Humans are multi-faceted beings, and our health is multidimensional. When we care for our patients, we get to know their story so we can take care of the whole person. What if we extended taking care of the whole person to ourselves as well?

Episode 52 of the Hope4Med podcast features Dr. Crystal Maxwell, a board-certified family medicine physician and founder and CEO of Light Family Wellness, the first direct primary care practice in Indian Land, South Carolina. Dr. Maxwell explains the direct primary care model and how it has helped her care for her patients wholly. But in addition to being a physician, Dr. Maxwell is also a wife, mom, daughter, sister, friend, and volunteer. She discusses how setting boundaries and prioritizing a work-life balance has helped her take care of herself and prevent burnout.

Connect with our guest:
Website: https://lightfamilywellness.com/

Transcript:

[00:00:00] Dr. JB: Welcome to Hope4Med.

[00:00:04] Hi everyone, welcome back to the Hope4Med podcast. I am your host, Dr. JB, and today’s featured guest is Dr. Crystal Maxwell. She is a board-certified family medicine physician, she’s the founder and CEO of Light Family Wellness, the first direct primary care practice in Indian Land, South Carolina. Welcome to the show.

[00:00:25] Dr. Maxwell: Thank you so much, I appreciate you having me. It is a joy to be able to share my story. I am coming off of celebrating my one-year anniversary for my medical practice, we had our ribbon cutting January 29th of last year and so the 29th, this past Saturday, we were celebrating our first birthday and it has been an absolute pleasure, in spite of being in the midst of a pandemic, which I was not expecting at the time I was planning to open my practice. But it has been a really great year, so I’m excited about having made that transition. I am, as you said, family medicine trained and I had practiced for 10 years at a community health center right out of residency training, moved to the South Carolina area and was working for a community health center for a couple years, I was just a physician there. After a couple of years, got introduced into doing some quality things as we were trying to transition into becoming a patient-centered medical home. I really liked having that administrative component to it of being able to influence what the day-to-day looked like and what the things that my clinicians working with me needed and how that patient care would look. And so I became the Chief Medical Officer and I was Chief Medical Officer for eight years after that, until I decided that I wanted to practice closer to home.

[00:01:47] I was driving an hour each way to my community health center, and I wanted to practice closer to home and I wanted to do something a bit different than the traditional model, which led me to the direct primary care model. Part of me had become kind of, while I was enjoying the, that manager administrative aspect, the clinical aspect was kind of draining. I was beginning to experience some burnout with that because I felt like things that I was dealing with patients, dealing with chronic diseases, having multiple things that needed to be done for them, just could not be managed in a 15, 20 minute on a, on a good day if somebody no-showed, but that just was not enough and adequate for the primary care that I felt that people were needing as I was trying to talk with them about changing their diet, increasing exercise, what that needed to look like, how that needs to look like, what kind of sleep do you need to be getting in because you’re always tired, but you’re always on the go and not stopping. Being able to have those crucial conversations for lifestyle changes, I just couldn’t have that. And so as I was trying to decide what my next step would look like with wanting to practice closer and wanting to do my own practice, I decided to do the direct primary care model.

[00:03:00] Talked with a few friends of mine who were doing it, I talked to someone locally who was doing a direct primary care in a city over from me, and she became my mentor. And so I was like, yes, this is medicine, being able to actually get to know your patient again and talk with them about what’s going on with them, getting down to the root cause as opposed to just the band-aid and having that unrushed time of not being worried about that you’re double-booked or triple-booked, and that you’ve got 15, 20 people waiting behind the schedule. That for me was part of what I saw myself, when I decided to become a physician when I was only 14, but that’s how I saw myself practicing. I saw myself spending time with people, getting to know them, kind of being part of the family as in family medicine, but that had been lost in the more traditional practice. And so direct primary care for me was a way to really get back to what I saw back when I was 14 doing, so it’s been a great year of being able to do that and we are growing.

[00:04:01] Dr. JB: Yeah. So, I mean, you shared so much, and we’re going to go back a little bit because it has been quite a journey, because you went from deciding to go into medicine at age of 14 and you went into medicine and then you went to community practice, or community center practice, then you did leadership, and then you are now in direct primary care. So walk me through what happened at the age of 14, because you mentioned that a couple of times, so what happened that kind of inspired you to go into medicine?

[00:04:35] Dr. Maxwell: Yeah, so, my grandfather was diagnosed with prostate cancer and it was one of the advanced stage ones unfortunately, not one of the common ones that’s kind of slow growing, but it was an advanced stage and we pretty rapidly saw him decline and ended up losing him to prostate cancer. But in the process of that, going to the hospitals and hearing nursing staff come to the house and just listening to the conversation when we were at hospitals, hearing the doctors talk about just different things, I wanted to know what they were talking about and what the words meant, what the terminology meant, what the machines were for, what all the tubes and all of that stuff meant. And so, that just really further piqued my interest in science and so after that, I just began going to different science summer camps and anything science-related, I just started doing that because I was like, yep, I want to be a doctor, this is something science, that’s what they say, so let me figure this out.

[00:05:30] And so, it was just really walking through that journey with my family, seeing them still come home and have questions about what the doctor said and it not being an easy feat to be able to get back and try to get that clarified was a frustration. And I was, I didn’t understand, like, why it didn’t make sense to me. And so, part of my passion to do it was, well, whenever I become a doctor, I want to make sure all my patients understand and when they need to clarify something or just check back in, they just call me, they just checked back in. And so, that was my idea of what I first saw of a way to be able to practice. Unfortunately, lo and behold, when I actually began practicing, I learned that it’s not quite that easy when you come to being in a system of medicine. There’s so many other things that come into play for that. And so, after just kind of playing the system for 10 years, I was like, well this still isn’t me and I felt like I was not giving the part of me of why I became a physician in the first place. And so I was like, I have to either discover how I can do that or honestly, I will have to figure out something else to do because I could not continue in that format because that just was not genuine for me. And so doing direct primary care, as I learned about that, seemed to make sense. And so in the past year, it has absolutely made the more sense of me actually being accessible to my patients and being able to give the way that I thought that I should be able to even back then.

[00:07:05] Dr. JB: Okay, so, so you said, yes, I want to be a doctor at the age of 14, my grandfather had been diagnosed with prostate cancer, but you decided family and not oncology or anything like that. What made you decide on family medicine?

[00:07:19] Dr. Maxwell: Well I, that came later when I thought about that at first, just because you can help everybody. But even when I went through training, I thought about cardiology as I had a lot of family members who had heart disease issues, even through rotating, at one point I thought I wanted to be a neonatologist. I enjoyed OB/GYN, I was like, ooh, I can do obstetrical surgery, I was like, oh, I can be a general surgeon, I liked surgery, I liked procedures. So honestly what, even when I went through all of my rotations, I felt like I could do this on pretty much all of them from psychiatry to being, doing nephrology. I ended up feeling like I could do all of them, which brought me back to well, that’s why I thought I wanted to be a doctor for the family anyway, in the first place, because I enjoyed everything. And so, it ended up coming back full circle that I really still want to be that medical liaison between patients so that they understand that kind of that quarterback is what a physician is, of making sure you understand what’s going on with your specialists. That you do have that person that you trust and see all the time that you can go back to and say, hey, can you explain this? They are doing this or, catching that two different specialists are seeing them and now they’re on similar the medicines ’cause one specialist don’t know that this was started by the other. So really being able to be that person who can guide them through has, was really what I felt to be my calling, and here I am.

[00:08:43] Dr. JB: Taking care of the whole person.

[00:08:45] Dr. Maxwell: Taking care of the whole person. Having seen my kids when I was in the previous practice going from, seeing them when they were little and then all of a sudden they’re hitting that teenage years of, it’s just, it’s really nice. And then being able to coach mom about them growing up and things like that. So just really being a part of the whole family for me was just really where my passion was.

[00:09:04] Dr. JB: Yeah, and that’s so key because as an emergency medicine physician, I take care of so many patients who come into the emergency department and they’ll be like, oh, my cardiologist is this, and my nephrology is this, and it’s like, well, who’s your family doctor? “Oh, I don’t have a family doctor.” And I was like, well, your cardiologist focuses on your heart, your nephrologist focuses on your kidneys, but who focuses on you as a whole to make sure that everything, the medicines that you’re on and whatnot are actually okay for you as a whole? So it’s extremely important.

[00:09:36] Dr. Maxwell: Yes. Yes, absolutely. So that has been the big joy for me, is being able to be that person. And now that I’m a lot more accessible as opposed to experiencing, two to, two weeks or so before a patient could get in. In direct primary care, like today, I was sitting in a meeting and a patient texts me and she has some issues that she had a yeast infection and I sent her a prescription while I’m sitting in a meeting. And so having that flexibility, because I know her, we’ve dealt with this before, I know what’s going on with her, I don’t have to bring her in. Pretty cut and dry of what’s going on with her. I could just take care of her without her having to interrupt her workday and losing hours having to drive over and do all of that stuff immediately. So it’s very nice that my patients have me and accessible to me and I’m able to guide them and they know that Dr. Maxwell is going to answer my question, and if she can’t figure it out, she’s going to– if she doesn’t know, she’s going to figure it out and she’s going to get back to me. And so being able to have that space in direct primary care to do that makes so much sense for me. And so, it makes me put a smile on my face, going to work every day.

[00:10:47] Dr. JB: Well, it seems like something direct primary care definitely aligns more with your vision of yourself from the age of 14.

[00:10:53] Dr. Maxwell: Yes.

[00:10:55] Dr. JB: Let’s talk a little bit more about that journey that led you down the path of direct primary care. So, you did family medicine and then you decided after graduating from residency that you were going to go into the community and community health center, what made you decide to do that?

[00:11:13] Dr. Maxwell: So in– so since I knew that I wanted to do, I was thinking family medicine from the jumpstart, so even when I applied to medical school, I was looking at financially, how am I going to pay for this? So one of the options that came up was the National Health Service Corps, and so I applied and became a scholar because I was going to do something primary care was, was what I had planned and that was a way that either rural medicine– I’m originally from Mississippi, grew up on a farm 20+ miles from the nearest hospital, so I knew rural, and then I went to undergrad in Atlanta and so was able to see urban underserved areas and do volunteer work there, so I knew that either I was going to do rural medicine or I was going to do urban underserved, something in primary care. And so National Health Service was able to provide me that financial option to get medical school and so, that was kind of what kind of led me and kept me towards that primary care. All though there are some other things, like psych and things like that, that you can go into to be able to do National Health Service Corps, but I definitely knew for the most part, it was going to be something primary care related, so that helped to kind of guide where, well, what areas I was going to end up practicing in once I finished, because I was going to have to serve back that time once I finished medical school.

[00:12:35] And then once I did residency, I got married during residency, met my husband during med school and he did a specialty training in pharmacy in, on the areas of internal medicine and cardiology. And so at the time that he was finishing up, well I was finishing up residency and he was beginning to look for jobs, it was more so it was going to be more difficult for him to find a cardiac pharmacist job than me. And so, we pretty much looked at where he would be able to go with the restriction that it had to be somewhere it didn’t snow all the time because again, I’m a Mississippi girl, I was not trying to have to go to work in the snow all the time because I’m a physician, so I don’t get a pass. So he found a place in Charlotte and I found a community health center that was within the National Health Service guidelines for me paying back that time, which is what led us, or led me to the community health center that I worked at for 10 years.

[00:13:36] Dr. JB: Yeah, no, you’re talking to a Florida girl, so I completely understand.

[00:13:41] Dr. Maxwell: Yes. Yes, I don’t mind heat. I am not there for the cold. I’m ready already for April, May to come on, so give me some heat. I would rather be hot than cold anytime.

[00:13:54] Dr. JB: Completely understand. So one of the things that you mentioned that was very interesting was you said that, you would get 15 to 20 minutes with the patient on a good day, if somebody canceled. So, can you walk me through your experiences in terms of trying to really connect with your patients and be effective in terms of helping them manage their health and how much time you had allotted to do that?

[00:14:21] Dr. Maxwell: Yeah, so one of the nice things about being on an administrative side was I was able to work on the schedule. And so, we initially started out on the standard template of 15 minutes scheduled, 30 minutes for a new patient, 15 for general follow up or 30 minutes for a physical exam. One of the things that we did end up incorporating was doing a 20-minute schedule to try to improve some of that time that the clinicians had with the patients, but still trying to, of course, maximize how many patients we were able to accommodate each day. And so, the 20 minutes schedule did help, but even still, there are numerous quality documentation things that you have to do to satisfy insurance companies, some of which is important for patients but not necessarily in terms of the timing in which they need to be done doesn’t coincide to when insurance companies may want to see that done.

[00:15:18] But the documentation for doing quality stuff, having your nurses try to do as many things as they could on the front end, such as getting an A1C before you walk into the room with the patient, or getting their foot exam done if they were doing a diabetic foot exam, having them do all of those things for pre-visit to give you more time was a way to help improve that. But even still, there’s only so much that the nurse can do because there’s still a lot that has to be documented and done with the patient, and so if you’re talking about someone who’s diabetic, high blood pressure, have high cholesterol, have COPD, may have anxiety and depression, I mean, you’re already looking at six or seven different things that you can actually spit take any one of those things. And to actually go back through and understand what’s going on with them at home to see what things may be impacting their ability to be under control, there’s no way that you can have those crucial conversations with all of those chronic conditions in 15 minutes or 20 minutes. And so, all of those things just, it makes it very difficult to really get down to some of the foundational things that are impacting people at home, that of course, in big systems, we try to have social workers come in or have other staff too, and nursing staff, behavioral health staff, to help to kind of take some of those things off, but for a lot of people, they want to have those discussions with their doctor. And there are things that your doctor will pick up on that even, as great as social workers, are behavioral therapists are, and the nursing staff are, there are still certain things that only the doctor will be able to pick up on and can really address because it’s the doctor that the patient is coming to see. And so they will withhold information until they get to you, and then you have to go back and try to figure out how to pull all of that together with the other priorities that your system, organization, insurance company is asking for you to do as well.

[00:17:15] And so sometimes, unfortunately the priority that the patient has, that they really deem important to be discussed, is not discussed. And so some of those things are lost in translation and you never get to really get down to some of that foundation stuff that they’re dealing with. And one of the great examples, I had a lady that was taken care of at least nine years in my previous practice came with me to my new practice, I still had a full one hour new patient visit with her. Even though I had known her for nine years and out of that visit, there were things that I never knew about her that genuinely impacted her depression and anxiety that. I was, it hurt me to know that she had been carrying so much of that that’s impacting her depression, anxiety, and I was never able to have that conversation and get down to that level of discussion with her. And once we were able to talk about those things and began putting in a plan to address those external things, that’s going on in her life, her depression began to get better. But I could never have that conversation in 15 minutes because we had so many other things that were quote, unquote “priority” to be discussed or the box checked. So, it definitely makes a difference when a patient is able to open up to their doctor and have those conversations and feel like it’s not rushed and it’s not a burden. And I know that somebody else is waiting for, “yeah, I’ll just wait ‘til next time,” because next time for some people never come.

[00:18:46] Dr. JB: That’s right. That’s right, wow. Wow, what a powerful example, nine years though with this patient, nine years of seeing this patient, taking care of this patient and trying to manage their medical conditions, and still, there are so much that you had no idea about. Wow. Just taking that extra time to discover and connect with that then you’re able to actually have a profound effect on their lives. Something that you’ve been working on in terms of like their anxiety and depression for nine years.

[00:19:19] Dr. Maxwell: For nine years, yeah.

[00:19:21] Dr. JB: Wow.

[00:19:22] Dr. Maxwell: Yeah.

[00:19:23] Dr. JB: Wow.

[00:19:24] Dr. Maxwell: So it’s, time with your physician makes, it makes a difference. And I know that, there’s so many things of saying, we can, like I said, I don’t– there, there is place for a team and teams are great, but you know, there’s nothing like that doctor, physician relationship, that physician, doctor, physician and patient relationship patients really take to heart. And so, I’m hoping as we go forward in the future and they’re more physicians who are doing direct primary care that will be heard because that’s what I hear from a lot of other physicians who are doing direct primary care is that is what their patients are saying that they have the time they have the space to be able to have those conversations that, go into more of the lifestyle and the lifestyle changing things that can help to impact their lives.

[00:20:12] Dr. JB: So you mentioned in the beginning that you had experienced symptoms of burnout. Can you talk a little bit more about what you had experienced?

[00:20:22] Dr. Maxwell: Yes. So with burnout, a lot of that came with trying to manage that work-life balance. On one hand, I was a physician seeing patients clinically, so I had those responsibilities. On the other hand, I was an administrator as a chief medical officer, so responsible to the board of directors, the CEO, all of the administrative operation team. And then also to the clinicians that I was representing, there are so many complexities to try to maneuver all of those things in one.

[00:20:52] And then I’m a wife, I’m a mom, I’m a daughter, I’m a friend, I’m a cousin, I’m a sister, so there’s so many different facets. I volunteer at church. I volunteer within the community. So trying to find balance in between all of those things just became very, it became a lot to do. And so I did have to, and my daughter was growing older, I did have to make some crucial conversations, crucial decisions about what my life was going to look like. So even prior to making the decision to leave that job and practice closer to home, there were times that I had to say, okay my daughter is at her soccer game, I am not going to answer my phone because I am at my daughter’s soccer game. But you know, there was, there were times that if a clinician called me because there was something urgent going on with them. Or there was something administratively going on that needed to be addressed I was just pretty much, I’m here to support you and what can I do?

[00:21:50] But I had to develop some barriers for myself and say, well, I have to stop and I have to give attention to my family as well, because work is work, but home is a job too. I have to definitely make sure that I’m dedicating that time to supporting my daughter, supporting my husband. So making some barriers to stop there and making sure that I’m delegating to other people. But that was hard to do because it was, well, I want it done a certain way and I know and so, but I had to start making some decisions about, okay, you still want to train other people to be able to do some of the things to support you in doing.

[00:22:30] And it was just, I had to make those crucial decisions of what was most important with understanding that, of course, sometimes family is going to take precedent and I’m just going to have to say no to work. Sometimes work is going to take precedent because this is really important, but you have to make sure that you’re looking at that all of your time. It’s not all on this one thing, especially for work, because at the end of the day, it is your family that’s going to be there when that job is not because you could die today and they’re going to find a replacement, but they won’t find another mom. They won’t find another—well, my husband could find another wife, but not me of course.

[00:23:05] But you know, there’s nobody to replace you in that family unit. And so those were lessons learned along the way. That I’m taking with me now that I’m in my practice. So even though I’m independent and it’s only me, I tell my patients if there’s something minor, I’m at home with my family, I’m enjoying my family, I’m not going to respond to your texts. If it’s something minor, if it’s after hours, I will respond to you in business hours the next day. And so that, that’s a very important conversation I have on the front end when someone’s enrolling in my practice because I don’t want to go back to that where, you know, this is work working again. I am– my success in my job is really dependent on me now that I’m an entrepreneur, but I still have to remind myself that I’m not in this alone and I will burn out on even something that I love doing with my practice. If I don’t set priorities and I don’t set those barriers.

[00:24:01] Dr. JB: So it sounds like, what you’re saying is boundaries and the importance of setting boundaries and being very clear about your boundaries to prevent you from going down the path of experiencing symptoms of burnout.

[00:24:14] Dr. Maxwell: Yes. And so setting those boundaries and also knowing that even when things become redundant in life, you have to still kind of look at what else can I do to fill in my day. So even though I enjoy clinical medicine to the fullest, I still enjoy doing a lot of things with the community. So, I’m still looking at opportunities that do non-clinical things, administratively, like consulting with community health centers to help them through their processes so that I still have another side of income that I’m still not strictly dependent on just that clinical income that’s coming in. So that I can do the consulting things when my daughters down for bed and my husband’s doing a business meeting and it’s after hours, I’m at home, so I can do a little bit of consulting then. So I’m trying to be very intentional about the way that I handle my time and give out my time so that I can still keep it forward and not burn out on all the things as I did before.

[00:25:13] Dr. JB: And so with this direct primary care that we’ve talked about, when did you get introduced to this concept?

[00:25:21] Dr. Maxwell: I actually, I mean, actually early on, one of my best friends that I went to residency with she started her practice probably a few years after we finished residency and I was like, go you! I’m employed, so I knew about it but at that time it just really wasn’t for me when I was still fulfilling my four years doing my National Health Service time back. But two, it was, well, I’m just, I’m okay with being employed right now. I have especially when I, once I became administrative and was given some voice, doing a lot of things for people who otherwise would not have healthcare because they didn’t have insurance or they were under-insured. So for me, I was doing things that I really enjoyed and still being able to give back by practicing at the community health center. So it was more of a support thing and like, okay, well, that’s a nice idea, but you know, you have to do it all yourself.

[00:26:16] And you’re the only one on-call and it’s just you. I don’t want to do that. At least now, it’s me and all of the other clinicians who are working take rotation on-call and all of that, it’s not solely on me. But as I progressed and began to get to know another friend who started doing some concierge and attending American Academy of Family Physician Conferences where I was hearing more family physicians talk about doing direct primary care. I had another medical school classmate who opened her own direct primary care and ran into her at a conference at the time that I was kind of like, I don’t know what next steps are. I’m kind of content, but you know, you never know. But having that conversation with her was like, well, maybe I should think about what, I’ve been, you know, it was probably about seven or eight years at that point. Maybe I should think about next step. Do I want to continue doing an hour drive for the next 10 years of my life? At that time I was content but I didn’t know, I just knew it was something that was…yeah, in terms of family physicians wanting to kind of take back ownership and be more available for their patients.

[00:27:24] And so just as I kind of was going through that low of maybe this is something to explore, things just began happening again, all smaller things of running into people all at the right times just begin happening. And so timing is everything. So I do believe that it was my time to begin exploring and hearing just because once I started hearing it, there were just different people that were starting to kind of plant seeds, both to this or hearing a lecture or somebody talk about it. So, there was just, it was at the, I think it was just a very predestined thing for me just to begin to be exposed to it in my eyes being open to, oh, well maybe I do need to go back and talk to all these people and investigate a little bit more. As I’m beginning to make that transition, my daughter was doing dance, soccer, and swim all at the same time, at one point in our lives and so, I knew that I wanted to be able to be more available for her, to be able to see her competitions and support her in the things that she was doing. So, it became a, well, let me investigate and research this more, more fully because I do want to be closer to her but I don’t want to go back into a more traditional model when I do it. I do want to have a more fluid flexibility of going to her school and during this, and if there is a school field trip that, you know, jump on and say, hey, I can volunteer and do that too. So, I think it was more of a timing thing that just kind of began leading me towards saying let me be a little more open and begin doing my own investigations into it.

[00:28:58] Dr. JB: And so with your setup, is this like a subscription or how does it work? Do you accept insurance? Walk me through direct primary care.

[00:29:05] Dr. Maxwell: So direct primary here is membership-based kind of like you can say subscription. It’s kind of one good analogy is kind of, say having a gym membership. So you have a gym membership but it’s like having your personal trainer included in your gym membership, your personal trainer being your physician. And so that gives you access, paying that membership fee to your physician, and so that you can access them directly. All of my members have my phone number, my email address, so they can either text call or email me directly, as opposed to going through the lavish phone tree with other people or having to press all the different buttons to get to this department. You actually send the text to me and I can respond directly to you. It provides a lot more flexibility and ease of access, in that regard. Your membership fee includes all of your visits with me for primary care services. So whether that’s an in-office in person or a video visit or a phone call, I do a lot of text visits now because people are technologically savvy.

[00:30:07] You can text them things that are pretty straightforward. And so all of that’s included in your membership fee and with their, the growing number of direct primary care physicians that are around, I’m not the first, this has been over 20 years of people who have done this and there is a Direct Primary Care Alliance who have put together working with vendors and labs pharmaceutical companies to help facilitate that process of what physicians would need to get the, get their supplies, to provide easier access to labs more affordably, to provide for medications for those who are in states who physician, where physicians can dispense medications. So there’ve been a lot of physicians ahead of me who put a lot of those things in place so that I can provide all of those services to, to my members. Particularly with the labs, even my insurance patients, when I go through the– about how much it would cost to do a cash pay option for their labs, the vast majority of them say, unless they’re Medicare or Medicaid, say I want to pay the cash pay option because I know my deductible, my co-insurance with this is going to be way more than what you’re quoting me to do those labs and I’m not going to be surprised billed. I know how much it costs now as opposed to I get it done and 30 days later, I’m like, oh gosh, that’s all my insurance paid on it? And so you avoid all of that. And so, every direct primary care practice is going to have a little, a few different nuances in the way that they’d set up in terms of what procedures may be included and things like that.

[00:31:44] But just in general it’s just kind of the subscription-based membership base, paying them monthly, paying a monthly fee to cover your access to your physician and that covers your overhead, that differentiates you from concierge in that a lot of concierge practices also bill insurance, direct primary care, if you’re pure, direct primary care, you don’t bill insurance. There are some hybrid models that choose not to opt out of Medicare, and so they may be Medicare, they may have their Medicare population and still bill Medicare for the, for those members, but for those who are pure direct primary care, they’re not billing any insurances at all.

[00:32:22] Dr. JB: Oh, that’s such an interesting concept. Do you find that patients will still come to you even if they have insurance? Or do you find that there’s some insurance?

[00:32:35] Dr. Maxwell: It’s a growing thing. I’ll tell you, 90% of my patients have insurance, over 90%, but they still– and they’re paying the monthly membership fee. For them, it’s the access. It’s the knowing that it’s my doctor who’s going to take care of me when it needs to be done, I don’t have to sit and wait in a waiting room for 30 minutes to an hour because I know she’s going to see me at my time.

[00:32:59] Dr. JB: And one of the things that you’ve mentioned in the beginning is I don’t have three weeks or a month to get that follow up. Like I can actually get in touch with my doctor and see them pretty quickly.

[00:33:11] Dr. Maxwell: Exactly. And when there’s something going on, there’s not that fear of, I don’t want to pay my copay today, if it’s something that’s not big and I don’t know if it’s big. And so for those people who delay and wait and it is big and they should’ve, they should have checked in, they were trying to avoid the copay because they weren’t sure if it was necessary. There’s none of that because your monthly membership fee is your monthly membership fee. I’m not going to charge you anything above that. If I have to talk to you every day, this week, it is your membership fee. And so, you don’t have to stress or worry or try to cut costs because you don’t want to go to the doctor unnecessarily because you’re not going to pay anything extra. I am your doctor who will see you, you don’t have to go down that rabbit hole of what Google may tell you, may be going on with you, and you think you’re dying. I can help filter through some of the information that’s on there and actually lead you to what is evidence-based, what is scientifically sound, and what is just somebody putting it up because that was very experienced, that maybe they experienced, but that may not be scientific. And so, I’m able to, yeah, with doing the membership-based, we can put all of that aside. Even with my diabetic patients, my ones who are uncontrolled, we can be very intensive and not worry about if I need to follow up with you the next day over the same thing about which, what insurance is going cover this, because it’s the same diagnosis and I need to be able to this two days in a row.

[00:34:32] I don’t have to worry about that. I don’t have to worry about, well, this is your Medicare wellness exam. And if I talked to you about any other thing that could be diagnostic, you’re going to get a whole other deal, even though you think you have a free visit today, so we have to talk about that on a different day. We don’t have to worry about that. Whatever is going on with you, I can address that. Or I see you this morning and I say, oh, yep, yes, you have a UTI, let me send you in some antibiotics. And then you call back at three o’clock in the afternoon because you stubbed your toe and now you got to cut and what do I do about my cut? Practices billing insurance can only bill one of those, even though it’s two separate things. They can only bill one visit that day. And so now you have to just, your practice has to decide which of those are they going to be helped and which one are they not going to be paid for? Which is, yeah, you can only bill one, one facility can bill one charge a day.

[00:35:24] Dr. JB: Even if those are separate?

[00:35:27] Dr. Maxwell: You can do one claim, one claim, you can only do one claim that your insurance will pay for. Unless there’s something that’s changed in the last few months, I doubt it, but you can only do one claim. And so, it used to be that if someone, if you were seeing someone in a doctor’s office and you sent them to the ER, Your doctor’s visit may not get paid for because they’re only making one claim there. They were only going to pay one provider that day. Now they, I believe they have changed that to where they will do both. But again, it’s playing a game to be paid for services that you render. Why do we as physicians have to coerce people to pay us for services rendered? I had a, we had something happened with our oven and we had an electrician to come out and take a look, and probably we unplugged the oven and we probably should have plugged it back up before we called because it was over the weekend. And when he plugged it back up, it was working again and he was like, well, it’s still $119.

[00:36:30] Dr. JB: That’s true.

[00:36:31] Dr. Maxwell: He came and he didn’t do anything, but yet in the medicine world, that same concept is, it’s your time but you didn’t do anything and so– or you have to convince or document and do all of these elaborate things to try to be reimbursed for what you’ve done for a patient. And so even though it may turn out to be nothing, the insurmountable years that you have gone to school, the hours that you have paid in going through school and being able to diagnose and acknowledge that yes, that is something simple. Yes, it may seem simple now, but it wasn’t simple for me to get the knowledge and all the time and investment that I can now know that is simple. So it’s very frustrating. We’re dealing with those kinds of things in terms of payment to provide care for people, direct primary care removes that by just doing membership-based, it doesn’t matter.

[00:37:19] You can have five things today, we’re going to talk about your five things. You can have three things today. You can call me back after you leave. I’m still going to be able to take care of you because I don’t have to play games to get paid to take care of you. So to cover my overhead, because again, at the end of the day, most physicians are doing this because we have a genuine heart and interest and passion to take care of people, but we do have to have dollars to be able to keep the doors open and pay the staff and all of those things and take care of our family. So we, it’s just a necessary thing that we have to do. We should not have to fight tooth and nail to make that process happen.

[00:38:00] Dr. JB: I’m sure some people could be concerned that well, if I have a patient who has full access to me any point in time that they want like this will utilize that and be at my office 365 days a year, maybe two or three times a day. Have you come across that or have you heard any things like that?

[00:38:20] Dr. Maxwell: So that was a concern, and that was why I told my friend when she was first doing hers, you can have it. I got a whole crew of people who can rotate it with but when I really thought about even after practicing 10 years and I thought about how many people called after hours that were my patients, not someone I’m covering for but that were actually my patients, it really wasn’t that significant. And it wasn’t that significant because the level of care provided and how I educated them on about what needs to happen after hours versus what can happen when you get, you know, have contacted me the next day. And so that onboarding process is very important when I’m talking to my members and we’re going through the patient agreement about what my expectations are and what I will respond to. Do I have some who utilize that a lot more than others? Yes. But I started making boundaries for myself too, of saying, looking at that message is not important. I’ll respond tomorrow. The pharmacy is closed, you forgot about ordering your refill, I’ll take care of it tomorrow. Your, your emergency– and I remind you, please give me time to do your refill, don’t wait until your bottle is out. Let me know, ‘cause you know that as soon as I do know, I’m going to take care of it provided it is during office hours. So I have those conversations.

[00:39:02] I’ve not had anybody who has completely abused it or when I reminded them of, Hey, I know that you did this after hours, but you know, can you keep this during business hours? They’re generally respectful one, you know, they are, they have a stake in it cause they’re paying a membership and so they know that. This is not too much, I make that clear. We’re not, my fees are not concierge level fees at all and so if that is the higher level of care that they run, then they may want to go and find a time of year. So, there’s a way to have. But you know, when people call after hours or address me after hours, for the most part, it’s usually something that I would want to know about anyway.

[00:40:23] Because I don’t want them to have to go to the urgent care unnecessarily and wait because they don’t know them, and they, for a lot of them, I could just handle it myself. And so I’m able to do that, but I know that it is that fear, but generally the people who tend to do the membership, they’re going to be people who respect you, but you do have to do that education onboarding and be willing to say if someone is over-utilizing, have your systems and policies built up of how you discharged someone from your practice because if it is not a good fit for you and taking care of them because they are doing more than what you feel that you can give them, then as long as you have your policies, procedures, of how to discharge someone in place, then you’re able to remove that patient from your practice and move on.

[00:41:10] Dr. JB: So, you mentioned about your experience with burnout as a clinician taking care of patients. Did you experience symptoms of burnout when you were in leadership?

[00:41:22] Dr. Maxwell: Well, it all goes together ‘cause I was still seeing patients and then administration at the same time. So I was never full-time, never full-time administrator. So I always had, I always did both. I always did both. So when I first started the two years, the first two years, I was clinical only. And then when I became medical director then I saw, I still saw patients and did administration. So I always had to do both.

[00:41:47] Dr. JB: Like, did they decrease the amount of time you had to spend with patients or they just added on administrative roles in addition to the allotted time you’re supposed to take care of patients?

[00:41:57] Dr. Maxwell: It was a progression. When I first started, I had a half, I had an afternoon of admin time. And then as they asked me to do more duties, I had to speak up and say, okay I’m going to need more admin time than this. And so, and so the time was increased to balance more um–

[00:42:16] Dr. JB:  If you hadn’t spoken up– sorry to jump in, if you hadn’t spoken up, what would have had happened?

[00:42:21] Dr. Maxwell: That’s a great question. I, I don’t know. I believe they did recognize that I was going to need more time, but I did have to advocate for more than what was being offered. So as with any position that you’re in assess your time, assess what you’re doing after hours, because it all matters and speak up and advocate for yourself. Or you do have to, be willing to say, well, I can’t add that on. We can delegate that to XYZ or I can’t do it. But I mean, it does take a little bit of motivating yourself to speak up sometimes because you want to do it and you want to get it because patients are at stake, your clinicians that you’re working for are at stake. But you still have to look at yourself and say, you are only one person and it can’t all fall on you and there has to be other people to support you in doing it.

[00:43:11] Dr. JB: Knowing when to say no.

[00:43:12] Dr. Maxwell: Knowing when to say no, it’s important.

[00:43:17] Dr. JB: That’s right. So, now that you are doing your own thing, you have your direct primary care practice. It really sounds to me from this conversation that you are actually incorporating a lot of the lessons that you learned through your prior experience to hopefully prevent you from getting burnt out from this new path.

[00:43:36] Dr. Maxwell: Yes I am. And it’s still a learning experience. I feel like I’m a workaholic by nature. It is still difficult to turn the off button all for work a lot of times. And so it is a constant reminder to myself that, hey, you’ve done enough for today. You’ve done enough. I still have to have that conversation with myself and remind myself of that. And I had a conversation last week with my husband about I was asked to do something for my sorority and I told them no. And I said, honey, you’ll be so surprised, you would be so proud of me because I was asked to do something else and I said, no. And he was like, where is my wife? Who are you? And I was like, I’m learning better, still it’s always an ongoing thing, especially as an entrepreneur it’s always going to be an ongoing thing of learning how to say no, because you do want to do so many things. You do want your business to be successful, especially if you’re in a small community. So I want to be a part of the community and help to support the things that are going on in the community, but I have to remind myself I’m still only one person. And if I spread myself too thin, now I’m not going to be able to keep up the pace and then it’s going to, something’s going to happen down the road so let’s prevent that from happening now. And, they’ll find somebody else. I promise.

[00:44:52] Dr. JB: They will, they will, and really always keeping an eye on self-care. But you know, learning how to set boundaries, learning how to say no, those are difficult things because that’s not something that we’re trained to do when we’re going through our training to become healthcare professionals.

[00:45:10] Dr. Maxwell: Yeah, it’s not. And I feel even, especially being a woman, we as women tend to be caretakers of everybody. And that just, that goes from your family to your work. You, that’s just kind of, I feel like it’s just an ingrained thing in us that we are caretakers and we are doers. And doers, the doer has to be taken care of or otherwise she can’t do. And so we just have to be more conscious and more aware that we have to take care of ourselves so that we can continue doing that beautiful purpose we were put on this earth to do. Otherwise, we’re not going to be around to do it for as long as we possibly could have.

[00:45:47] Dr. JB: So with that being said, if my listener wanted to learn more about you and your direct primary care, how can they get in touch with you?

[00:45:56] Dr. Maxwell: I can be found on my website is www.lightfamilywellness.com. I’m also on Facebook and Instagram @lightfamilywellness. I also have another Facebook page, Dr. Crystal Maxwell. So I’m a lot on social media, do a lot of posting there. But those are the ways that you can find me. And I do love responding to messages, so people who send me messages on Facebook, you are more than welcome to direct message me to get more information as well.

[00:46:27] Dr. JB: All right. Perfect. And so, in closing, do you have any last pearls of wisdom for our listeners?

[00:46:34] Dr. Maxwell: Absolutely. One, don’t be afraid to step outside the box. Even though it may seem overwhelming to do, if it, if there’s something that is your passion and you need to step away from something that’s kind of burning you out, don’t be afraid to do that. Find some mentors. Find people who are like-minded like you who are doing something similar, it may not be the exact same thing, but find that support team to give you more information. And as you’re going along and doing that universal thing that you are creating and putting in place, don’t lose yourself. Make sure to take time out for you, make sure to take time out for your family because at the end of the day it’s your family that’s mostly depending on you and that going to be there when nobody else will.

[00:47:18] Dr. JB: This is Hope4Med, med. New day for med, med. For us, by us, and just for us. This is Hope4Med, med.