind of like a clinic opening,
Unknown Speaker 13:31
and we raised a whopping, I think, $3,500. And I was like, okay, like that's good, but
Unknown Speaker 13:41
I think we're gonna need more than this for this. And then
Unknown Speaker 13:46
you apply for grants, but if you don't know them,
Unknown Speaker 13:49
you are not going to get it. Within the first three years, nobody trusts you,
Unknown Speaker 13:55
and that was a thing too that I also did not know when I opened my nonprofit. I remember I went somewhere and they were like, "Oh, everybody opens a nonprofit, and I was like oh they do. I also didn't realize the
Unknown Speaker 14:07
abuse that goes on within a lot of nonprofits, and that the transparency piece is so important. I remember we didn't get one grant because we were
Unknown Speaker 14:19
in the same building in the same office space as New Life, which is for profit, and they were worried that that would be taking
Unknown Speaker 14:29
something from the money from the nonprofit, just little by little. And honestly, we don't bring in a ton of money right now. Something that we are still working on. We have got a few grants recently, which helped us pay for an ultrasound machine. These have pretty much been local or community
Unknown Speaker 14:50
grants, rather than you know there's big ones. But when you apply for the big grants, they also want all the the details and all the paperwork, and you almost.
Unknown Speaker 15:00
Have to have somebody who's in a paid position full time to either be a grant writer or the accounting part of it. When you apply for the big grants, they want a lot of details. They want a lot of follow up,
Unknown Speaker 15:15
and for the one doc trying to run two businesses, it can be very difficult. And I think that's why I
Unknown Speaker 15:23
feel like if we can recreate this, and we've already paved the path, we could just say, "Here, we've done all the work. Here's a branch you want to deliver.
Unknown Speaker 15:33
OB patients, you want to help people who need help.
Unknown Speaker 15:38
Let us help you, and you help us, and kind of form this relationship, so people don't have to go through this whole process. I do know there's a lot of interest within the
Unknown Speaker 15:50
physician community to help other people. I mean,
Unknown Speaker 15:54
a lot of us, yes, we donate a lot of free memberships within direct primary care, or we give a lot, so we find ways to get them what they need, and that's really good. I just feel like
Unknown Speaker 16:09
if somebody can
Unknown Speaker 16:11
pave the way and everyone else can kind of follow, it saves everybody time without the corporate
Unknown Speaker 16:19
thing that we're all trying to avoid of someone controlling you or telling you what you can and can't do.
Unknown Speaker 16:26
So I haven't completely figured it out, but I also would in the future like to have a portion of
Unknown Speaker 16:33
our nonprofit helping physicians who just want to
Unknown Speaker 16:38
provide
Unknown Speaker 16:39
free or charitable care to both women or men, any kind of primary care. But I have a passion myself for women's health and OB, so those have kind of been my focus, and I feel like
Unknown Speaker 16:55
they have been somewhat ignored for a while within the
Unknown Speaker 17:00
primary care scope and media and those kinds of things. I think it's improving, maybe within the past few years. But,
Unknown Speaker 17:08
but yeah, I would like to help physicians who want to,
Unknown Speaker 17:12
who just need some basic resources. And I know it sounds crazy, but a lot of us are trying to do things without proper tools, and I think it can work. But I've been a big promoter of quality care.
Unknown Speaker 17:26
It drives me crazy. Like, I think you should have a pat with a light that works. I think you should have speculum. Yes, a lot of people are using the metal ones, but if it's just a matter of
Unknown Speaker 17:40
a few dollars or a cost for the comfort of the patient, or or for me, what's more important is can you see better with a plastic speculum and a light that goes in, which means you won't miss things, which means
Unknown Speaker 17:56
you are giving better quality care. One of the focuses, you know, a lot of the federal programs for the morbidity and mortality with pregnant women has focused on access to care, and I do believe access to care is important. But I also highly believe that quality care is just as important because so many of these patients have Medicaid and they get two minutes with their doctor.
Unknown Speaker 18:24
And how are you going
Unknown Speaker 18:27
to hear or know what's going on in their life or what the problems are in those two minutes? No, you're going to listen to feel heart tones. You're going to ask about five so questions, and yes, those are important. And then you turn everything over to a nurse, you may or may not get that information back. And
Unknown Speaker 18:46
I, I think with quality care comes more time with the physician. And I know myself just
Unknown Speaker 18:51
10 minutes in the room with the patient, and a lot of times that 10 minutes
Unknown Speaker 18:56
is when they start to open up, and then you start to hear what's going on, and that's when you hear about domestic abuse. That's when you hear about you know a rape case or us living close to the border. Sometimes women are pregnant because they were raped on the way, or and they don't want to tell their family and they don't want to tell their spouse. Or you know you get to the complicated part of medicine. The longer you're in the room, most of the time, sometimes yes, it's the chatting, but it's the chatting that leads to the
Unknown Speaker 19:30
deeper stuff a lot of times. So,
Unknown Speaker 19:33
yes, access to care is important, but quality care is just as important. You're so speaking my language because you know I'm a scope of practice you know maniac and because what I always hear
Unknown Speaker 19:47
is access access access and I say exactly what you do actually access to poor quality care has been shown to be worse than no access at all people always kind of like look at me like.
Unknown Speaker 20:00
I'm crazy when I say that because it's kind of counterintuitive. But if you're getting care from somebody that's not providing it properly, you might have been better off just not going anywhere at all. So I I totally agree with you, and I so respect and admire the work that you're doing and your passion. And so I'm excited to share this story. And is there a website link that I can share in case so people can check it out. Yeah, so it's just my doc like
Unknown Speaker 20:26
doc.org.org. I've gotten a lot of criticism, a lot of opposition about this nonprofit, and so many people even as talking to an OB hospitalist, and she's like, "Well, your foundation and your patients and I was like, this is not my foundation. Like, this is not my patients. These are our patients. These are people in our community. Like, I do not get paid by this nonprofit. I feel like a lot of people feel like somehow I am benefiting from this.
Unknown Speaker 21:00
I'm like I am not. I don't get paid. I probably work 30 hours a week for the nonprofit. All of our physicians are volunteer. Like
Unknown Speaker 21:11
there is nobody benefiting from this other than the patient.
Unknown Speaker 21:17
But I I feel like the more
Unknown Speaker 21:20
the more you're like that, the less people trust you, and so I'm like, okay, we gotta get money so we can start paying people, so that people can trust us, so we can get more money to take care of the patients. Like, actually, what you're saying makes sense. I remember when I was moonlighting at a hospice, and the medical director, I said, well, you know, I can probably volunteer, and he said, no. He said, "Actually, it's very, very important. We think for our professional, you know, integrity and value that you do get payment. You're not going to get, you know, top dollar, but you need to get fair compensation for your work. And that always kind of sat with me because I'm, I'm like you. I'm always like, well, we can just do it for free, and we can do it altruistically, but then there's that double-edged sword where then you're looked upon as not providing quality or not doing you know doing it right because you're doing it for free. Yeah, and the other thing with it was
Unknown Speaker 22:15
the like just the the credibility. I don't know why. And like when we started,
Unknown Speaker 22:20
we were charging, I think, $25 a month
Unknown Speaker 22:25
until we were considered a charitable clinic.
Unknown Speaker 22:28
And I will tell you, it was a night and day difference from going from
Unknown Speaker 22:32
any paid amount to completely free,
Unknown Speaker 22:36
because it was again, it was a trust issue. People are like, "Oh, you're making money off of these patients, and I was like, $25 is not even keeping the electricity
Unknown Speaker 22:46
on for these patients, or you know, or providing any medical supplies or anything. Like, so, so you're saying that you got more funding or a better response when you told people that it was free versus charging $25? Yes, in fact, I went for
Unknown Speaker 23:03
Arnoises County Medical Society something, and I had just made the decision like a month ago, like we're gonna move to free.
Unknown Speaker 23:12
And
Unknown Speaker 23:14
they had a photographer. We were supposed to be doing our professional photos for
Unknown Speaker 23:17
the directory, and the photographer asked me, "Oh, what do you do? And I said, oh, I have a direct primary care, and I have this nonprofit, and we offer free. And I was like, kind of trying out my, you know, like, oh, we offer free care for women. And he was like, oh, I'm gonna give you
Unknown Speaker 23:32
free extra professional photos to use for your website and everything. And I was like, no way, like just changing it to free like I just start people started being like oh okay I'll give you this I'll give you that and I was like oh my goodness why did we spend nine months of charging $25 and not getting anything from anybody
Unknown Speaker 23:53
and
Unknown Speaker 23:54
then changing it to being free and
Unknown Speaker 23:57
it was just so different I don't know it opened doors that's so interesting! Wow.
Unknown Speaker 24:03
Yep, and you know, I had when I came up with the C for doing that, I was like, oh, let's you know do something that's minimal, but that makes people want to come because I, you know, we always have this idea that if you offer something for free, people are going to no show and they're not going to take it seriously, and you know, nobody's gonna want to fund it, but I was like, my thinking was
Unknown Speaker 24:25
completely different than what the nonprofit world sees
Unknown Speaker 24:29
as being transparent. So I was like,
Unknown Speaker 24:32
or credible, I guess. So I guess that's just part of this trial and error. You know, you you make your best guess, and you you know based on research and you know what other people are doing, and then you try it out, and then sometimes you pivot. And I think that's what is so amazing is you know being able to say like do it your way, say like this isn't working, let's try it this way and see if that works, and if that works, great. If not, we'll try it a different way. Yeah, and I think you know that's part.
Unknown Speaker 25:00
Part of the DPC community is we really want to help other people, so I really hope that this podcast will help people, you know, who are considering either starting a nonprofit or
Unknown Speaker 25:11
wanting to provide care for patients in need who won't be able to afford it. That it would, you know, they wouldn't have to go through all these trial and error, and they can just take from this and build on it. I drank the Kool-Aid. I 100% believe in direct primary care, but I know a lot of us also want to,
Unknown Speaker 25:30
you know, go beyond direct primary care and offers either free or reduced pricing for things for patients that really need it. And I think we're on the we're at the forefront. We know which patients really need it. You know, I have a patient who's diabetic. Every month, he does not pay his membership, but he will at some point,
Unknown Speaker 25:56
and I know that. And so, you know,
Unknown Speaker 25:59
I don't fire him. I just say okay, just pay whenever you can.
Unknown Speaker 26:04
I don't have a very high fee for my direct primary care.
Unknown Speaker 26:09
Honestly, if he didn't pay, I probably wouldn't do anything anyway. So,
Unknown Speaker 26:15
but yes, I mean, I think there's a lot of us. We have a heart, and that's why we went into this profession. I think a lot of times people don't know that physicians have such a deep heart
Unknown Speaker 26:28
because we are known as the decision maker and
Unknown Speaker 26:32
in direct primary care the business owner and this and that, and we don't always get that
Unknown Speaker 26:38
painted picture
Unknown Speaker 26:40
of the sympathetic, caring, empathetic person who's going to be there, and we don't want to take money from people who don't have it. We do want to help them, but we also have a business and we need to run
Unknown Speaker 26:53
it. But I just I don't think we're often painted
Unknown Speaker 26:57
as the empathetic physician. You know,
Unknown Speaker 27:01
that's kind of the point of this podcast in this small way to try to show, you know,
Unknown Speaker 27:06
it's of course made for physicians, but also just to feature like the hard work and the dedication and the caring that so many doctors have, and you really epitomize that.
Unknown Speaker 27:16
Thank you so much. I I I'm very
Unknown Speaker 27:18
proud to be a part of the direct primary community, and I'm very proud to be on this podcast because I do believe there's a lot of us trying to improve things for physicians, and then also for our patients. Thank you so much for listening to this episode of Physicians Taking Back Medicine. I'm your host, Dr. Rebecca Bernard, bringing you true stories of day-to-day physicians just like you, who are working to improve the healthcare system. Thanks again, and we'll see you on the next episode.
