Nick Soman, Decent
I am here with Monica McKitterick, who is a killer DPC out in Texas at Impact Family Wellness, and she leads a team of Nurse Practitioners that are delivering five star primary care. And I'm not making that up. That's according to Facebook and Google and Yelp. I checked all of them. So really excited to be here with Monica. She's an inspiration to me and to our team. And hopefully at the end of this quick Q & A, you'll understand why. Monica, anything you wanted to say before we jump right into the questions?
Monica McKitterick, Impact Family Health
No, just excited to be here. Nick, let's dive in.
Nick Soman, Decent
Okay, let's dive in. So my first question, and you've told me a little bit about this, but I want you to be able to share it with other people. What first appealed to you about the DPC model? Usually I'd ask, how did you find DPC? But I think in your case, I get to ask, how did DPC find you?
Monica McKitterick, Impact Family Health
DPC definitely found me. I had been a Nurse Practitioner for ten years in the insurance based realm, doing everything from primary care to urgent care to orthopedics. I even did venous and lymphatic medicine. I did a fellowship in that. I loved all of it. But I really have a passion for primary care because I was taught to take care of all of it. And so, especially when I was in ortho and I would see a patient with a broken bone and be like, wow, your blood pressure is really high. And I know how to fix that, but that's not my job, so you have to go. But then in the primary care world, it was so hard. I was having to see 30 patients a day and I was like the Wizard of Oz. I'd be like, “Oh, call me if things aren't good.” And they would, but they had to get through the receptionist, the medical assistant, the nurse before they could get to me. It was like I was behind this door, like nobody could talk to me unless you got through all the keys. And so it was exhausting. And so I was relocating to Texas, trying to figure out what I was going to do with my life. And Facebook sent me an ad and the ad said, primary care physician takes home $400,000 a year and is home in time for dinner. And I was like, well, that's a lie. And I clicked on it and it was all about direct primary care. And I was like, wait a second. This is amazing, by the way, I don't make $400,000 a year. Not even close. But anyway, basically someday soon, right? I went to my husband and I was like, by the way, my husband has an MBA. I'm going to open a practice which he first of all laughed at. I'm going to open a practice where I can see less patients, take better care of them, have more control of my time, and make the same amount of money. He laughed in my face. Nick he literally was like, Monica, that's not real life. You can have, like, two of those, maybe a third, but you can't have all four of those. So I took a deep dive, and here I am, almost five years later, living my best life.
Nick Soman, Decent
I love it. It literally found you, and it found you via targeted Facebook ad, whereas I get Facebook ads for, do you want to be a truck driver? And would you like to buy this Tastybake Oven? You must be doing something right. I really love that. And it actually tees into my next question for you, which is, you're an inspiring person. Right? I've made a few intros of people to you, and they get back to me and they'll say, oh, this person's amazing. We were on that nice thread last night about this. What would you say to people that are the clinicians that are sort of in that fee for service system? Maybe they don't see a way out. Maybe they see that there is a way out, but they're afraid. What advice would you give people that either are looking at this and they aren't sure, or they should be looking at this and they're not yet. What would you tell them?
Monica McKitterick, Impact Family Health
Do it, honestly. I mean, if you had asked me a year, in fact, about a year before I opened my practice, I was playing tennis with this girl, and she had just graduated from college. And I was like, oh, what did you get your degree in? And she said, Entrepreneurial Studies. And I said, what's that? I didn't even know what an entrepreneur was. And the idea of owning my own practice never crossed my mind. I even told my husband back in the day, I was like, I will never own my own. Like, I don't want to worry about who turns the lights on and who's doing all these things. But the more I learned about DPC, the more I realized I can do this. I have the skills to take care of people. So why do we need all of this other fluff in the world of billing and coding? I went to school for nine years to take care of people, and I was just taking care of insurance companies. All I was doing was paperwork all day long. And that was not what I wanted to do. I wanted to have relationships with my patients and make sure that they were well taken care of. And I couldn't do that in the insurance based world. And so this idea that I could do this was awesome. . . And within the first two months I was cash positive. I didn't pay myself for the first six months, but only because I could have paid myself, but I was just putting the money back into the business. But yeah, here we are five years later and we're over a million dollars in revenue, which I never expected. I did DPC to start to give myself a job, not to start a business. And it's kind of just delved into that because DPC is a service that people want and they need, they just don't know it exists. And so it is the best situation for patients and especially for providers. I employ almost at least seven NPs next month and none of them will leave me because I pay them well. Their life work balance is amazing and they get to do what they've always wanted to do. So if you are even considering doing DPC, first of all, call me. I'll have a conversation with you and convince you to do it. But there's so many resources. Like I did this five years ago and so there weren't a ton of like I went to a nuts and bolts conference and that was helpful, but there weren't these giant Facebook groups of people just offering up their help. And I'm here to tell you, most of the providers and clinicians in the DPC space are here to help you because we want you to be successful, but you have to be really good at what you do. So if you're just a mediocre provider, we don't want you in DPC. I need the badass providers of this nation to become DPC providers. So do it and call me and I'll help you.
Nick Soman, Decent
You got me fired up thinking about how we can help too. So now I'm thinking about Decent funding awards to help create new DPCs or something. It sounds like you want the best providers, they should call you. And if people are thinking about this and they're a top quality provider, they ought to do it. So now I want to go a little bit into real talk, founder to founder, because I think of you that way. It's so much better than what you were doing before. But you and I both know it's not perfect. So I want to know the part of your job and the worst part of your job, your job as it exists today. And, yeah, I don't have to say be real with me, because you always are.
Monica McKitterick, Impact Family Health
Yeah. So my job is a little bit different now simply because not only am I a Nurse Practitioner, but I'm the CEO, right? It was one thing when I was just my own boss that was fine, but now I have employees and payroll and taxes and all these things that go into the business side of it, which actually is my favorite. Now, I will tell you, my least favorite part of my job is crazy patients. But guess what? That's in any healthcare practice. Unfortunately, our world has changed a bit where healthcare providers aren't nearly as respected as they used to be. Because Google exists, right? Everybody can diagnose themselves. Everybody knows what's going on. And my 15 years of experience doesn't actually matter to them. And so I got to say, dealing with the Google mds of the world is not my favorite. Also, I'm a lover, not a hater. And so I have changed a lot in the last five years in terms of building a backbone, because I have always wanted to just fix everybody. And so, especially when I started, it was really hard for me to be like, no, you have to pay me to do that. Turns out I have to keep the lights on. But that's because it was just me, right? And I didn't get paid. It was okay. But now I have a giant payroll to pay. Like, paying Nurse Practitioners is not cheap. And so I've definitely changed who I am in terms of having that business mind. Like, listen, I'm here to help you, but it took me a long time to get here. I think so many people think, oh, you can just write a prescription. It's no big deal. Just do that. Right? It takes you 20 seconds to do it. Yeah, except it took me nine years to get the license to do it. And also, I have to pay a lot of money in malpractice, and something goes wrong with that prescription, it's on me. It's my license. And if I lose that license, guess what? I can't just go get another one, right? It's not like I'm a blue collar worker who can be like, oh, well, I got fired from this job as a plumber, but I can go get another job over here as a plumber. Right?
Nick Soman, Decent
And people are coming to you because of that tremendous amount of experience you have and because you take it really seriously to do it right. So I want to know the best part of your job, too.
Monica McKitterick, Impact Family Health
Oh, man. I have so many best parts of my jobs. I will tell you, my best part of my job is probably some of those crazy patients, too. I do love taking care of patients, but what I love more than anything is seeing the happiness in my patients, in the patients of all of our offices. Right? We have three locations, and so seeing the messages come through the, like, oh, my gosh, thank you so much. This is so amazing. And then also seeing how much better the lives of my employees are. Right? We're all really close. We all do events together. We hang out together, we watch each other's kids together. And so knowing that I've built this place, that's not only amazing for our patients, but also for my employees, it really warms my heart every day.
Nick Soman, Decent
That resonates a lot. And actually, I hope your employees are feeling some love, because when I went and looked, honestly, I was like, wow, five stars on Yelp. Okay? Five stars on Google. Okay. Round to five stars on Facebook. It's incredible what you've been able to deliver. And in my know, if there's ever a kerfuffle about whether Nurse Practitioners can provide five star direct primary care, I would just say scoreboard, but I'm petty like that. And so my question to you is, what are some misunderstandings about Nurse Practitioners? We'll charitably call them misunderstandings that you would like to set straight.
Monica McKitterick, Impact Family Health
Sure. Well, I think we did a terrible job naming ourselves, because a lot of people just think that we're the same as nurses, we're just an RN. Right. But as Nurse Practitioners, we can diagnose, we can prescribe, we can do all sorts of things. And it's all based off of your training. Right. And it's also based off of which state you live in, of how much autonomy you can get. I lived in full practice authority states for the first ten years of my life, and so it wasn't until I came to Texas that they were like, oh, yeah, now you need a supervising position. I was like, oh, I apparently left my IQ in New Mexico when I left. Okay, cool. But we follow the rules. We do all the things, but there's really not much that a primary care physician can do that I can't do. And, in fact, I love to do procedures. And so I've done a lot of training in procedures, and so there are procedures that I do that a lot of family physicians probably don't do. I cut out ingrown toenails. I do joint injections. I put in iuds because I love those things. And so I've done the training to do it. And so our license is basically, you do what you've been trained to do. There's no like, oh, you can't do that. You can't do that. Now, some states do have rules on what you can prescribe, but that's a whole nother story. But in general, there's really not a big difference between a Nurse Practitioner and a physician, especially in the primary care world, which I think is where we fit the best. And it's interesting. People ask me all the time, what's the difference between a doctor and a Nurse Practitioner? I was like, well, our schooling is different in terms of how many hours you do and that sort of thing. But I think one of the biggest things is that doctors are taught to treat diseases and nurses are taught to treat people. And there's a big difference in how you approach a patient from that side. Not to say, listen, here's the deal. I know some amazing physicians out there that are just like the best thing ever, and I adore them. And they're very good friends of mine.
Nick Soman, Decent
Me too.
Monica McKitterick, Impact Family Health
And I know really great Nurse Practitioners, but I know really crappy Nurse Practitioners, too. Right. And I know really crappy doctors, and I know really crappy plumbers, and I know really crappy people that sell insurance. Right. And so this is part of my ploy for DPC is I don't care what your credentials are. If you're an NP or MD. I don't care. You just have to be a badass.
Nick Soman, Decent
And I heard a couple other things in there. You have to be a badass, and you're all practicing within your license, so that's not an issue.
Monica McKitterick, Impact Family Health
Absolutely.
Nick Soman, Decent
And then it's not that you're saying every NP is as good as every doctor because not every doctor is as good as every doctor. And so it's really just about a quality bar practicing within the license. The other thing that I think gets lost, and I'm a big fan of big tents where everybody inside the tent accidentally fights even though they're all marching up the same hill. We need this. We need this as a country. And I think I hear from a lot of physicians, there aren't enough primary care physicians. That's also true. And there aren't enough Nurse Practitioners. And infighting is not going to allow us to be of service in the way that I know you want to. So I love it. Yeah, you got me going a little bit. Last question for you. Who else in healthcare inspires you and why? And let's not talk about other. Well, no, you can tell me, whoever inspires you in healthcare and why.
Monica McKitterick, Impact Family Health
Sure. So Josh Umber is the head of Atlas MD, and he has grown an empire over there. And he's one of the founding people of DPC and an incredibly kind human being. He doesn't care what your credentials are. He just wants people to understand. His brother is a lawyer. And I put out a message in a direct primary care Facebook group and I was like, hey, guys, I need a lawyer to help me with some things. He's like, oh, we have a free one here. Email him. Guys, I don't even use Atlas MD. I've never paid them a dime. And they have sent me document after document. I got to talk to this lawyer. His name's keen and he's hilarious on the phone. I was like, can I join the family. Like, I just want to be adopted right. Josh has just built this team, right? And if you have questions about DPC, they are so welcoming and so, like, yes, we don't care if you use our software. We don't care if you do anything we want. We just want you to know about DPC, make it safe and make it work. And that inspires me. Right. Because DPC needs to take over the world. And I feel like Josh and his team are doing such a great job. I just want to emulate, right. And also be of help to other people as they grow these things. And so I'm sure Josh is doing fine. But, yeah, I just appreciate that they are so welcoming and helpful because sometimes this world DPC can seem like it's competition, but to be honest, I don't see any other DPC as a practice, as a competition. And this is the beauty of DPC, is it's a free market. So people come to my office because of Monica, because of Joanna, because of my mps, because they relate to them. Other people go to Dr. Miller, who runs a DPC 3 miles from my office because they like Dr. Miller. And that's the best.
Nick Soman, Decent
Is that Dr. Melissa Miller or is that a different doctor? Yeah, yeah, I love her, too. Great.
Monica McKitterick, Impact Family Health
Yeah, they're great. And so I've met every DPC doc here in the Austin area. I know all of them. I could call any one of them, and they're all great human beings, right? And it's all about that collaboration so that we all can spread the word of DPC to make sure everybody knows.
Nick Soman, Decent
Oh, thank you so much. This has been wonderful, as always. I feel like I could talk to you for an hour and a half. Thank you for your time.
