Podcast Episode Summary: DPC Pediatrician — Zest Pediatric Network

Host: Dr. Marina Capella

Guests: Dr. Drew Hertz & Dr. Keili Mistovich (Co-founders, Zest Pediatric Network)

Episode Overview:

This episode features an in-depth conversation with Dr. Drew Hertz and Dr. Keili Mistovich, co-founders of the Zest Pediatric Network. The discussion centers on how Zest is transforming the landscape for pediatricians interested in Direct Primary Care (DPC) by providing a supportive, collaborative network model that lowers barriers to entry, maintains physician autonomy, and enhances patient care.

Key Highlights

Why Zest Pediatric Network Was Created

* Zest was founded to make it easier for pediatricians to enter the DPC model, especially for those who are hesitant to manage all business and clinical responsibilities alone.

* The network aims to lower barriers for doctors who may not have business experience or resources to start independent practices.

* The founders believe every pediatrician should have access to the DPC model, not just those with entrepreneurial backgrounds.

Team-Based Approach

* Zest operates on the philosophy that "DPC is a team sport," offering pediatricians the benefits of independence with the support of a collaborative team.

* The network provides two main types of support: Business Team: Handles back-office operations, freeing doctors from administrative burdens so they can focus on patient care. Clinical Team: Offers cross-coverage among doctors, making it easier to take vacations and manage time off without compromising patient care.

Expanded Services Through Economies of Scale

* By pooling resources, Zest offers access to additional professionals—nutritionists, sleep consultants, lactation consultants, psychologists—who support comprehensive pediatric care.

* These services would be difficult for solo practitioners to afford or coordinate independently, but are feasible when shared across multiple offices.

Network Structure and Autonomy

* Each doctor operates as an independent LLC, preserving their autonomy and preventing the network from becoming a corporate healthcare system.

* Zest emphasizes a "servant leadership" model, where the network supports the physicians rather than employing them, and clinical support professionals are also independent contractors.

* The structure allows doctors to have equity in the network and a say in its development and direction.

Operational Efficiency and Growth

* Zest has successfully launched multiple offices (three in Cleveland, two in Pittsburgh) and can help new practices become operational quickly—sometimes within three months.

* The network manages everything from patient onboarding to administrative tasks, allowing doctors to focus solely on clinical care.

Integration and Community Partnerships

* Zest has established contracts with schools, Medicaid, and therapy centers, enabling broader service offerings such as autism assessments and evaluations.

* The network's unified electronic medical record (EMR) system allows seamless sharing of patient information among the team, ensuring coordinated care.

Maintaining the DPC Ethos

* The founders stress their commitment to preserving physician autonomy and avoiding the pitfalls of corporate medicine, which many DPC doctors seek to escape.

* Decision-making within the network prioritizes the independence and preferences of member physicians.

Notable Quotes

"DPC is a team sport because not everybody wants to go it alone."

"We work for the doctors. The doctors don't work for us."

"Maintaining autonomy for our physicians is always front of mind when making decisions about the network."

Conclusion

Zest Pediatric Network offers a unique, scalable solution for pediatricians interested in DPC. By combining business and clinical support, expanding access to ancillary services, and maintaining physician autonomy, Zest enables doctors to focus on what they love—caring for children—while enjoying the benefits of teamwork and shared resources.

In this episode of DPC Pediatrician, Dr. Phil Boucher and Dr. Marina Capella dive into the frequently debated topic of whether DPC practices should charge an enrollment fee. They share their personal experiences, perspectives, and practical advice for pediatricians considering this approach.

Key Highlights

1. What Is an Enrollment Fee and Why Consider It?

* An enrollment fee is a one-time charge for new patients joining a DPC practice. It helps offset the upfront time and effort spent on onboarding families, such as reviewing medical records, conducting lengthy initial visits, and creating follow-up plans.

* Dr. Capella initially disliked the idea of enrollment fees but later found them beneficial for protecting against families who leave shortly after joining, despite significant upfront investment.

2. Benefits of Charging an Enrollment Fee

* Commitment Indicator: The fee encourages families to think carefully before signing up, ensuring they understand the membership model.

* Financial Protection: It provides a buffer for the time-intensive onboarding process.

* Clarity: It reinforces the idea that DPC is different from traditional practices, helping patients understand the recurring membership structure.

3. Practical Approaches to Enrollment Fees

* Both doctors charge $100 per family as a reasonable fee but note that practices can set their own amount or waive fees in certain situations (e.g., newborns or special cases).

* Waiving fees can be used as an incentive to encourage sign-ups during meet-and-greet sessions.

4. Alternatives to Enrollment Fees

* Minimum Membership Commitment: Practices can require families to commit to a minimum duration (e.g., six months) instead of charging an enrollment fee. This ensures stability while avoiding upfront costs.

* Flexible Policies: Some practices opt not to charge enrollment fees or enforce commitments to minimize barriers for families, especially in lower-income or rural communities.

5. Tailoring Fees to Your Community

* Pricing strategies should reflect the economic realities of your patient base. For example, in areas with lower average incomes, an enrollment fee might deter families from joining.

* Testing your market and adjusting policies based on feedback is crucial for success.

6. Final Thoughts

* The beauty of DPC is its flexibility—practitioners can decide whether to charge fees or enforce commitments based on their values and community needs.

* Both Dr. Boucher and Dr. Capella emphasize that it’s okay to experiment with different approaches and adjust as needed.

In this episode of DPC Pediatrician, hosts Dr. Phil Boucher and Dr. Marina Capella welcome Dr. Dhanu Sant and Dr. Valerie Miles from ThriveWell Pediatrics in Jacksonville, Florida. The discussion centers on their journey into direct primary care (DPC), their partnership model, and how integrative medicine shaped their practice.

Key Highlights:

1. Backgrounds of the Guests:

* Dr. Sant's Journey:

* Originally from Columbus, Ohio, Dr. Sant trained at Ohio State University and Columbus Children’s Hospital.

* She began her career in a large pediatric practice but grew frustrated with the limitations of fee-for-service care, particularly the lack of time to address foundational health issues like nutrition and sleep.

* Inspired by her Indian heritage and yoga practice, she transitioned to integrative medicine and started her own pediatric practice in Columbus.

* In 2019, she decided to move to Florida for family reasons and began exploring a partnership with Dr. Miles.

* Dr. Miles' Journey

* Trained in Salt Lake City, Dr. Miles felt drawn to pediatrics early in her career.

* She practiced in Durango, Colorado, where she encountered holistic approaches like garlic oil for ear infections, which sparked her interest in integrative medicine.

* After moving to Jacksonville in 1999, she started her own insurance-based integrative practice in 2000 and became board-certified in integrative medicine.

2. Formation of ThriveWell Pediatrics:

* Drs. Sant and Miles met through integrative medicine conferences and maintained a supportive professional relationship over the years.

* In 2019, they decided to combine their expertise and open ThriveWell Pediatrics as a direct primary care (DPC) practice in Jacksonville.

* They attended the Nuts & Bolts DPC conference, which provided the foundational knowledge needed to launch their practice in 2020.

3. Benefits of Their Partnership Model:

* The doctors emphasized the importance of finding the right partner, likening it to a marriage.

* They balance responsibilities based on their strengths, such as accounting and patient communication, making the workload more manageable.

* Both agreed that having a partner enhances the experience of running a practice compared to doing it solo.

4. Integrative Medicine in Pediatrics:

* Both doctors highlighted how integrative approaches—such as addressing nutrition, sleep, and natural remedies—can be transformative for pediatric care.

* Their shared vision for holistic care was instrumental in shaping ThriveWell Pediatrics into a unique DPC model.