Anatoli (Toli) Berezovsky, MD — More Time, Better Care: Launching a Direct Primary Care Practice for $1,800

Michael Jerkins, MD MEd

October 2026

Most residents are just trying to get through the week. Dr. Anatoli (Toli) Berezovsky started a practice for about $1,800, with no clinic space and his neighbor as his first patient, he launched Mila Family Health, a direct primary care practice in Fort Worth. His goal was to give patients the time and attention they deserve at a price they can afford. Today it has about 240 patients and a wait list. The former high school chemistry teacher joins host Dr. Michael Jerkins to share how he built it lean and grew it through Instagram, networking, and word of mouth.

From there, it gets practical. He books an hour for new patients and sees three to six people a day, which leaves time to deliver the care the guidelines call for. Buy equipment when you need it, not before. Set after-hours expectations early so you can grow without burning out. Let technology handle the busywork, but remember it can’t capture the whole patient.

How can DPC reach people who can’t afford a membership? What does it look like when specialists work directly with patients? And how do you tell normal fear apart from real evidence that an idea won’t work? Tune in for an inspiring conversation with a physician who will tell you the healthcare system isn’t broken. It’s working exactly as designed, and that’s why he’s building something different.

Here are 5 takeaways from our conversation with Dr. Toli:

1. Start small and build around real patient needs

You don’t need a fully equipped clinic or a perfect tech stack to begin. Dr. Berezovsky started with basic tools and his first patient, then added services and infrastructure as he learned what patients needed. This minimum-viable approach lets an owner test assumptions before committing to larger expenses. It also keeps early decisions grounded in actual patient feedback rather than a plan made entirely on paper.

2. Keep overhead low while you prove the model

His startup costs were roughly $1,800. He chose inexpensive, practical tools and delayed major expenses until the practice had enough patients to support them. His costly lesson: buying clinic equipment before he had a space for it tied up money without helping the practice. Lower fixed costs can give a new practice more room to grow gradually. They can also reduce pressure to take on a high patient volume before the care model is ready.

3. Treat patient access as a question of time, not just panel size

A smaller panel can give a physician more time for each patient, longer appointments, and stronger continuity. The episode challenges the idea that patient numbers alone measure access, arguing that the quality and availability of care matter too. Dr. Berezovsky contrasts a large panel that may be difficult to serve thoroughly with a smaller panel that allows for a more manageable workday. For practice owners, it’s a reminder to define access by the experience patients receive, not only by how many names appear on a roster.

4. Plan for sustainable boundaries from the start

Direct access doesn’t have to mean being available every minute. As his practice grew, Dr. Berezovsky created after-hours workflows to distinguish urgent needs from routine messages. Clear expectations can support patients while protecting the physician’s time and well-being. Structured communication also helps patients understand how to get help when something is urgent. Designing that process early can make access more dependable without making the practice depend on constant, unstructured availability.

5. Build through relationships and find support for the journey

Social media helped people discover the practice, but networking, local coverage, and word of mouth contributed to growth. For physicians considering a new model, he recommends talking with people who have done it and surrounding yourself with supporters—because uncertainty and outside skepticism are part of starting something unfamiliar. A strong patient experience can turn existing relationships into referrals and community trust. And trusted peers can help a new owner work through practical obstacles without treating every setback as a reason to quit.

Transcript:

Toli Berezovsky:

Direct primary care is all about restoring the doctor-patient relationship, right? So all you need is the doctor and patient. And then if you want to get paid for that, you set up a way to get paid for that. If you need a blood pressure machine, you buy a blood pressure machine and then start taking blood pressure measurements and slowly but surely build up and add the services that you need in order to care for people well, just based on what your patients are telling you that they need.

Michael Jerkins:

Welcome back to another episode of The Podcast for Doctors (By Doctors). Very excited about our guests today and the topics we’ll be talking about, as always. Today we’re joined by Dr. Anatoly Berezovsky. He’s a Fort Worth-based family medicine physician who practices direct primary care. That’s primary care that does not require insurance, through his clinic, Mila Family Health, which he founded. He also works part-time at the local county hospital, where he educates residents and medical students. His work there includes labor and delivery, performing prenatal care, ultrasounds, and rounding in the hospital.

He’s married to his awesome wife, Alyssa, who works for a local educational nonprofit. They have an 18-month-old son named Nico and two dogs, Jax and Mosley. Very busy. Welcome to the podcast.

TB: Thank you, thank you. Good to be here.

MJ: I am super excited to hear about how you started your own direct primary care practice. I get questions about this all the time from people trying to understand what they’re supposed to do. They think it might be a good idea. Walk us through your journey.

TB: First of all, I think it’s a great idea to start a direct primary care practice. I’ll say my mom always gets really mad at me when I tell people that it’s really easy to start a direct primary care practice because I honestly think it is. The alternative to direct primary care is insurance-based primary care, which just isn’t good medicine or good primary care a lot of the time because you’re forced to see so many people in such a short time frame.

Direct primary care just makes sense. The way I started my practice kind of goes back to my training a little bit. I was trained in something called design thinking. Are you familiar?

MJ: I’m not.

TB: It’s a process by which you can design goods and services that people will actually use. I spent a year learning that mindset. It’s kind of an entrepreneurial mindset, and it’s all about creating a minimum viable product, getting that product into the hands of the people who are using it, and then iterating and making it better. You get feedback from people, see how they use it, and keep improving it.

When you get down to it, direct primary care is all about restoring the doctor-patient relationship, right? So all you need is the doctor and patient. Then, if you want to get paid for that, you set up a way to get paid for that. If you need a blood pressure machine, you buy a blood pressure machine and start taking blood pressure measurements. Slowly but surely, you build up and add the services you need to care for people well, based on what your patients are telling you they need.

MJ: So what was your MVP for your direct primary care?

TB: I was like, “I need a practice name.” So, hence, Mila Family Health. I needed a logo, hence 30 days for free on Canva, and I got this logo. I needed to incorporate with the state, which was about $300. I needed malpractice insurance, which was about $1,200. I needed a way to bill people monthly because I knew I wanted to charge a monthly fee, so I just chose Square because it was the easiest way to do it. You could sign a BAA with them and make it HIPAA-compliant.

I needed a way to take notes on my computer in a way that synced everywhere. With Google Drive, if you have a Google Workspace, you can sign a BAA with them. For $14 a month, you can have a running list of your patients on Google Drive in a HIPAA-compliant way.

Then I had e-prescription software so I could send e-prescriptions, and that was $90 for a year because I was a resident at the time. And that’s what I started with.

My first patient signed up. He was basically a neighbor of mine. I went to his house with my little go bag of vitals equipment that I had to buy on Amazon the day before. And then, yeah, he was my first patient.

MJ: So you were a resident when you opened the practice? How did your program take that? Were there any issues there?

TB: Yeah, I was. Our program is awesome. Our program director is super supportive of new and innovative ideas and really open to things like that. But you’re right to be skeptical because I think a lot of academic medicine isn’t supportive of things like this. The whole system is built to keep you in the system, basically, but not our program necessarily.

MJ: Okay, very interesting. So you started with your neighbor. How many patients do you have now, if you don’t mind me asking?

TB: Yeah, I have about 240 patients.

MJ: So, 239 patients later, walk us through the growth and how you acquire those patients.

TB: I started the practice in September 2023, when I was a fourth-year resident doing my obstetric fellowship. I just started posting on Instagram. I learned how to do that, got a professional Instagram account, and started posting. I’d never had Instagram or done it before. I learned from an influencer how to create a post.

By the time I finished residency in June, I had about 20 to 30 patients and no brick-and-mortar location. I was driving all over the city in my spare time as a resident, so it was a lot, honestly.

Eventually, I got enough patients, maybe 40 or 50, that the revenue coming in offset the rent. I was able to open a small brick-and-mortar location, and I’m still in that space now.

Slowly but surely, word of mouth is the best way for DPC to spread. But you also need networking events, fairs, and opportunities to meet small businesses and chambers of commerce. I reached out to our local nonprofit newspaper, the Fort Worth Report, and ended up getting an article written about me there, I think in December 2024, if I’m remembering correctly. After that, I got a lot of interest, and it’s kind of just continued to snowball.

Now, it’s honestly no longer an issue of patient demand. The patients are there. I have a big waitlist, and I’m looking for another physician. That’s the issue. That’s the bottleneck: finding doctors who are willing to do this kind of medicine.

MJ: All right, so give us your elevator pitch to a doctor you’re recruiting to join your DPC.

TB: I don’t want to pitch them. If they’re not frustrated by their current work, then don’t switch. But if they’re frustrated by seeing 30 patients a day, 25 patients a day, having shortened appointments, having to work through lunch, or having to kick people out of the room and excuse yourself when the patient is in the middle of discussing an issue, there are so many things we do that aren’t patient-centered. They’re that way because of how the system is structured.

Some people are fine with that, but most people aren’t. Most people burn out on clinical medicine doing that. Most people don’t want to practice medicine that way, and that’s why people are moving away from primary care. They see insurance-based primary care and think, “I don’t want any part of that. It seems like an awful job.”

If you’re happy with it, stay with it. Good for you. I’m happy for you. But if you’re not happy with it, we should talk. Come visit me, or visit your local DPC and spend some time with them. That’s all I have to say.

MJ: You might get a lead or two from this. Who knows? It is a conversation. Just so you know, when I practice, and I still practice part-time clinically, it’s at an insurance-based primary care clinic. I totally hear what you’re saying. I think it’s maybe the hardest job in medicine to do insurance-based primary care and meet all the expectations that come with that type of system. It isn’t super sustainable for most people who go into it, full stop.

TB: I appreciate that. I appreciate that.

MJ: How do you deal with the critique of DPC that it actually doesn’t improve access to care?

TB: If you’re just looking at numbers and you have the same number of physicians, let’s simplify it. An insurance-based primary care physician has a panel of 2,500 patients, and a DPC physician has a panel of 500 patients. If you’re looking at panel size, then, yeah, the DPC doctor is taking care of one-fifth the number of patients as an insurance-based physician.

But the question is, are they doing the same thing? Are they providing the same level of care? I’d argue the answer is probably not.

There’s a study that came out saying that, for an average patient panel of 2,500, a primary care physician needs something like a 27-hour workday to implement all the guideline-directed care and everything else. You only have 24 hours. You need to sleep, eat, and spend time with your family. It’s literally an impossible job to take care of 2,500 people.

So you have to shrink that panel. It’s kind of interesting: 27 hours divided by five is about five or six hours. That’s a reasonable workday, maybe a six-hour workday. Bump your panel up to 600 or 700, and then you’ve got an eight- or nine-hour workday. That’s a reasonable workday to provide care that doesn’t burn you out and actually gives people good health care.

If you just look at panel size as a proxy for access when talking about scaling, then, yeah, you can’t compare them. But you have to look at what’s actually being offered, the cost of care, and the systemic issues that I’m sure we’ll get into.

I know it sounds like I’m bashing insurance-based primary care. I try to bash the system, not the people doing the work. People practicing insurance-based primary care are doing the best they can and trying to do the best they can for their patients with the limited time they have. They’re working their butts off and often burning out because of it, unless they have a side job where they own a bank, too, you know?

MJ: Yeah, I don’t know anybody like that.

TB: Yeah, no one, not at all. But the people who do this day in and day out, four and a half days a week, I can’t see most of them doing it long-term. They often have an exit strategy: “I’m going to work hard for this long, and then I’m going to leave medicine altogether. I didn’t sign up for this,” and all these things. It shouldn’t be like that. You shouldn’t hate your job when you go into work.

MJ: And that comes through with your patients, too. I’d argue that the turnover causes harm to patients when they’ve had maybe three or four doctors or PAs in four years. I’ve seen that time and time again because of the churn, as opposed to having a longitudinal relationship, like you mentioned.

I want to go back to your startup costs. I didn’t do the mental math, but what was the rough total for your DPC startup costs?

TB: Less than $2,000, probably less than $1,500. We’ll say $1,800.

MJ: $1,800 to start your practice. How long did it take you to generate $1,800 in revenue, do you think?

TB: That’s a question. During residency, I moonlighted a good amount. I heard you needed something like $30,000 in cash or something, so I didn’t moonlight to have that much, but I had about $20,000 or $15,000 in the bank. I was thinking, “I’m going to need all that.”

And $1,800… My first patient paid me $50 a month. So what is that? Yeah, banker, thank you.

MJ: Six hundred.

TB: That’s $600 annually. I was like, it’s not $600 a month. Yeah, $600 annually. So it’d be three years with just that one patient. But to make back the $1,800, I don’t know what it was, maybe six months.

MJ: You earned that back within only a few months. Overhead is quite low. Were you doing labs and stuff when you got your space?

TB: Even before I got my space, I was doing labs at people’s houses or at my house. I was doing labs and just charging them cost plus for those labs.

MJ: So walk me through your day, if you don’t mind, because this is so fascinating to me. I know it varies depending on the practice, but how many patients do you see on a normal day? We’ll start there.

TB: Probably three to six a day currently.

MJ: Okay. And how long is each patient appointment?

TB: I usually schedule new patients for an hour and follow-up patients for half an hour. I might switch it to 40 minutes and 20 minutes or something, but that’s usually what I schedule people for. And it usually turns out to be about that amount.

MJ: And throughout the clinic day, how many patient messages, phone calls, or refill requests do you think you field?

TB: On a busy day, probably about 15 to 20. On a less busy day, fewer than 10.

MJ: If anyone is listening to this who does insurance-based primary care, I think there’s literally zero percent of people who would listen to that and say, “That doesn’t sound that good to me.” No one’s saying that.

Again, as someone who’s practiced primary care for a very long time, that would be a dream, to have that much time with patients. I don’t think all patients want to spend an hour with me, but it’s nice to have the time and breathing room.

Most people listening have probably experienced having a hand on the door, about to exit, when all of a sudden the patient tells you about their chest pain that they didn’t mention during the first 14 minutes of the visit. Having the ability to really care for a patient holistically is probably extremely appealing. That’s why so many people are asking about it. It’s just a matter of whether they can pull the trigger.

That’s a big risk. You went from being a resident, which is a slightly unique situation, as opposed to being an employed, salaried attending who has a cost of living and a quality of life that your run-rate expenses are trying to support, or that your job is trying to support.

It’s an even bigger risk to say, “Hey, I’m going to start with my neighbor and make $50 in the first month.” What do you say to someone starting a DPC as an attending physician, as opposed to starting it as a resident?

TB: If you’re doing this organically from the ground up, without taking out loans, or if you’re joining Mila Family Health, for example, you have to grow your patient panel to make what you’re making in the system. Eventually, you’ll probably make more than that, or you can make less and be happy with it. You can still be a well-paid physician without making $200,000 or $250,000 for primary care.

It takes time. A couple of things: I was really fortunate not to have loans in medical school. I almost ran out of money in medical school, but I didn’t have loans, which is incredible. For people who have loans, the situation is a little bit different. I’m sure you have resources for people, and I have some resources for people, too. That can change the discussion a little bit.

Working part-time in the system, making more money than you made as a resident while you build your panel on the side, is an awesome way to go.

Or, if you’re an attending physician and feel comfortable financially, then planning ahead and knowing that you’re going to take a little bit of a financial hit, but setting yourself up so that it’s not detrimental to you, is almost 100% doable, I feel like, if you’re smart about it.

DPC notoriously has super-low overhead, pretty good retention, and a pretty high success rate for people who are just starting a clinic, honestly. If you’re joining a clinic, again, if you’re in Fort Worth, let me know because we probably have 100 patients on our waitlist who are waiting to join and waiting for someone to be their doctor.

If you’re joining a clinic, it’s a little bit easier because you don’t have to do all the marketing and networking you would if you were starting up.

MJ: Are you finding that trainees are viewing direct primary care… That’s just not fair. I’m the one asking questions.

TB: What are your thoughts? How do you think they’re finding it? I’m curious what you think because you’ve probably encountered trainees.

MJ: I think it sounds appealing, absolutely. I think it’s not quite the reality of what insurance-based outpatient care is like. Most of us experience it in residency to some degree, but the day-to-day is a lot different when you’re…

I call it parallel play. It’s different when you’re with your resident friends and you’re kind of all in it together, and there’s some variety because you’re doing inpatient work, et cetera.

But when it’s just you and your panel, my experience was that I joined a practice after residency. I loved the partners and the system, but it was one of those situations where I accepted anyone who needed to come see me. Whatever your insurance was, I didn’t really care. As long as you needed a doctor, cool.

But the problem is when you go from a guarantee to what you collect. I didn’t pay any attention to what insurance people had. It turns out that when you have a high Medicaid panel, you don’t get paid very much. It’s tough to make decisions like that, especially when you’re in primary care in an area with a high amount of public insurance.

I’m rambling. This is why I ask the questions and don’t answer them, I guess. I just think that if you’re a resident, it’s probably really hard to know what the alternative is and understand how appealing DPC could be from a quality-of-life perspective.

TB: Exactly. I like that answer a lot. I’d say I just did a talk for the residents on direct prenatal care specifically, and the residents and medical students were jazzed about it. It’s a lot of the people who’ve been in the system for a while, like some of the older attendings, who are like, “Whoa, guys, slow down. These are all the reasons you shouldn’t do it.”

It’s just odd. A lot of the young residents I talk to are interested in it, which is a lot of fun.

MJ: I think we also have a generation coming through training that’s probably more entrepreneurial in some ways than when I was going through residency. It’s just more prominent for a variety of reasons to go out and have a side hustle or start your own thing, and this scratches that itch.

But just like anything in medical training, it’s hard to do something you haven’t seen anyone do. The people training us most likely work in academic medicine or at an academic medical center. That’s what they’ve always done, and the people who trained them did the same thing. It’s really difficult to do something different if you haven’t seen it.

As we were talking off camera before, doctors are really good at navigating new things. It’s just a matter of whether we have the opportunity to do it, and DPC seems like one of those opportunities.

Let me ask about the actual day-to-day of DPC. What was, let’s call it…

TB: Yeah, definitely. It’s a great opportunity.

Michael Jerkins:

The cheapest investment you made in your practice that produced the highest ROI? I’m going to ask the opposite after this, too.

Toli Berezovsky:

I was ready for that question. No, the most expensive. Okay, yeah, thanks for preparing me.

Everyone tells you that you have to choose an EMR, and that’s not true. The whole purpose of an EMR is to document patient encounters, keep your notes straight, and maybe collate a bunch of information together. But an EMR itself isn’t necessary for good health care.

Most EMRs, even the ones made for direct primary care, are encounter-based, and encounter-based EMRs don’t make sense for direct primary care. They also don’t help you manage your patients from a population health standpoint.

That’s one reason I didn’t bite the bullet on an EMR. I was also trying to build things from the ground up. I thought, “I don’t think I need an EMR. Let me try to build this tech stack myself.”

That’s why I used Google Drive. The cheapest thing was my EMR, which was just Google Workspace. Every patient has their own little folder, with subfolders containing their chart and everything. That was $14 a month. So that was my EMR, as opposed to something that costs $300 a month.

MJ: Is $300 a month about the average cost for DPC EMRs?

TB: Yeah, $300 a month. It’s much more doable than people who say, “How do I reach out to Epic?” It’s like, no, no, no, you don’t want to reach out to Epic.

MJ: That’s not it. But I’ll ask the inverse. What’s something you thought was going to generate a high ROI, spent a bunch of money on, and it didn’t turn out that way?

TB: The thing I spent the most money on was a storage unit and stuff to fill it with. I found a good deal on Facebook Marketplace for some old clinic equipment. I have some of it here, like an exam bed and some chairs, but it was old. I spent about $2,500 on it and put it in storage. It sat there for $80 a month, then the price jumped to $100 a month, and then it jumped to $130 a month. It was just sitting there, and we ended up giving most of it away. Some of it broke, too.

So that was a lesson learned. That was not in the spirit of design thinking. Hoarding is not in the spirit of design thinking.

MJ: Hoarding isn’t a stage of design thinking, okay?

TB: Well, you know, it might be a stage. It’s probably a stage, but it’s not the right stage for me.

MJ: I’ve had this question, too, that people have asked me about call. I mentioned during your average day, who calls for normal messages to the doctor and things like that. But what about after hours? How does that work? How do you handle that? What’s the call volume like?

TB: When I first started, again, I started really cheap. One of the things I had was a Google Voice number for about $9 a month. It was a separate phone number but still went to my cell phone. When someone called or texted and I knew they were a patient, I had them saved in my contacts as a patient.

At first, there was no way to direct after-hours calls somewhere else. But once I reached a certain number of patients and was getting enough phone calls and texts on the weekends, I didn’t have a great way to organize them or triage them to determine what was actually urgent versus what wasn’t. It got to be a lot.

There’s another app called Spruce, and it lets you set up little workflows. If it’s after hours, patients get an automated text saying they’ve reached the after-hours line. If it’s urgent, they’re asked to call a number, and it walks them through something like a phone tree. Honestly, I hated setting that up, but I did.

My patients know that it exists now, and they know that if they hit the “Yes, this is urgent” button, I get a text on my personal cell phone. Oftentimes, I see it and can call them right away.

A lot of people are afraid of being on call 24/7, and that is concerning sometimes. It’s all about how you set up expectations with your patients and how you build a relationship with them. If someone wants you to be available 24/7, then they don’t understand that doctors are also people and need family time, sleep, food, and vacations.

If someone has those unrealistic expectations of you, they’re probably not a good fit for your practice, unless you have that expectation of yourself or have some way to provide that 24/7 access. But that concern does hold a lot of people back. They think, “I don’t want to be on call 24/7.”

MJ: Yeah, I think that’s again just a matter of having thousands and thousands of patients you could be covering for an entire practice, as opposed to 250 patients who know you personally and whom you know personally, because you saw them at their first patient visit. I would suppose that’s a very different experience.

You mentioned that a full panel for DPC would be about 500 patients, right? In a practice like that, what’s the ideal model for support staff outside of the physician?

TB: I think you could get by with one support staff member for a 500-person panel, working 30 to 40 hours a week.

Right now, I’m at 240 patients, and I have one part-time assistant. She’s pre-med. She finished her undergrad and is going to apply to medical school in the next year or two. She works about 20 hours a week. A lot of it is remote work. Sometimes she comes in and helps with procedures, lab draws, restocking, and cleaning.

Honestly, it’s a super lean operation. She’s really good, too, so that helps. Find yourself a pre-med.

MJ: Wow. That’s like the pre-meds I know who did dictation and scribing, which might be a dying human technology by this point. Speaking of which, what AI tools make it more possible to run a DPC?

TB: I have some people for you to talk to and ask that question.

I’m trialing an EMR that’s non-encounter-based and is trying to rethink how we do documentation. There are so many scribes out there that can listen to a conversation and write the note for you. But you need more than that.

That’s fine for insurance-based primary care, where you’re just trying to generate a note to send to insurance to get paid, and then that’s all you need. But in non-insurance-based primary care, where you’re actually trying to get a whole picture of the patient’s health, that doesn’t quite cut it anymore. There’s not great technology for that yet, but I think people are working on it.

I haven’t explored all the AI tools just yet, but for my onboarding process, I used to do everything on paper and with Google Forms. Now, using Claude Code, I coded scripts, and there are APIs with Square, Google, and all these things. So all that stuff is automated now.

I just send someone one link. If they want to sign up, they follow the link. If they don’t want to sign up, they don’t. I don’t have to think about all these things I was doing that created extra work on my end. There’s so much you can do.

MJ: Yeah, I guess my thesis would be that it’s only getting easier and easier to do this with the technology that’s coming out. It’s probably going to get cheaper and cheaper, too.

Are there models for direct specialty care that you’ve seen work? What are some specialties where you see it working well?

TB: Yes, definitely.

I’ve seen it work well with endocrinology and rheumatology. I’ve even seen direct oncologic care work well. That’s the one specialty people always say, “If I get cancer, I need insurance.”

I consider myself pretty knowledgeable about direct primary care. I’m a little less knowledgeable about direct specialty care, but there are a couple of things I’ve seen.

First, a specialist is typically an internist, Med-Peds physician, or pediatrician. So they can also be a primary care physician. When their patient needs an additional service, like endocrinology or rheumatology, they can put on their specialist hat and provide that care.

These specialists can have a steady stream of income doing direct primary care. Then, from the community or their own patients, they can say, “Hey, if you need a rheumatologist, I’m your person.” Or they can offer fee-for-service rheumatology consultations to the community the way they typically would.

That’s how I see people doing direct specialty care. I don’t think everybody does it that way, though. There’s Dr. Granita out of California, who’s a rheumatologist, and Dr. Rodriguez out of Florida, who’s an endocrinologist.

I’ve hopped on three-way calls with them, just like me, you, and Brianna. It’s me, the specialist, and the patient. I know the patient’s story, so we can cut to the chase pretty quickly. Then the specialist asks the patient questions, and we come together with a plan.

I’ve seen it work out really well. For example, there was a woman with thyroid eye disease whom we got started on a new monoclonal antibody. We got it fully funded, and I’d never even heard of this treatment before we got on a call with the specialist. She was able to start the treatment, and now her thyroid eye disease is much better.

It’s just a really cool model to hop on a Zoom call with an endocrinologist and talk through the case.

MJ: As you said, I would guess this is a throwback to what medicine would have been like a very long time ago. Maybe not Zoom, but the idea of it.

I’d love to get your take on the health care system in general. I know you wrote an article that we can link, but the title was “The Problem With Our Health Care System Is It Ain’t Broken,” right?

I love that saying because I say the same thing all the time: every system is perfectly designed for the output it produces. So it’s not broken. It’s just producing something that a lot of people don’t like.

What role would you say doctors have in trying to change that system?

TB: The whole purpose of the health care system is for people to get and stay healthy through visiting a doctor. The doctor is key to that.

It’s kind of our job to ensure we’re working in a just, equitable, and good system and doing the best we can. In saying that, I think you can get yourself into a little bit of trouble by blaming people, whether that’s doctors who stay in the system or doctors who leave the system because they’re seeing fewer patients. You can easily get into a blame game.

We all have a responsibility to play. We get paid pretty good wages to help people get and stay healthy, so we have to think critically about how we’re contributing to the problem in the current system as physicians and how we’re contributing to the solution. How can we make this better? How can we keep working without burning ourselves out?

There’s agency and free will. You can do what you want, but you really have to think critically about the system you’re working in and the incentives you’re working under, then decide for yourself: Do I feel good about this, or do I want to do something different?

MJ: Have you seen people start DPC practices because of your work and the example you’ve set?

TB: I’m hoping so. I’ve had a lot of people interested in it, and I think some have started. I used to try to track it, but I talk to so many students and residents now that I can’t keep track of them all.

I hope so, because I’m trying to tell people, and again, my mom hates when I say this, “Y’all, it’s really easy to do this.” She’s like, “Don’t say that. You worked hard for this.” And I’m like, “Well, yeah, true, but it’s also not that hard to start a practice.”

I try to preach that, and I feel like I’m just starting this thing, so it’s still kind of early. I’m hopeful, but I don’t have a number.

I have a couple of stories. Priyanka Kadari, I think, has started a practice. I think she already incorporated with the state. Sage Family Health or something like that. She’s starting a direct primary care practice, and there are a lot of people interested in it.

There’s more fear than interest, honestly.

MJ: Really?

TB: Yeah. The energy is there, but people don’t pursue it because of fear and complacency. The alternative is that you can make a six-figure salary, get bonuses, and things like that. When you first sign the contract, it’s not like that, but then they start piling on more and more until eventually you burn out. That’s kind of how I see it.

MJ: Yeah, that makes sense. I’m curious about employers in this model. I know of employers who basically sponsor their employees’ memberships in a DPC. Maybe they contract with the DPC. How do you see that working? Do you think it’s actually helpful, or is it just a different form of insurance-based practice? Tell me your opinion on that.

TB: My opinion from the beginning is that it’s not pure DPC, but it depends on your goal.

If your goal is to inspire as many people as possible and show them that there’s an alternative to insurance-based primary care, that’s a good way to go. If you’re trying to grow a movement of people who aren’t giving their money away to insurance companies but are paying physicians directly, or if you’re an employer trying to save money, then 100%, that’s the way to go.

But the relationship is different when you go that route versus contracting directly with a direct primary care doctor.

There are quite a few people out there designing plans and connecting employers with DPC practices. Many of them are doing it as purely as possible, but they’re still introducing a third party. When that third party grows big enough, or when one physician or a couple of physicians become too dependent on that third party, you’re kind of back to where you started. You’re dependent on third-party primary care instead of non-insurance-based primary care.

MJ: Okay. Yeah, their employee status changes.

TB: Exactly. It’s a good way to get the word out, but for me, it’s all third-party primary care.