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.

Key Highlights: Transitioning to Direct Primary Care (DPC) with Dr. Laura Lindner

1. Motivation for Transition

* Dr. Lindner experienced growing frustration and burnout in her previous group practice due to a lack of autonomy, inefficiencies in patient care, and an inability to implement her ideas.

* She was inspired by colleagues and other DPC practitioners who demonstrated the potential for this model in pediatrics.

2. Initial Steps Toward DPC

* Dr. Lindner began by researching the DPC model through Facebook groups like "Pediatricians that do DPC" and "DPC Docs."

* She explored the financial feasibility of starting her own practice, including preparing for a temporary loss of income.

* A healthcare attorney helped her navigate her employment contract, focusing on non-compete clauses and patient record ownership.

3. Navigating the Transition

* To comply with legal restrictions, she used creative methods to inform patients about her new practice:

* Created a personal Instagram account to connect with patients indirectly.

* Shared updates about her life and later redirected followers to her professional page after leaving her employer.

* She emphasized the importance of maintaining professionalism during the resignation process, giving ample notice (four months) to avoid leaving her former practice in a difficult position.

4. Challenges Faced

* Finding office space within the constraints of her non-compete clause was particularly challenging. She eventually secured a rental arrangement for one exam room in an existing office.

* Establishing an online presence was initially difficult due to SEO limitations and issues with gaining control over her Google profile, which was managed by her previous employer.

5. Lessons Learned

* Dr. Lindner advises others transitioning to DPC to:

* Thoroughly review contracts with legal assistance.

* Plan for logistical aspects like securing a business address and managing online visibility.

* Maintain positive relationships with former colleagues and staff to facilitate smoother transitions.

6. Results and Reflections

* Within six months of opening Homegrown Pediatrics, approximately 5–7% of her former patients followed her to the new practice, increasing to about 10% over time.

* Despite initial fears, she successfully built a sustainable practice while maintaining ethical and legal standards.

Key Highlights:

* Journey into Direct Primary Care (DPC)

* Dr. Amber Hull transitioned to DPC after a disability from a femur fracture in 2021 forced her to reevaluate her career.

* She created Village Pediatrics, a low-overhead, concierge-style pediatric practice that focuses on house calls and direct patient access.

* Her practice primarily serves children under five, with many families joining during pregnancy.

* Postpartum Health & Women's Care

* Dr. Hull integrates maternal health into her pediatric care, recognizing the impact of postpartum hormone shifts on women's well-being.

* She educates families on the similarities between postpartum and menopausal hormonal changes, emphasizing issues like vaginal atrophy, decreased libido, and emotional challenges.

* She collaborates with pelvic floor therapists and mental health professionals to support new mothers holistically.

* Challenges in Postpartum Care

* The healthcare system inadequately prepares parents for postpartum challenges, including relationship changes and physical recovery.

* Many women experience a lack of medical guidance in navigating postpartum hormonal shifts and intimacy concerns.

* Dr. Hull encourages open conversations with both parents to foster understanding and support during postpartum transitions.

* DPC as a Sustainable Model

* Dr. Hull discusses the benefits of DPC in allowing her to balance patient care with self-care.

* She emphasizes the importance of setting boundaries, outsourcing non-medical tasks (e.g., bookkeeping, marketing), and maintaining financial sustainability.

* Unlike traditional healthcare models, DPC allows her to cultivate direct relationships with specialists and community resources.

* Resources & Continuing Education

* Dr. Hull is an advocate for improving physician knowledge in postpartum and sexual health.

* Recommended resources:

* International Society for the Study of Women’s Sexual Health (ISSWSH)

* Menopause Society

* Dr. Kelly Casperson's book & podcast: You Are Not Broken

* She will be speaking on menopause and intimacy at an upcoming medical conference.

Final Thoughts

Dr. Hull’s approach to DPC highlights the need for integrative, patient-focused care in pediatrics. By addressing postpartum health alongside infant care, she provides a holistic model that benefits both mothers and children. Her story is an inspiring example of how physicians can reshape their practice to align with both their values and well-being.

In this episode of DPC Pediatricians, Dr. Phil Boucher and Dr. Marina Capella recap their recent experience attending the Pediatric DPC Mastermind conference.

Key highlights from the episode include:

* Networking and Community Building: Marina shares that her favorite part of the conference was connecting with other DPC pediatricians from across the country. She emphasized the importance of these relationships, as DPC pediatrics can be a lonely field. Meeting others with similar challenges and practices, such as those focusing on house calls or integrative pediatrics, was especially rewarding.

* Integrative Pediatric Care: Marina and Phil both highlighted a talk by Dr. Valerie Miles and Dhanu Sant from ThriveWell Pediatrics on integrative pediatrics. Their discussion on tools for managing common pediatric conditions, including the use of red blood cell magnesium tests, provided actionable insights that they have already integrated into their practices.

* Surprise Birthday Celebration: A memorable moment for Phil was a surprise birthday celebration during the conference, which included a humorous video from his colleagues. This gesture made the conference even more meaningful for him.

* Marketing and Growth Strategies: Phil talks about his talks on marketing and practice growth strategies. He emphasizes the importance of creating intentional marketing plans and targeting specific areas of expertise to grow a practice.

* Utilizing AI in Practice: Phil and Marina both discuss how they've started embracing AI tools like ChatGPT to improve patient communication and reduce administrative tasks. This includes creating patient handouts and personalized treatment plans.

* Clinical Learning: Both doctors reflect on various educational talks, including sessions on urgent care procedures, PANS/PANDAS, and managing complex medical conditions in pediatric DPC. They appreciate how DPC offers more time with patients, allowing for a deeper level of care.

* Appreciation for the Podcast's Impact: They also express gratitude for listeners who shared how the podcast has influenced their practices and decisions, noting the responsibility they now feel in providing helpful advice.

The episode concludes with a playful moment, as Phil's parody of "Popular" from Wicked is featured, humorously promoting the importance of social media in growing a DPC practice.

For those interested in attending future conferences, they mention that details will be available soon on the Pediatric DPC Mastermind website.

Key Highlights:

* Journey into Direct Primary Care (DPC):

Dr. Jalan Burton transitioned from traditional pediatric practice to DPC after experiencing burnout in the conventional healthcare system. She founded Healthy Home Pediatrics in 2019, offering 85% house calls and 15% in-office visits.

* Challenges in Traditional Healthcare:

She describes systemic burnout, unrealistic time constraints (10-minute follow-ups), and the lack of autonomy in patient care as major reasons for leaving.

* Building a DPC Practice:

* Knowing Yourself & Your Needs: Entrepreneurs should assess their strengths, weaknesses, and personal circumstances before launching.

* Financial Planning: Many DPC practices fail due to a lack of financial sustainability.

* Avoiding Comparison: Success in DPC looks different for everyone, and comparing to others can be discouraging.

* Balancing Motherhood & DPC:

* Dr. Burton has three children, and one of them was born while managing her practice during the pandemic.

* Strong support systems (family, childcare, home organization) helped her navigate work-life balance.

* Maternity leave was planned strategically by scheduling early visits and arranging coverage with trusted colleagues.

* Lessons Learned & Advice for New DPC Physicians:

* Avoid blindly following online advice—every DPC practice is unique.

* Invest in business coaching and mentorship.

* Prioritize self-care and structured time management (e.g., dedicated self-care Fridays).

* Implement systems for managing finances and patient memberships.

* Future Plans & Mentorship:

* Dr. Burton is launching a mentorship program for mothers in medicine and women of color transitioning into DPC.

* Emphasizes the importance of creating sustainable, joyful practices that benefit both physicians and their communities.

Key Highlights:

* Dr. Marina Capella’s New Clinic Building

* Purchased a historic home for her practice, creating a welcoming, therapeutic environment.

* Plans to expand services with a women’s health provider, a mental health therapist, and potential physical/occupational therapy offerings.

* Dr. Phil Boucher’s Strategic Focus Areas

* Prioritizing care for newborns and mental health patients.

* Adjusting marketing efforts to target these patient groups effectively.

* Exploring ways to demonstrate the long-term value of DPC for families with older children.

* New Service Models & Pricing Tiers

* Dr. Capella introduced three membership levels:

* Essentials Membership (basic pediatric care with visit limits)

* Complex Care Membership (for behavioral health or specialized care)

* Concierge Home Visit Package (for high-end personalized care)

* Designed to align pricing with service intensity and provide flexible options for families.

* Virtual Care Memberships

* Dr. Boucher is launching a virtual membership option to reach families in rural areas or those preferring remote care.

* Covers basic pediatric consultations, behavioral guidance, and parenting support.

* Vaccine Program Expansion

* Dr. Capella successfully implemented VaxCare, reducing out-of-pocket vaccine costs and improving financial sustainability.

* Challenges include workflow adjustments, but overall, it's a positive step for the clinic.

* Adding Multidisciplinary Care

* Dr. Boucher welcomed a speech-language pathologist to his clinic, expanding services for speech delays, autism support, and infant feeding.

* Enhancing his practice as a true medical home with integrated care.

Final Thoughts:

* Both doctors are refining their DPC models to improve patient experience and financial sustainability.

* They encourage other pediatricians to experiment with new service structures and share insights.