Nick Soman, Decent
You have several degrees in nursing, including a DNP. How did you get into healthcare, and how did healthcare get you into direct primary care?
Penni Vachon, Lowcountry Wellness Center
I knew as a kid that I wanted to be a surgeon, and I wanted to operate on the world's impoverished with Doctors Without Borders. In my senior year of high school I met my husband and I thought “Yeah, I don't think I'm gonna do that, I think I'm gonna marry this crazy guy”, and I changed my plan. I went into real estate out of high school. And then I had three back to back high risk pregnancies, so I spent a lot of time with my obstetrician. And during that third pregnancy he and I started to talk about “Hey, you know, you're very successful at 24 as a real estate agent, but is that really what you want to do forever?” and I was like “Well no, I really wanted to be a surgeon but now I'm gonna have three kids and you know I'm only 24 and what do I do?”
So he kind of put me on the path. He said, “I think what you're going to do is you're going to go to med school. But I think you're going to do it the nursing route. So let's get you into nursing school. And then you'll move to the University of Virginia where you'll be pretty much guaranteed a seat because you'll work there as a nurse. And then you'll go to med school. You'll come back and take over my practice.” And I said, “Yeah, OK, I'll do that.”
So when my youngest was a week old, I applied to nursing school. And I didn't tell a soul, only he and I were the only two who knew about it. And a few weeks later, I got the letter saying that I had been offered a seat. I called his office in a panic and I said, “Oh, my God, you told me that they were going to interview me and nobody interviewed me and they just gave me a seat. Now I have to go to freaking nursing school. What am I going to do?”
And he's like, “I think you're going to go.” And of course, you know, his first question was, “What did your husband say?” I was like, “I haven't told anybody. Like I need a plan. That’s why I called you.” And so, you know, over the next few years, I finished nursing school. And sure enough, I graduated nursing school May 21st of 2004 and May 22nd, we moved our family of five to Charlottesville, Virginia so that I could go work at UVA to go to med school, which is where his daughter was in med school, which is also why he picked UVA.
So I immediately started working on my bachelor's degree the next semester. I graduated with my associate degree in May and I started my bachelor's courses in June and he said he'd come down for parent weekend and we'd all go out to dinner. And I had already realized that I did not want to go to med school. I did not want to walk away from my kids for 11 plus years. The kids that I went through hell to have. And so we went out to dinner, you know, as couples, and I sat across the table from him and I said, “I can't do it. I'm sorry, I can't do it.” And he said “That's why I put you on the nursing path. All I ask is that you take nursing to a terminal degree.”
I said, “I can do that. I can do it.” And so when I finished my doctorate and I'd gone back home to visit, I swung by his office and I walked in and I said, “Hey, Dr. Hare, just wanted to introduce myself. Dr. Vachon here.” And he just gave me the biggest bear hug. And he was like, “I knew it. I knew you would do it.” I already owned my practice by then. So yeah, so that's a long story of how I got to be a nurse practitioner and how I got all my degrees.
He gave me that initial shove to say, “This is what you're going to do.” And I said, “Okay, sure, I'll do it.”
Nick Soman, Decent
I love that. Now who gave you the initial shove for DPC?
Penni Vachon, Lowcountry Wellness Center
I kind of started to look at alternative things. So when I opened my practice originally, I opened as a traditional fee for service and felt like I'd sold my soul to the devil. And then in early 2018, I became an autoimmune patient myself. And I realized that holistic autoimmune care didn't exist in Charleston. And so I was going to have to create it. And I knew that with my list of credentials, if I wasn't getting the care that I wanted, then nobody else was getting it. And that came up pretty quick. Even my specialists were like, why aren't you using your name and your title when you call around?
I said, “But that's not who I am. You know? If you're not going to see me because I'm Penny Vashon, then I'm not going to tell you that I'm Dr. Penny Vashon, the nurse practitioner. You don't get that privilege. If you can't treat me like a f***ing human. You're not going to treat me differently because of my title. So that's really, you know, kind of what made the shift for me was I started to become a patient and realized how it was on that side of things.
And then I made the transition later in 2018 and I said screw it, you know, patients were asking me constantly, you know, holistic ways to treat their ailments, know, the pressure and cholesterol and diabetes. And I was like, I can do it. Do I love it? No, but I can do it. And then finally, I just said, you know what, if I'm going to do this, I'm going to get really good. I’m going to do it. I want to. To give the care that I want to receive as a patient.
So the final culminating event was I had gone for a physical with my traditional physician. And something in my brain said, time this, this is not going to go the way that you think. So the medical assistant came in, took my vitals and I set a timer on my phone and I dropped it back in my purse. Nine minutes later, I was standing at the checkout desk for my annual physical.
She'd never touched me, never looked at a thing, never listened to a thing. It was, know, type, type, type, type, type. “When's your next procedure? When's your next test? When's your next follow-up? Great. I'll see you in a year.” I said to her as I was walking out the door, “Dr. T, how many patients are on your panel?” And she said, “Well, myself and the nurse practitioner, 4,000.” And I said, “How the hell are you providing adequate care to 4,000 people?” And she said, “I’m not. That's why I don't know anything about anybody.”
Her office was across the street from mine. So in the minute or two that it took me to get across the street, I had made the decision that I was canceling all of my insurance contracts and going the DPC route. I got back and I said to my then billing manager in my pissed off state as I was cussing out the world and throwing everything around the office.I said, “I'm done, I'm stopping, I'm closing the practice, we're going to DPC.” And she's like, “I don't even know what the hell foreign language you're talking about. But I do the insurance billing.” And I was like, “We'll find a new job for you. I can't do this anymore, I can't, I can't continue to sell my soul. Patients need me to be present and I can't be present if I have to take care of freaking 4,000 people.” So that was really what it is. That was October of 2018.
Nick Soman, Decent
Put yourself in the shoes of an NP that's been working in the traditional system for a while. What is she feeling? And what should she know if she's wanting to contemplate DPC or should be wanting to contemplate DPC?
Penni Vachon, Lowcountry Wellness Center
Well, she's feeling like she went into this for all the right reasons, right? Went into health care. I went to all of this school and to become a nurse practitioner to take care of people and I can't. Right? Hands are tied. I'm bound by the corporatization of medicine. You know, I can't spend the time with my patients that I want to spend. I can't educate them the way that I want to educate them. And she’s on a straight shot to burnout.
And so, the answer to that is go DPC, buy your life back, but more importantly, buy the time with your patients to be able to provide the care that you always wanted to give, but couldn't in a fee for service way.
Nick Soman, Decent
And what if she's going, gosh, that sounds good, but how am I gonna get members?
Penni Vachon, Lowcountry Wellness Center
Yeah, so it's word of mouth, in my Facebook group I host a monthly meeting and I tell everybody that your biggest advocate in the beginning is like-minded people. So you're gonna get out and you're gonna meet every chiropractor in town because you know how they think. They think like us, they're holistic. They think body, spirit, mind as a whole, right? You're gonna go and meet all of your acupuncturists, massage therapists, and you're gonna go and meet all of the referral sources, nutritionists, and your registered dietitians. Those are gonna be your primary referrals. Then you're gonna start to branch out into the urgent cares and the walking clinics and stuff like that.
But you need to make a name for yourself first. And so you're gonna blast social. You're going to get a good Google business page going, you're going to have a good website that answers all these questions, and then you're literally going to pound the pavement, you're going to go to every networking group you can find, and you're going to put yourself in front of all of the people, because who needs you, I don't know, everybody breathing, all of them. So you're just going to get yourself out there in front of everybody and educate. My first year as a DPC, I won the Charleston Choice Award for Best Family Doctor in Town, and we had t-shirts made that said, “My doctor is the best. Is yours?”
Nick Soman, Decent
Oh wow, I love that story. Okay, what's the best and what's the worst part of your job?
Penni Vachon, Lowcountry Wellness Center
It's the same thing in one. It's being an entrepreneur, right? Being self-employed is both freeing, but also a mind-f***. And so it's, you know, it's a double-edged sword, right? I get to come and go as I please, but I also bear all of the responsibility for an entire staff of people and, you know, all the, you know, 1,000 people who rely on me to keep on with life.
Nick Soman, Decent
That's huge and meaningful and probably feels different from real estate. For me, it feels different and I’m not even a clinician. Boy, I get that.
Okay, this is going to be a sparky one for you, but what are some misconceptions about nurses that you would like to clear up? You can be as intense as you want on the answer to this one.
Penni Vachon, Lowcountry Wellness Center
So I think, you know, there's a misconception that nurses are doctors, assistants, and we're not, right? You know, especially in the primary care world. I am not a physician. I would never profess to say that I'm a physician. But when I treat a lot of physicians in my practice, that tells you that I'm doing something right, I'm not a moron. Nurses are not stupid. We didn't go into nursing because we couldn't get into med school. We went into nursing because we wanted to change lives and some of us wanted to go to med school and did nursing as a way to get there and then realized I don't need to sell my soul, I can do nursing.
There's also this misconception that nursing is cute. And it is the farthest thing from cute, it is dirty, it is grungy, we work long hours, we smell, it's not cute, it is not cute at all.
It's not cute. But it's also the most rewarding thing outside of being a mom and wife and grandmother that I've ever done in my entire life.
Nick Soman, Decent
I love it. Who else in health care inspires you?
Penni Vachon, Lowcountry Wellness Center
I've got quite a few that I love. I love the disruptors like Dr. Barbara O'Neill, she's a naturopathic physician who got exiled from Australia now lives in Alabama because she was professing natural health. I love the disruptors, you know, really anybody that is like minded, that is going to spread the word of especially DPC, right? If I could handpick who I sat down and had a meal with in the healthcare world today, Barbara's going to be at the top of my list.
