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Join Andrea Wadley, a pediatrician who navigated career burnout to embrace the direct primary care (DPC) model. Discover how DPC transformed her practice, offering personalized care, shorter wait times, and improved doctor-patient relationships. Andrea’s journey sheds light on how DPC can revitalize both a physician’s career and patient care.

Andrea Wadley is a pediatrician.

She discusses the KevinMD article, “How direct primary care saved my career and my life.”

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Transcript

Kevin Pho: All right, welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Andrea Wadley. She’s a pediatrician. Her KevinMD article is titled “How direct primary care saved my career and my life.” Andrea, welcome to the show.

Andrea Wadley: Thank you so much for having me. I’m excited to be here.

Kevin Pho: So we’ll get to the article in a little bit. First off, just briefly share your story and journey.

Andrea Wadley: Yeah, awesome. I met and married my husband when I was in residency, so we lived apart for a few years. I knew I was going to move home, which is where he lived, so when I moved back, I got a job as a hospital doctor, a pediatrician, a newborn doctor. I did that job for eight years and loved it, but it got to the place where corporate medicine was kind of sucking the joy out of the actual medicine part of it and seeing the patients.

So at that point in my career, after eight years, I had been admiring my husband, who was a somewhat new entrepreneur, and looking at him and seeing how great his life was, when really he was hiding kind of the hard spots of entrepreneurship. But I was seeing his flexibility. Additionally, I just knew I didn’t want to work for someone else again. And for eight years I had taken care of newborns, which I love, but I always imagined taking care of kids and watching them grow and being called their pediatrician.

So all of those things intersected. I contemplated working for the big hospital system in the area. Most of the pediatric practices are owned by one or several hospital systems. And it just never worked out. Then I pondered starting an insurance-based practice, which is really hard in an area with mostly hospital-owned practices, right? The little guy doesn’t really get the good contracts, and I would have to hire several people. I just thought about what I wanted. I wanted to be able to be a good doctor, a good pediatrician, but I also wanted to be present for my family.

Then, during that kind of exploration, I guess a midlife crisis maybe, I stumbled upon a Facebook group of doctors who were doing direct primary care. At the time, it was really mostly family physicians doing direct primary care. It was somewhat unheard of for a pediatrician to do it. I had sought out the guidance and experience of some of the concierge-type pediatricians, locally and afar, but really there weren’t that many.

So I jumped in with both feet. I decided to do direct primary care and started off doing home visits, because, having been a mom myself, I wanted to go nowhere after I had a baby, including dragging her to the pediatrician’s office and all that good stuff. I also do breastfeeding medicine, so doing all of that at home seemed ideal. Over the years, people have grown to love the home visit model, and so I’ve stuck with it this whole time.

Kevin Pho: All right. So you talk more about your journey in your KevinMD article, titled “How direct primary care saved my career and my life.” Now, before I ask questions about your direct primary care practice, I always want to get a sense of what your life was like when you were a pediatric hospitalist working for someone else for those eight years or so. You said that corporate medicine interfered with the actual medicine. Give some examples of how that was.

Andrea Wadley: Yeah. So it was a new group of pediatricians started by a corporation that also owns different types of medical practices. At first it was just me and one other doc, and then as the years went on, we expanded into different hospitals. We would see the newborns that were unassigned, which means their primary care doctor didn’t come to see them in the hospital, so we would see them. Then over time, more and more pediatricians were like, “Hey, this is a great deal,” and so we were seeing the majority of the patients in some of the busier delivery hospitals.

So while that was great and wonderful, and we were expanding, our expansion was outpacing our staffing. There was just a handful of pediatricians covering seven to eight hospitals all the time. It started out as a kind of on-for-a-few-days, off-for-a-few-days sort of job, and then it became on for weeks at a time, starting practices in new hospitals where people were not familiar with the policies and procedures, and with the fact that they didn’t need to call us for everything.

It just got to be a lot, to the place where the answer was always, “Well, you’re making a lot of money doing it, so keep on.” And it’s great when you make a lot of money, but if you don’t have time to spend that money or see your family, it just got to a place where I didn’t see a path forward as far as them increasing staffing and doing all of those things.

Additionally, something I advocated for was to have nurse practitioners kind of extend us and help us, but it became, “Hey, sign off on all these charts,” even though you haven’t seen these patients. I just felt uncomfortable using my license in that way, because it’s a license that I worked hard for, and it wasn’t a job that I planned to have forever. So all of that added together to get me to that place where I just needed to do something different.

And no harm, no foul. I appreciated all of my time in that job. I have just always been an independent sort of person. I want to make my own decisions and have some control over my life, and I just didn’t feel like I had that control. And because we were traveling between multiple hospitals, I was giving new moms and babies two to three minutes of my time, because I was seeing 40 babies at one hospital, driving across town, starting all over and seeing 40 more at a different hospital. It’s just a vulnerable time of life, and it’s nice to have a few extra minutes to spend with those families. So I think many doctors experience a lot of these corporate structure problems as well.

Kevin Pho: So now, when you were looking to transition to something different, you mentioned that you were in a Facebook group of other direct primary care physicians, and you said a lot of them are in family practice. That is true. I actually don’t see a lot of direct primary care pediatricians. So what was it that made you decide to pursue that particular path when so few pediatricians had done so previously?

Andrea Wadley: Really, the main issue with pediatrics and direct care, and direct care is where we charge a monthly membership fee and we don’t take any insurance for the visits and the practice, is vaccines, really. Vaccine costs are high. The average baby in the first two years of life gets enough vaccines that it’s close to $2,000 if you pay out of pocket. So that was the issue.

Different people have had different solutions over time, and I thankfully was able to work with a company that’s able to bill insurance for vaccines. So I attracted a lot of families at first that had insurance. I used their insurance for the vaccines, I gave the vaccines to their kids, and then they paid me for the visits and the access and all that good stuff.

Since then, pediatricians have gotten really creative. I started a Facebook group specifically for DPC pediatricians, because it was such a novel idea. Nobody really understood how to do it, but they wanted out of the system. Now we have over 500 members in the group, and many, many practices are starting up every day. Vaccines are not perfectly solved at this time, but there are ways that we work around it. So I just did it. I was jealous of their ability to spend time with the patient. Really, that’s what I wanted to do.

Kevin Pho: So give us a sense of what your typical day is like. How many patients would you see? How long would you spend with each patient?

Andrea Wadley: Yeah, so I have a house-calls-only model, like I said. I have a home base. Really, I had to have a commercial space to get vaccines and medications, so I share office space with my husband, who’s an entrepreneur as well. So it’s my home base, and I travel within usually 15 miles of that home office to see patients.

Really, a family will find me, they will sign my contract, and then they start their membership with the practice. I charge the same amount every month, on the first, and that gives them access to me. So there’s lots of texting. I solve a lot of things over the phone, and then I do all of their child’s well visits per the AAP guidelines. I do their vaccines, or I direct them to a place to get their vaccines done, and then I’m also available for sick visits.

In order to drive in a large metro area, I had to kind of extend my radius. I do have patients outside of that. As a result, my goal is to have about 100 patients, so I really don’t do lots and lots of visits every week, honestly. I cluster well visits by geography, so in different areas of town I try to stay and see several patients in that area of town in one day. It just makes the driving a little bit easier. Then sick visits are unscheduled and unplanned. A lot of times I can take care of stuff over the phone, but if I can’t, I move stuff around and I go see the patient when they’re sick, for sure.

So on average, some weeks I see no patients, and some weeks I see 10 to 15 patients in a week. I generally can’t do more than five or six in a day, unless it’s a lot of siblings. There’s a lot of driving. Getting out of the car, getting all the stuff ready, talking with mom and everything, all that takes time. But in general, for the patients I’ve seen a lot and know well, it’s about a 30-minute visit. Some of the newer patients get an hour to an hour and a half, depending on how many questions mom has. A lot of newborn visits, especially their first few, take longer, just teaching and reassuring parents that they’re doing a good job.

Kevin Pho: I want to ask about that transition period. You went from being a pediatric hospitalist with a relatively steady paycheck to something that was pretty much unknown. Were you scared during that transition period? Talk about some of your fears and trepidations, and how long did it take you before things stabilized and you had a regular panel of patients in your new practice?

Andrea Wadley: Yeah, that’s a really good question. It was really, really scary. It was frightening to step out on my own. My husband had a somewhat new business that was getting a little bit of income for our family. I had some savings from my previous job and used that to start the practice. But really, I was unknown as a general pediatrician. I’d been in the hospital for eight years, and I moved back to the community after residency and medical school, so really nobody knew me as a general pediatrician.

So it took a lot of talking to anyone that would listen, everyone that would listen. I did networking, I did marketing groups, I did social media posts. Back in the day, when Facebook’s business pages got a lot more reach, I would teach different pediatric topics and it would get shared. I mean, I’ve lived in this community for a while, and my husband has lived here longer than me, and so we have a lot of connections. I would share with people, and they would share my posts and tell their friends.

All of that at first was really slow. I’d get one patient, I’d get another, and it was a slow, slow process, with lots of desire to quit, especially in the beginning. You can ask my husband how many times I wanted to quit. But eventually, around 18 months, I had enough patients that I was covering my overhead. My overhead’s not super high, but I was covering overhead, and I was starting to be able to pay myself back the investment that I’d made in the practice. Then really, kind of the two- to three-year mark is where things exploded a little bit more. I got to a sort of critical mass.

Then during the pandemic, I really just maintained the practice. I added some families that had reasons why they didn’t want to sit in a waiting room, like they had a kid on immunosuppressives or something like that, so I did home visits for those families. Some of them stayed, and some of them moved back to a regular office after the pandemic. But in the last maybe 12 months or so, I’ve added enough that I feel like I finally arrived at the goal that I was setting out to reach. I’m paying my bills, I’m contributing to our household income, and I’m starting a second vertical for the practice, because I have some cash flow now, which is really nice.

Kevin Pho: Now, for those pediatricians who may be listening to you on this podcast, what kind of questions should they ask themselves, and what kind of characteristics should they have, if they’re to consider direct primary care going forward?

Andrea Wadley: Yeah, that’s a great question. I’ve actually mentored several pediatricians to get them started, and a lot of times, you have to have some sort of capital to get started with DPC. It’s not a ton. A traditional practice is lots and lots of money: You’re getting a building and hiring people and all that stuff. But with DPC, really, $10,000 to $20,000 is pretty reasonable to get started. Then, if they’re leaving a current job, like an employed job, they should look at their non-compete and try to figure out what an ideal scenario would be for starting a practice.

I also advise them to do some personal branding. So if they’re leaving a previous job, start a Facebook page that’s just them, teach people, start on social media and kind of become a presence and a brand, and try to start a waitlist before they start. And then, of course, figure out vaccines, what that looks like in their part of town and area, and how that’s going to be for their patients.

There are also ways to do DPC pediatrics without worrying about vaccines. There are pediatricians and family medicine doctors who do just fourth-trimester care, so you take care of the baby and the mom for the first three months of life, and then you send them on, and you don’t have to worry about vaccines. There are also some friends of mine who are doing mostly mental health, like ADHD evaluations, autism evaluations, that kind of stuff. So you’re not really the primary care, and you don’t have to worry about vaccines. So just have them examine what their desire is and what that looks like.

And then just make sure they know it’s hard. Entrepreneurship is hard. Being a doctor is hard enough. It used to be that you could hang up a shingle and say, “Hey, I’m a doctor,” and people would come to you, and even in fee-for-service practices, it’s not like that anymore. You have to be able to market yourself: open houses, networking, meeting the specialists, doing social media, doing video webinars, those kinds of things. You just have to keep putting yourself out there in order to be able to build a patient panel. Not everyone has that in them, and that’s OK, but it’s just knowing that ahead of time. Those are kind of the main things I advise new pediatricians to do.

Kevin Pho: We’re talking to Andrea Wadley. She’s a pediatrician. Her KevinMD article is titled “How direct primary care saved my career and my life.” Andrea, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Andrea Wadley: Gosh, I never wanted to be an entrepreneur when I was finishing residency, but I just think it’s time for physicians to stand up, whether that’s owning your own practice or using your degree and knowledge for other entrepreneurial adventures. I really believe that we are the change in medicine, and nobody’s going to come and change it for us.

So if you’re considering entrepreneurship, there are plenty of people who can help you and who can cheer you on. If you’re a pediatrician wanting to start your own thing, or a family medicine doctor, we are a well-connected group of entrepreneurs and direct primary care physicians, and we would be glad to help you make this transition.

Kevin Pho: Andrea, thank you so much for sharing your story, time and insight, and thanks again for coming on the show.

Andrea Wadley: Appreciate it. Thank you so much.