From Burnout to Breakthrough: Dr. Corey Duncan on Reimagining Primary Care

Welcome back to Hometown Jax — the podcast where hosts Aaron Bacus and Jason Kindler sit down with Jacksonville’s entrepreneurs, professionals, and community leaders to uncover their journeys, challenges, and the stories that make our city thrive. Each episode dives deep into what drives our guests to make a difference in Northeast Florida, celebrating the spirit of hard work and hometown pride that keeps Jacksonville growing.

In this inspiring conversation, Aaron sits down with Dr. Corey Duncan, founder of Duncan Health Direct, to explore his journey from biology student to family physician — and how his experiences in traditional medicine led him to create a more personal, patient-first healthcare model. Dr. Duncan shares candid stories from medical school, long hospital shifts, and the mental toll of the pandemic, before explaining why he’s now passionate about direct primary care — a model that puts relationships and real access back at the center of medicine. If you’ve ever wondered what it’s really like to become a doctor or how healthcare could be done better, this episode will change how you think about modern medicine.

Transcript

00;00;00;00 - 00;00;14;29
Unknown
Where are your hosts, Aaron Backus and Jason Kindler? We like to sit down with our guests to hear their journey, their challenges, and how they impact the local community. So grab a seat. Tune in and let's get inspired by Jacksonville's everyday workforce. Welcome to Hometown Jacks.

00;00;14;29 - 00;00;35;12
Unknown
doctor. Corey. Duncan, thank you for being on hometown. Jax, I appreciate this. I'm real happy to be here. Thanks for inviting me. I'm excited. I'm excited because you're the first doctor we've had on the podcast. And I have to tell you, I've asked a few and they didn't really want to come. So I'm really happy that you're come and you're going to be here to talk about your journey as a doctor.

00;00;35;15 - 00;00;50;20
Unknown
I think it's super interesting. I've always had a lot of respect for doctors, because I know how much studying you had to do to get that. Yeah, well, thank you very much. Lots of studying, Yeah. It's a it's a journey. Yeah. For sure. They say it's lifelong. You know, you got to kind of keep at it, right?

00;00;50;20 - 00;01;06;09
Unknown
Right, right. But, yeah, it's definitely gotta hit the books pretty hard. Pretty early? I would think so. I would think so. Well, let's go through your journey. So did you come from a medical family? What gave you the itch to be a doctor? Yeah. You know, actually, my my dad was a pipefitter. Okay, well, that's a little different.

00;01;06;09 - 00;01;30;11
Unknown
Yeah. You know, I, you know, I was one of those people in high school that I kept changing my mind about what I wanted to do. And, I ended up studying biology with a focus in zoology in undergrad. And there were some volunteer programs at Miami Children's. And I went one weekend to basically, we were just going into the pediatric unit for the kids that were not sick, but having to be in the hospital for a very long time.

00;01;30;11 - 00;01;47;22
Unknown
And we would just play with them. And I kind of got interested and they were like, well, hey, why don't you take the mcats and see if you hit the prerequisites and ended up taking the test and applying it and, well, you know, got into Florida State. I remember the date actually. Did you go undergrad? I went to Bury University in Miami Shores.

00;01;47;22 - 00;02;07;22
Unknown
Okay. Miami. Okay. Yeah. Kind of a small Catholic school. Okay. Not a big pre-med school. I think my graduating class for biology was, like, 20 people. Oh, wow. Yeah. Very small, which was great, because I got to do, like, a lot of hands on research, but none of it was medical or clinical. Actually, actually got published in 21 for a Chicago paper that I worked on, like the bugs.

00;02;07;29 - 00;02;26;11
Unknown
Yeah, yeah, I was part of the data collection team. We were, like, measuring the wingspan and stuff. Interesting. That was really cool. And I got into Florida State. I remember I got the call on April 1st, and when the, recruitment person called me, I was and I was actually, like, at a restaurant for some friends.

00;02;26;11 - 00;02;46;16
Unknown
And I was like, this is a joke. Somebody's pranking me right now. Did you apply to a lot of medical schools or. I played it maybe a dozen. Okay. Mainly in the southeast. And, I only really got into Florida State. I got waitlisted in Miami, but ultimately, I think they talked to each other. And then once I had already started at Florida State, they were they were like, okay, well, you know.

00;02;46;19 - 00;03;04;16
Unknown
Right. Yeah. And I already started there. Florida State starts earlier in the season. And the schools my school started like the typical August September but fortunately starts in May. What was that a difficult football decision for you I mean, man, well, I mean, my my mom did go to so like it kind of was a young family my wife went to, okay.

00;03;05;04 - 00;03;22;17
Unknown
But, no, I mean, Florida State is an awesome school. It's it's a great community. Yeah. So, like, it was really I even though I have no regrets, I always felt so welcomed by the school. They really did a good job of. That's all taking care of my daughter. And my wife went to Florida State, so we got a lot of Florida State in our house, so oh, that's awesome to hear.

00;03;22;17 - 00;03;49;15
Unknown
So you grew up in Miami. Kind of got the itch going to some medical things and volunteering. So obviously you had that that urge in your heart to help people. Is that right. I think what drove me the most is I love talking to people. I love to, you know, and what better profession to really know somebody in an intimate level than position, you know, and there's you don't get a lot of opportunities in life to help people, you know, and whenever you can.

00;03;49;15 - 00;04;06;06
Unknown
It's just such a privilege. And I just really like that aspect of it, you know, like you really get to meet lots of people from lots of different walks of life and lots of different situations and get to know them. And that was really what attracted me to to being a physician and applying a medical. That's awesome. And ultimately the primary care.

00;04;06;08 - 00;04;26;16
Unknown
So let's talk about medical school because I, you know, a very select group that ever goes to go to that, like, so how how is is it four years and is it just get progressively harder like talk about your life during that four years. So undergrad is pretty you know, it's the same for most people. You have to hit a certain number of prerequisites, in order to apply.

00;04;26;16 - 00;04;43;29
Unknown
I take the mCAT, the medical college admission test, and then you make your applications. And mCAT, I'm assuming is very difficult. It you know, I joke at that time it was the most difficult test I had ever taken. It's about 4 or 5 hours long, if I remember correctly. Back then, I took it on paper. I'm kind of dating myself.

00;04;44;15 - 00;05;15;14
Unknown
And I took a test equally as hard in medical school every month, really, from that point forward. Interesting. So. And then when you actually take your boards, you know, they're even more intense. So it's pretty it's it's kind of it. Does stepwise get more difficult? For example, like if you're a full time student, an undergraduate, you're taking between 12 and 18 credit hours, but you're usually taking 21 or 22 credit hours per semester in medical school, and they're in semesters or summer, fall, spring.

00;05;15;15 - 00;05;43;15
Unknown
There's not usually a break. Sometimes there's one that first summer you get a break, but not always. It depends on how things are going. Interesting. And it's a lot of credit hours. They always call it. They say it's like drinking from the firehose knowledge. Just try to absorb as much as you can. And weekly quizzes and study groups and, and just you have that, you have that block test and everything is regimented where you have to take anatomy and physiology and pharmacology and all the test covers, all the classes at the same time.

00;05;43;15 - 00;06;04;14
Unknown
Wow. So it's pretty intense. And you kind of just have to absorb as much as you can and keep moving. The first two years, traditionally and most medical schools in Florida say it's a little different because they start exposing you to clinical very early, which is great because. But and I go over that, but most of the most schools, first year all sciences, you know, all just background sciences.

00;06;04;14 - 00;06;21;00
Unknown
You take your United States medical licensing exam, step one, the end of the second year, in which is now a pass fail, which is good, used to be a graded. And then if you pass that, then you go into your third year and your third and fourth year, or your clinical years, where the third year is like your core clinicals, and then the fourth year is more of the elective.

00;06;21;00 - 00;06;43;09
Unknown
And when you say clinical, in my mind that means that you're working in a hospital probably, or an office, you know, like you have to get your core rotations internal medicine, pediatrics, family medicine, surgery, obstetrics and gynecology. So they're just rotating you around so you can get a good glimpse of everything more or less to figure out which way you want to go after that, or also because everybody should know it, right?

00;06;43;10 - 00;07;01;07
Unknown
It's like really the basics, you know, and and it is why you're doing that. You start to kind of get a feel for, okay, I want to go. The dichotomy really goes on. Am I going to be medical or am I going to be surgical, you know, and there's a big you know, there's a big difference between kind of being a medical doctor and a surgical doctor.

00;07;01;10 - 00;07;28;22
Unknown
Well, what is that? That's interesting to obviously surgery. You're doing surgery, but like, what would medical what just everything else? No, I mean, so medical would be more like diagnosis and management of diseases. And surgical would be more like procedural, you know? So like, for example, in an emergency setting where you come in abdominal pain, I work you up, I find out you have of say this, but then at that point, I'm passing you off to the surgical team who's there going to fix the problem, you know, but sometimes you come in and you have diverticulitis.

00;07;28;22 - 00;07;49;04
Unknown
It's not a surgical issue. Stays in the medical team. The you'll be a minute for antibiotics or go home antibiotics depending on how things are going. Right. So it's, I had a gentleman. I had a really great general surgery, preceptor when I was in medical school. And, I don't know, I guess I shouldn't use any foul language, but he told me, like, hey, when it really hits the fan, you're going to call a surgeon.

00;07;49;06 - 00;08;05;23
Unknown
That was kind of his pitch. So it's a little ego thing there. So. Right. You're saying, oh, I mean, well deserved. Well deserved. I mean, like, you have to have utmost confidence in yourself to go into that room and. Right, try to fix that problem I have a lot of respect for. So I would think, well, I mean, we all do, man.

00;08;05;23 - 00;08;24;03
Unknown
When you put that gas on and you forget about what's happened and you just you hope they know what they're doing. Yeah, they they're very skilled and they go through a lot of training. Their residencies are longer typically than the medical unless you're specialized. But like for example, family practice was three years. But a general surgeon even just basic general surgery is five years.

00;08;24;05 - 00;08;39;14
Unknown
Wow. You know, before they're fully independent. And did you ever think about being a surgeon or you knew that you didn't want to do that? When I had first started and I had the opportunity to shadow one when I was a first year and I was like, this is really cool, but it's not for me, right? Yeah. You knew right then, right?

00;08;39;19 - 00;08;57;06
Unknown
The first week. Interesting. I really enjoyed it. I actually had a lot of great exposure to the operating room when I was in medical school. But I just kind of knew it wasn't my my forte because the surgeon like it kind of going back to what you said about, you know, working with people and help them with their problems.

00;08;57;06 - 00;09;16;00
Unknown
Yes, a surgeon does that, but they're more I'm thinking in more of a specialty, like. But, come in and do it and I'm out. You you're for the long term, more or less. Yeah. I'm kind of more of your preventative, you know, like mitigating symptoms, improving life, like quality of life kind of thing. But, I mean, when something is wrong, you got to call the surgeon and fix the problem, right?

00;09;16;00 - 00;09;36;07
Unknown
Right. And my job is to try to keep you from getting to that point, or at least identify when that point is right early enough that it's not a big problem. Interesting. You know, just for example, for cardiovascular surgeons, right? I mean, they save lives every day doing coronary bypasses, you know, heart attacks, things like that. But if I had my way, you'd never be on that team.

00;09;36;10 - 00;09;51;28
Unknown
And they would like that, you know, they would prefer that they got other things to do. Right? Yeah. So, so kind of from the primary care standpoint, I'm trying to get patients in super early so I can say, okay, what are your risk factors? What are our modifiable risk factors. Some of them you can't control. It's oh my dad and my mom.

00;09;51;28 - 00;10;09;14
Unknown
They all had heart attack. You can't control that right. That's genetics. But if we can get a little bit of weight loss or we can stop some bad habits that might be promoting the heart disease, you know, hopefully you never end up on that table with current events. That's an ideal. Yeah. So first year medical school, you figure out you're not going to be a surgeon.

00;10;09;28 - 00;10;34;06
Unknown
You want to go the other direction? Yeah. So are the days. Just like I mean, I just envision, you know, we've all seen the movies, but, like, it's literally just school study, sleep school study, sleep. Like, there's this. Is there no time for anything else, really? I mean, you make time for mental health. I mean, the first couple years are pretty intense, and, you they have to be.

00;10;34;06 - 00;10;49;27
Unknown
It's it's just it's such a large volume. Is there a large is there a big fall out rate of people that. No. Not. No. They're very selective about who they bring in. So they. Yeah, pretty much no, I think maybe in my class of 122 people maybe didn't make it to the end. And I think one was a family issue.

00;10;49;27 - 00;11;04;29
Unknown
It wasn't even academic. Interesting. Yeah. And I'm not sure, you know, because I was like, I don't know all the details, but The dropout, they do not want you to drop out once you're there, which is why they're very selective about who they bring in. They want you to do what's called the match, where you get your residency program.

00;11;05;01 - 00;11;23;07
Unknown
They want you to get the match you want. They want you to pass the test on the first time. And that's part of the whole process of applying is like, they really want to pick the best candidates, and it's not necessarily always the person who has this four GPA in the high score, like they're looking for people that are more well-rounded and have life experiences and might handle the stresses better.

00;11;23;23 - 00;11;44;02
Unknown
Yeah. Once you get into residency it's even more stressful. Oh I would think so. So you really the first two years. Yeah. It's a lot of just go to lectures you know hit the books after lectures. You do start to have to pick what we call high yield stuff. When it comes down to test time, you're not going to be able to cover every single thing.

00;11;44;02 - 00;12;02;11
Unknown
So you kind of got to look at what's the most important stuff for me to cover. And then kind of triage, you know, your study habits and and it really it's funny, I used to say, I'm sure they're smarter colleagues than me that didn't feel this way. But when I hit about my second year of practice and residency, all that stuff in the first two years started to click.

00;12;02;17 - 00;12;21;12
Unknown
Interesting. I was like, oh, wow, I get why this disease, why I was reading this, presents this way. So I'm assuming you have a very good memory. I mean, I would think that would be a prerequisite. Not necessarily. I think you just have to play to your strengths. I am one of those few people that has like a really, really intense memory.

00;12;22;17 - 00;12;40;17
Unknown
That had some times in my practice during the pandemic when I lost it, it was really no notable, right? There was that burnout. But, there are people that if you kind of learn your study habits, you know, which most people in medical school have, you just got to play to your strengths. You know, some people are visual learners, some people are audio learners and some people, they have to write it down or do things to remember them.

00;12;40;17 - 00;13;01;03
Unknown
And it's all about finding that interesting. Yeah, I remember my first semester. I went from being like a straight-A student. I took my first anatomy test. I got like a 78, and I was like, what? What happened? 78? Man, there's some people that are happy to get A700 no, I was devastated. And, what I had done is I was a musician in college, so I was always up super late.

00;13;01;07 - 00;13;19;03
Unknown
Right, right. And, you know, undergraduate for most medical students, it's pretty. You know, I don't want to say easy, but compared to our peers, like we didn't, most of us, we could walk into a test and and do fine. Right. And, when you get to medical school, that's not the case anymore. At least not unless you're like, at the top, top, top 1%.

00;13;19;03 - 00;13;44;13
Unknown
Right. And I tried to change everything about myself. I was like, oh, I'm not going to stay up late anymore. I'm gonna go to sleep at a certain time. I'm gonna study a certain time. And it didn't stick right. And then I figured out that my focus best focus was 9 p.m. to 12 a.m.. So as long as I studied from those hours every day, and I was really consistent about it and then slept 12 to 6, like my grades came back interesting.

00;13;44;18 - 00;14;01;19
Unknown
And it was just that's because that's not I mean, I know the word normal, but like that would be contradictory to what a lot of people would say. Like, that's not a very efficient time. But just like you say, play to your strengths. You know, for me, it's the time I'm on the, you know, the even if I it's just my sleep wake cycle.

00;14;01;20 - 00;14;16;29
Unknown
I mean everybody has their own circadian rhythm. I can I've only slept four hours a night before. It's very difficult for me to get to sleep for midnight. Interesting. It's just who I am. But there's other people that like they gotta be in bed as soon as the sun goes down. Right. But then they're up at the crack of dawn, right, right, right.

00;14;17;03 - 00;14;37;16
Unknown
Just how we're different. Well, when you start in medical school and you show up to your class, is it most people coming out of undergraduate that are your age younger or is it more on the older side where people are coming back or what's kind of the mix? It was a pretty diverse mix. The majority would be people like myself that had gotten an undergraduate degree.

00;14;37;16 - 00;14;53;04
Unknown
They were in their early 20s, and now we're leading into medical school, graduate school. Some of them had graduate degrees. I remember there was a couple of my class that had MPH is from Johns Hopkins was pretty impressive. And they they were a little bit older. There was an hour in, in my class. Okay. Katie, I remember her.

00;14;53;04 - 00;15;10;22
Unknown
She was awesome. And, and then there were people that I remember. There were, I think there was a chiropractor in my class that had, like, left his practice to enter medical school. Interesting. So he was in his 30s. And there was some I think the oldest might have been in the early 40s. But then you stay with this group for four years, pretty much.

00;15;10;22 - 00;15;26;11
Unknown
So you get to know most of them, right? Yeah. You get to know him pretty well, right? We do kind of splinter off. FSU's a little different when we get to our third and fourth years. They have satellite campuses throughout the state and we split into six groups of 20. Interesting. So really that group of 20 is the one that I got the closest with, right?

00;15;26;14 - 00;15;45;10
Unknown
Yeah. I've gotten to know them really well. But yeah, you kind of get to know your peers pretty close and you're studying together all the time. And so when you said something about top 1%, like, so is there a group in that 120 that you're just like, oh my gosh. Yeah. There's always somebody. Yeah. Like there's nothing more humbling than being in a group of valedictorians.

00;15;45;10 - 00;16;07;01
Unknown
Right? You thought that you were good and you just meet a girl that like, like got a perfect score on the mCAT and like, she's, you know, and, like, they're just so chill about it, right? Right. You know, it's like they're just on a different wavelength. Is it, is it is it is it because it comes easy to them or do they still work hard and study like is it or is it just they're just so much different level of brains.

00;16;07;01 - 00;16;25;01
Unknown
I think, you know, there are people that are just yeah, you know, I one of my professors, I'll just give an example. I had a rare condition at residency. I ended up seeing one of my professors to get diagnosed. Interesting. And he, you know, I had seen, like, 5 or 6 specialists before I got to him, right?

00;16;25;01 - 00;16;38;26
Unknown
And everybody was telling me different things, and, like, I was a physician, too. So I'm like, this doesn't make sense for me. You know, I get to him and he, you know, he looks at me and he's like, hey, how are you doing, Cory? My boy, you know, like slapped me on the shoulder and kind of grabs my head and takes an old fashion, you know, down the scope.

00;16;38;26 - 00;16;59;04
Unknown
Looks in my eye. Yes. Oh, yeah. I wrote a paper on this in 1988. This is fun. And he starts talking about it, and he starts talking about how photons have some kind of negative charge that go across the optic nerve and, well, it goes into this deep physics about it. I can't remember a word he said. Oh, it's just like it was just completely over my head after you'd been to multiple specialists.

00;16;59;04 - 00;17;16;15
Unknown
You're a doctor yourself. And then he swoops in with this, and he was like, on the he was I wrote this paper, you know, like, I know exactly. Chip. And he was 100% correct. That is why he was so, so basically I had gone, like, partially blind in one eye. Wow. And it was nobody could figure out when it wasn't.

00;17;16;15 - 00;17;34;11
Unknown
My optic disc was once everybody panicked because sometimes that can mean bad things, right? You know, and, he was a has from some virus you had. And it'll go away in a couple years. Right. And, his recommendation was so strong when I got my disability insurance, they, you know, I had you have to mention everything, right?

00;17;34;14 - 00;17;52;00
Unknown
I thought, oh, for sure, they'll put a writer for blindness or something right now. They just contacted him and they didn't put any rider like I was like, wow. Like, it's. So he's no sir. And he was right. It took about two years and went away and, you know, not only did he write the paper, but he had the confidence to just diagnose the like, yeah, I know what it is.

00;17;52;06 - 00;18;14;16
Unknown
You know that. I mean, he had a lot of data in front of him at that point. I had done a ton of testing before I got to him. But, you know, everybody else was having me do, like, laser scans and, like, all these fancy. And he was just, you know, just a handheld device and. Oh, that's interesting, you know, but that that's my example of somebody who, you know, this guy is I'm never going to get it like he's above.

00;18;14;16 - 00;18;30;24
Unknown
Right? Right. That's a good point. It kind of makes me think of, you know, the the word on the street is I these days, like, I was going to do this. I was going to do that. But those are the kind of things you hear. Well, that's just the the human that is in quantifiable a little bit, you know.

00;18;30;24 - 00;18;53;01
Unknown
Yeah. I think the clinical gestalt is, is invaluable, you know, and I kind of pride myself on it too. I mean, and that's why training is what it is. It's why the rest of the hours are so long. You have to be exposed to 25,000 cases, you know, 100,000 cases, and to for it to stick so that when that 1 in 1,000,000 person is in front of you, you don't miss it, you know.

00;18;53;01 - 00;19;12;22
Unknown
Right. And the only way to do that is to get exposed to it. And then you have to get all that exposure. I think AI is going to be in medicine. It's going to be an extremely useful tool to correlate data and look at patterns and help you see the patterns that are there. But ultimately, the person kind of putting it together should be the physician on the other, for sure.

00;19;12;27 - 00;19;28;15
Unknown
For sure. Radiologists, for example, you know, it could highlight things on an X-ray and be like, hey, what do you think about this over here? You know, oh, look at this density behind the heart. Cardiac, you know, and and then the radiologist might look at a little bit harder and it's going to make them more efficient. And it's going to mitigate some of the fatigue that they might be feeling.

00;19;28;15 - 00;19;48;01
Unknown
After reading 200 x rays. Yeah. Right. One of the really useful things that's really amazing with AI, I don't personally use this, but I do know some colleagues that do. Is the AI scribes, where you can go into an exam room and put your laptop down, put the microphone on and it listens to the conversation and it just fills the note out.

00;19;48;03 - 00;20;07;09
Unknown
That's nice. It does the entire history, listens to the patient, listens to the doctor. And you could just call the exam findings and it's just so much more efficient. Yeah. And then, you know, we use it in our business a lot for meetings and like just the the ability of absorbing the whole meeting and summarize it and then keep history and then being able to correlate.

00;20;07;14 - 00;20;29;14
Unknown
Oh well, you remember you said this six months ago and like it's like invaluable. Yeah. I remember you know, I was a first year resident when they were kind of rolling out the meaningful use electronic medical records stuff. So like we kind of had half of our stuff on the computer and half on the paper charts. Right. And you'd have to go get the stack of charts and like, oh, what was their kidney function last year?

00;20;29;14 - 00;20;52;17
Unknown
What was it the year before that? What was the year for that? Did they have an echocardiogram six years ago we pulled through this chart right. You know, and now it's all on the computer. But it's kind of like you're doing it. This data mining, you really have to go. And there's lots of systems like so like in my practice, I might have to log in to the Baptist portal and look over here, or maybe I'll go over to precision and I'll look up this and just trying to find the data so I can make a decision for the patient.

00;20;52;19 - 00;21;12;08
Unknown
And I think eventually, you know, once we have these like national systems which are being built, epic is really amazing on us. Great to hear. And, you know, you'll be able to go, hey, give me my patients. You know, glomerular filtration rate over the past ten years. And I go, here you go. And then you you see it, and you can make an educated decision right there.

00;21;12;08 - 00;21;36;16
Unknown
So much more efficient. That's amazing. Yeah. So the first two years you go through and then you start your clinical. So what were you doing there? Were you when that small group did you stay in Tallahassee or. I went to Fort Pierce, Florida okay. Which was awesome. So in an e.R there or what? What? So so when you're doing your third year, you basically you're in Florida State, you're in a group of 20 and you have to do what's called four clinicals.

00;21;36;16 - 00;21;56;18
Unknown
And those are different for everybody. So it's pediatrics, internal medicine, general surgery, obstetrics and gynecology. I believe emergency medicine is one of them. I might be forgetting one, but I remember I started pediatrics and it was mostly outpatient. We did six weeks of outpatient and two weeks of inpatient, and, it was it was, it was really get thrown in the deep end.

00;21;56;18 - 00;22;12;29
Unknown
You know, it's kind of like you're. Oh, here you go. Let's see some patients. Tell me what you think when you say outpatient. Literally you're going out to see them? No. Like in an outpatient office. Oh, okay. Okay. Just like a regular. Yes. Versus outpatient. Meaning, like, not in a hospital. Got you. Yeah. And then inpatient would be like the kids that are in the hospital.

00;22;13;10 - 00;22;30;03
Unknown
Yeah. So what kind of goes back to where you started. You were started starting with the kid. Yeah. That's true. That's really true. I always enjoyed pediatrics. And I flirted with applying to pediatrics for a while. But I also really enjoyed like internal medicine and geriatrics. So that's why ultimately I chose family practice. I got to do all.

00;22;30;03 - 00;22;48;24
Unknown
Do it all. Yeah. And, yeah, it's it's it's you start getting exposed to, like, the patients in the clinical setting and seeing real pathology. I remember one of the hardest things I had in my first rotation was I could not see the kid's eardrums. I think one of the most basic things that doctors do, right, you know, look in an ear and I'm great at it now.

00;22;48;24 - 00;23;02;01
Unknown
But like, that was like my whole goal for the first two weeks. I'm like, I just want to see ear infections come in like 3 or 4 times a day, right. To those offices. Yeah. And you can't see it's like you're just going to throw antibiotics at the kid that says his ear hurts every time. It's not good practice, right?

00;23;02;03 - 00;23;21;05
Unknown
Yeah. So yeah, I mean I remember that very clearly. Just interesting. You know, I was just making sure that I could examine these ears. Right. You know, before I moved on to the next thing. Yeah. That's for sure. So fourth year, what are you doing on the fourth year? Fourth year? It's like you're doing an advanced course, so it's like shorter version.

00;23;21;05 - 00;23;55;00
Unknown
So, for example, you do like advanced internal medicine, which is like a really more intense hospital rotation and you'd have more responsibilities. One of the great things about Fort Pierce for five states, there's no teaching hospital. At least there weren't then. They're not teaching hospitals out there. So you kind of got treated as a resident a little bit, where the attending physicians were like letting me evaluate the patients side by side and put in orders and, like, real practical, hands on experience, you know, and, I did a, like, you do, like an advanced internal medicine, advanced pediatrics, and then you get a more electives, you know, so that's where you kind

00;23;55;00 - 00;24;15;05
Unknown
of get the time to. Okay, I really think I might want to do oncology or I might want to do, put out enough an entry. On oncology or what am I thinking? Right, right. You know what I'm saying? You know, I think, like, get in the specialties and you get you get to also do externships where you might go to another university or another academic institution for a few weeks.

00;24;15;05 - 00;24;34;10
Unknown
Okay. And, that's those are fun to take advantage of too, because there really is differences between academic institutions, you know, and, you learn a lot when you do. You ever did you ever have a patient freak out? Like, I don't want a, student to work on me kind of thing. I was really lucky with that.

00;24;35;26 - 00;24;53;10
Unknown
I think the only time I can think of as a student that I had a patient say, I don't want the student in the room was a woman of a faith that didn't want men to. And it was an ob gyn. Ruth got it. So it wasn't a personal thing. Yeah, yeah, I did have some colleagues that, like, they suffered from that a little more.

00;24;53;10 - 00;25;13;08
Unknown
Yeah. I think it's maybe how you like, kind of present yourself, you know, like like I'm not sure, but, no, that really didn't come up much. Well, I just know of any experience I've had, like. Yeah, I mean, we want the next person to learn. I mean, that's go, you know. Yeah. I think I always tried to make sure I represented myself, you know, as a student.

00;25;13;09 - 00;25;28;22
Unknown
Yeah. Not as you look very official and get the white coat. And we had long coats too, like you used to use. Only the attending physicians used to have a long coach for this thing. So you're all getting long coats. And we had like, these gold badges and like, little pins and, you know, stethoscope and, like, you just look like a young doctor.

00;25;28;23 - 00;25;43;13
Unknown
Yeah. They were really up in, like, you had to be shirt and tie, you know, like like you look very official. I mean, even sometimes more official than the resident. So, like, burned out and, like, wearing scrubs, right? Well, I like the scrubs, man. I feel like it just kind of loosens things up a little bit. You know?

00;25;43;18 - 00;26;00;14
Unknown
It's not so official. Yeah, I think it's kind of become the official uniform. I mean, I barely wore the white coat the last five years of my practice. And I have one, you kind of think about it, especially during the pandemic. It does. You get long sleeves, you can't wash your arms, and you don't want to spread things around them.

00;26;00;18 - 00;26;14;05
Unknown
Right? Yeah. So in a sense, it's more of a practical uniform. When I started this new practice, I was like, oh, I'm gonna dress. I wear a suit and tie all the time, and I eventually it just, I kind of got the vibe that maybe people thought it was a little stuffy. I started, I just went back.

00;26;14;05 - 00;26;19;26
Unknown
I'm like, I have to go back to wearing. Yeah, yeah. Like it's hard to block and tackle whenever you have a, a full suit on

00;26;19;26 - 00;26;34;08
Unknown
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Unknown
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00;26;50;16 - 00;27;00;27
Unknown
so forth here. You, you, you go through that and then you graduate. And then what happens after that. So there's a, there's a day March, please march 15th called match day. Okay.

00;27;00;27 - 00;27;16;11
Unknown
So basically third year in the third year you take what's called USM step two. There's two parts that they might have consolidated it, but back then needs to be two parts. There's a like a written exam similar to step one. And then there's a practical skills exam which is only given, I believe, Atlanta and Georgia, maybe a couple other places.

00;27;16;11 - 00;27;38;07
Unknown
So you have to fly out to do that. And if you pass that then you can start to apply for residency. Okay. And those are your training programs. And you pick the residencies based on what you want to do. So like if you wanted to go into family medicine, you would apply to general medicine. If you want to do emergency medicine, they have like a different application service and you apply to the places you want to go.

00;27;38;07 - 00;27;56;12
Unknown
And then hopefully you get interviews there during the fourth year and you kind of arrange those, then you do your interviews, you pick ten or 12 or 20. I mean, you can get in there right? And you would do what's called a rank list and they do a rank list, right? You pick 1 to 10 or 1 to 20 or however many you want.

00;27;56;15 - 00;28;13;12
Unknown
What programs I want to go to, starting with. I want to go to this one. After that, if I can't get in there, I want to go here and so on and so forth. And they do the same thing with the students, and there's a computer program that matches it all together. And on March 15th, match day, the whole school comes together and get in the auditorium and you go up on stage.

00;28;13;13 - 00;28;31;00
Unknown
They handle your level of interest in the open an envelope and tells you, where are you going? That's a little stress. Yeah. I'm there. Yeah. It's it's, it's, it's also like a lot of joy. Yeah, too, because you're very, you know, there's people that want to match in certain places or certain specialties that are difficult to get into, and they work very hard to get there.

00;28;31;00 - 00;28;49;11
Unknown
And, you know, that moment when they're like, oh, man, I'm getting into EMT, you know, like, I never thought I'd get that. Like they're just there's so much like joy. And so it's even more joy than seeing somebody graduate. Yeah, right. Match day was just crazy. So where did you match up to? I match to Tallahassee. Memorial Hospital.

00;28;49;11 - 00;29;05;26
Unknown
And that's when you're in the E.R.. That. No, that was a family practice program. And that was my number one choice there. Really awesome. Like, it was what we call an unopposed program. So, like, a lot of times of family practice, you like to go somewhere where there's not other residencies because you get to do everything right.

00;29;05;28 - 00;29;31;08
Unknown
And, really great training. I had there and, practice Tallahassee for a bit. Finished residency there. And I actually got a colleague, former resident there I was friends with. I was a year ahead of me, came out to Jacksonville to work for, you know, basically in the Baptist here in Flagler, which is kind of an interesting they have a multidisciplinary approach where like in the era, a Baptist, it's, you know, there's air guys, but then there's family practice and pediatricians together.

00;29;31;11 - 00;29;52;06
Unknown
And like, we kind of like divide the patients as appropriate, right? Yeah. And they they were working out here. They really loved it. And I didn't really know where to go. You like. And I was like, oh, you know, I'll go interview and met the group. They really awesome, super nice. And the CEO at the time was kind of his thing was like, we believe that every patient that comes in deserves to see a physician.

00;29;52;06 - 00;30;13;18
Unknown
And, you know, like, I like that tagline. And. Yeah, and she was really nice guy, Doctor Stromberg, like Rick Stromberg, just retired a couple of years ago, actually, but he was always in the trenches with us. Yeah. Great guy. Yeah. And, you know, it was it was it was a good experience. You know, a lot of stuff that comes into the emergency room is urgent, but yet not critical, right?

00;30;13;18 - 00;30;30;04
Unknown
You know, so having the, like, the family practice and the pediatricians, you know, like, really helps kind of take the burden off the guys, right. That had the major heart attacks and strokes, major injuries, you know, and they and they have the experience from their training to do that. So it's kind of nice to take the load off.

00;30;30;07 - 00;30;51;20
Unknown
Do you remember, do you remember the first patient or two that you were completely on your own? Like, I'm a full doctor, this is my first patient without anybody supervising me. Well, that actually would probably go back to residency because, I used to moonlight on residency at Urgent Cares. And I think one of the ones that sticks out the most, I was moonlighting as, like, a second year.

00;30;52;00 - 00;31;09;05
Unknown
I had a lady that tripped in a hole and came into an urgent care, like, 9:00, and she had such a severe ankle fracture, it was a completely destroyed, like, misplace. This is one of those, like, this is going in the operating room. She somehow dragged herself in to an urgent care, and that urgent care was hooked up to the hospital.

00;31;09;05 - 00;31;25;12
Unknown
So, like, I got her back and I X-rayed it, and I called the orthopedic surgeon on call, and he was like, she came in, she walked in. I was like, I swear. Yeah. And and he's like, well, I mean, it's actually in decent alignment. And like, her vessels are working and he's like, I could probably just see her in office in the morning.

00;31;25;12 - 00;31;43;05
Unknown
If you split it up, I'm like, okay, you know, like but I was just at the time I was like, freaked out about it. I was like, oh, well. The kid was called a tribally OLR fracture where, like, all three parts of the ankle are broken. Okay, that's almost always surgical. Yeah. Most ankle fractures are just like, you know, one part, and you just put a splint and send them home on some crutches.

00;31;43;05 - 00;32;04;04
Unknown
You know, it's usually not that big. So it was a serious hole she fell onto. She she really did a number people have continuously impressed me about how tough they are. Right. You know. And you would you I've had patients walk in with like a broken hip and they walk in and get on the stretcher. And then you do the X-ray and like the hip then like, how did you put weight on that.

00;32;04;06 - 00;32;17;29
Unknown
Supposed to be one of the most painful things. Right. It's excruciating. I'm sure. Yeah, but they did. I saw them do it. Yeah. People come in with like, major heart attacks or they're worried about their family at home and they're like, I gotta go home and take care of X, Y, Z. And I'm like, you're having a major heart attack.

00;32;17;29 - 00;32;39;03
Unknown
You know, like, that's interesting. There's probably a, tale in human condition. Like if your, your brain really controls a lot about how everything else is working, I would say, I always said medicine's a lot like left field. You know, it's most of the time people are fine, you know? But that ball comes your way. Everybody's looking at you, and you better not drop it right, exactly.

00;32;39;09 - 00;32;58;10
Unknown
It really is like that. Like things sneak up on you. And that's where all that experience, it's like, yeah, people. I saw somebody talking yesterday about, like, why do they make residents work such long hours and like they've gone back and forth on that. But really, when it comes down to it's like they've kind of proven that a tired doctor that knows the patient is probably going to do better than passing the patient off over and over and over.

00;32;58;10 - 00;33;15;06
Unknown
Yeah. You know, and a lot of the medical errors happen when you pass things right for sure. Yeah. Yeah. And and it's you just kind of have to get exposed to everything so that when it shows up in front of you, you go, okay, I've seen that for sure. Yeah. Well, I imagine being in a hospital like that, like you've seen some pretty serious stuff, like.

00;33;15;06 - 00;33;33;18
Unknown
Oh, yeah, gun shots, knife wounds, like car accidents, all that stuff. Yeah. I mean, that's not a trauma center. So luckily I didn't get too much trauma. Did a lot. I did a lot of shifts up on the north side, and occasionally gunshots were coming through the front door. As a family practice guy, I'm not the one handling that.

00;33;33;18 - 00;33;53;16
Unknown
I might be an adjunct. Doesn't like an assistant, but like, the younger guys are going to take over those, right? I, I think more of the caution is the people that seemingly look okay, but they're actually really sick. Right. One that comes to mind. I had a grandmother brought in, like, three kids and herself when she checked herself in, and the kids had, like, the sniffles.

00;33;53;16 - 00;34;09;09
Unknown
And then she just said, I think I have the same thing, right? And the kids were all fine like they were then. I called, you know, like, that's, I had checked the kids first because she was really insistent on it. I get to her and, I'm looking at her and she's, like, really pale, and I'm like, what's going on?

00;34;09;09 - 00;34;23;17
Unknown
She's like, well, you know, I've had like, menses for a couple months. I'm going, let's get some blood. And like, she had like almost no blood, you know, like she needed, like an emergent transfusion. Really? Yeah. And, you know, she was just downplaying it, you know, she was like, I'll take care of the kids first, right? Right.

00;34;23;21 - 00;34;40;24
Unknown
You know, and that's the kind of thing I'm talking about. It would be really easy to kind of go, oh, she must have the same cold as, you know, her vital signs weren't that of normal, right? Right. You know, she maybe had, like, 105 heart rate. Nothing that would make you raise alarms. And, you just kind of got to pay attention to those kind of people are stoic people, you know?

00;34;40;24 - 00;34;59;29
Unknown
Because sometimes they is testing the blood, kind of the catchall, like, literally. Can you see most everything of a blood test? And like, I always wonder when you do the blood test, why don't they just do everything? Why does it always have to be? Well, it's just going in for this test. Is it just expense or. No, no, no, some of it is expense.

00;34;59;29 - 00;35;17;10
Unknown
That's a nuance question. There's so many things that you could test. Got it, that if you were to do everything, you would end up with so much data, and then you would start chasing these little bits of data that may not have anything to do with what's going on. And that's where like, it kind of comes up.

00;35;17;10 - 00;35;32;15
Unknown
So I get to treat the patient at the number, right? You know, like, look at the patient, look at the vital signs, look at what's going on, what they're telling you. And then you try to order things that are going to back up or confirm or deny things that you're worried about. Right? So, for example, if you were to come in and you were like, I'm have a chest pain, right?

00;35;32;15 - 00;35;47;10
Unknown
And my dad had our attack when he was my age. And, you know, I'm really worried about a heart attack. You know, may do an EKG and like you, a lot of times you get what's called a nonspecific reading. Like it's not obviously, a heart attack was not completely normal, right? Right. And you do the blood work, right?

00;35;47;12 - 00;36;03;07
Unknown
And blood works fine, right. Well, then the question is, well, where do we go from here? Right, right. So sometimes the blood work on a heart attack take a couple hours to show up. Right. Sometimes you don't. You get what you like as a result. That's in the gray zone. And you kind of have to risk stratify. Like you get a gray zone result.

00;36;03;07 - 00;36;23;26
Unknown
It's like, okay, who's safe to go home to see a cardiologist next week who needs to come in tonight and which inconveniences the patient or a lot of patients. They don't want to go to the hospital. So like you really. And you can potentially subject people to dangerous testing, you know, like for example, a lot of people, why don't you just take them to the cath lab so the arteries look like it's like, well, I mean, it's the radiation, the dye.

00;36;23;26 - 00;36;42;24
Unknown
You could puncture the artery, right? Right. You know, and, even doing the stress test, like, if they're, they have, like, a narrow artery that you're not aware of, and you put them on the treadmill, like that might cause the heart attack. And so, like, you got to be selective. I never really thought about it like that because you think, from the layman's point of view, just just test blood in there and test for everything.

00;36;42;24 - 00;37;03;29
Unknown
Well, and that probably makes it worse. You know, there's way too much stuff. Yeah. To quantify there. That comes up a lot. You know, there's a new emerging field of medicine called precision medicine. And there's a lot of these genetic tests, right, that they kind of look for genetic markers. And the argument against that right now is like, yeah, we can test for these things, but we may not necessarily know what they mean clinically.

00;37;04;02 - 00;37;21;02
Unknown
Right. You like you can have a mutation that has no effect on your life. Right. And why start treating something that has no effect, you know, and it could cause a lot of distress for the person to know that they have that. Yeah, yeah. And they may lead them down a path that's worse than when they started. That's really interesting discussion.

00;37;21;07 - 00;37;40;28
Unknown
Think about that. Because we go back to the mental part of the human condition. I may not want to know. I have that gene if in that specialty. Right. Nothing's happening. Yeah. I think as these tests are more recognized and there's more data, like they'll become more useful. I mean, it's breast cancer Awareness month. So, like one of the great examples would be the BRCA gene.

00;37;40;29 - 00;38;00;04
Unknown
Right. So like if you have a female family member or a male family member who had breast cancer at a young age, I would recommend getting the test for that gene. Because if you have that gene positive, you want to start your screening very early. You want to do MRIs, you know, and you may in some cases may even want to do prophylactic surgery to prevent cancer.

00;38;00;08 - 00;38;25;20
Unknown
So like if I had a woman who was 18 years old and she was BRCA positive, she want to have children, I would advise her to have those children very young. Right. Interesting. And then and then and then consider having prophylactic surgery or just doing other measures to mitigate the risk of breast cancer, as she is. Right. So like if she waited till she was 25 and she developed breast cancer, I mean, she's, you know, like so so there are we have some genetic markers that are critical, right.

00;38;25;23 - 00;38;47;18
Unknown
But we just don't know enough about all the different ones that are out there. Right, right, right. For some people that can be hugely beneficial. Like if you have, there's, you know, it's just a little controversial right now because there's still kind of an emerging field. So that's just a great example of like, testing this, like there's some routine tests, like nobody would argue for me to get like a complete blood count once a year on a patient.

00;38;47;21 - 00;39;05;24
Unknown
You know, it may be unnecessary in a healthy patient with no symptoms, but, you know, it's it's one of the it's a it's a basic test. Right. And you can measure off of it something a word that I did write down is, bedside manner. You strike me as somebody that has a good bedside manner, because the way you say it, your your, your interest kind of started.

00;39;05;24 - 00;39;32;04
Unknown
I can tell by your personality because I just think that's really important, especially when you're talking to a patient, kind of just making them feel comfortable in a short period of time. On explaining whatever it is. I think bedside manner is crucial. Is that something that. Yeah, they teach the psychology of that. In medical school, Florida State did do, lectures on something called motivational interviewing, which is kind of like, how do you get somebody to like you?

00;39;32;04 - 00;39;50;21
Unknown
You know, one of the things that's really frequent in medicine is you come in, you're like, you're having chest pain, right? I go when it start. Okay. Does it feel sharp? Yeah. No. Yeah. Okay. Can you, do you having trouble breathing? Yeah, that's a close question, right. It's. Yes. But like, if you really just let the person talk to you and say we have a chest pain, like, tell me, how does I feel?

00;39;50;21 - 00;40;08;09
Unknown
You know, like, what does that feel like to you? Like when gets instead of giving them the answer they're going to tell you what's going on. Right? And they were like all these studies that showed that the average physician interrupts the patient within, like 10s of, like walking in the room. It's like person sits down. It's like, hey, Mrs. Smith, how you doing today?

00;40;08;26 - 00;40;25;03
Unknown
Oh, thanks, doctor. You know, I'm really concerned about my knee. Oh, wow. Okay, well, anyway, let's take a look at that. And then, like, they just didn't even let them tell what's going on. And it may seem something simple, like back pain, for example, usually just musculoskeletal, but like, hey, they could have an aneurysm, they can have some kind of spinal cord lesion.

00;40;25;05 - 00;40;42;15
Unknown
And if you let them talk for a second, they'll tell you that. They'll tell you, you just take responsibility, that you have it. You just you never know what path you're going to go down. It is an awesome responsibility. It is a privilege since there's, you know, you don't there's not a lot of opportunities in the world to kind of bring positivity.

00;40;42;15 - 00;41;03;12
Unknown
And, I just think that whenever we get a chance, like uniquely as physicians, we get a chance to kind of just make people's lives better. Well, I think, you know, perception is doctors make a lot of money. And I've always thought, well, they should make a lot of money, but regardless. And you can't be I can't imagine doctors doing it for the money.

00;41;03;12 - 00;41;24;24
Unknown
Like, it's just you've got to have an intrinsic, urge to help people, like, because that the money would not last. There's no way. I mean, there are some specialties that make more than I did. But, like, the money doesn't buy it. Yeah, like you have to enjoy it, right? You know, and, I think it's important to remember that too.

00;41;25;09 - 00;41;45;27
Unknown
I remember, there was a moment during the, during the pandemic, I think was during the Delta wave. I was, working with a friend of mine who he unfortunately later passed. Sorry. The, you know, we were sitting there and, like, when there's a cardiac arrest, were you down in Baptist here? And I don't know if I should say I don't if they're getting upset with me.

00;41;45;28 - 00;42;03;28
Unknown
Oh, yeah. I was, got it. Yeah. I was about to south that day, and, the, you know, we were sitting in a pod together and seeing patients as they came through. And, there was, you know, whenever there's a cardiac arrest, there's they call code blue room, whatever. Blue room, whatever. Right. And, it was going off every five minutes.

00;42;04;00 - 00;42;25;07
Unknown
I mean, like, every five minutes. Code black. And because of people coming in, because of the severe pandemic, it was like, all over the hospital. I mean, like this. We were just overwhelmed and there was just so much severe illness. And, it really there was a moment when it felt really futile, you know, and I said that, I said, I don't want to say his name, but like, here I go.

00;42;25;11 - 00;42;45;09
Unknown
You know, I think we chose the wrong profession. I said it to him, right? Because I was just burned out. And, and he goes, no, he goes, no, he did it. He goes, what do you want to do, be in Wall Street right now, right? Like and not that there's anything wrong with that, you know. But like and he goes, he said to me, he's like, at least we have the chance to bring some light into the world and makes a difference for some people for sure.

00;42;45;09 - 00;43;01;23
Unknown
And then he got up and he went to the code, you know, and that, you know, like I was sitting here pitying myself. These people are sick, right? And I'm fine, but I'm just the physician and like. And he, you know, he had it harder than me. And, he got up and did his job, and he was right.

00;43;01;25 - 00;43;21;13
Unknown
And it's like, it's it gets easy in the modern medical system and to get frustrated with it. And it really is like a maze, you know? And, it doesn't have to be that complicated. And I think, you know, I've had great preceptors in my career that had great residency directors that like, they're like, the patient should never be the enemy.

00;43;21;13 - 00;43;43;19
Unknown
Like, if you ever feel that way, you need to take a step back in. Kind of interesting, interesting patients should never be the end. Yeah. It's an interesting statement. Yeah. I mean, sometimes it's it's like you can get people that are in difficult walks of life, surely argumentative and difficult to work with. And it's easy to start to like, you know, put it back on them when you get frustrated and go, why?

00;43;43;23 - 00;43;57;06
Unknown
You know, but really, like if you just kind of take a step back and look at it from their perspective, you know, they're in a vulnerable position, they're feeling pain, they're feeling as are feeling. The other thing like it's, you know, you should objectify yourself a little bit and kind of just try to see where it's coming from.

00;43;57;07 - 00;44;21;03
Unknown
Oh, absolutely. That's great. That's great. Well, I did want to hit on with what you're doing now is, I think this the right word. Concierge medicine. Yeah. It's that's the more common term, but it's kind of a it's it's a newer trend. You know, it's been going on for a while, but, you know, I personally use something like that, and I've just been amazed by it.

00;44;21;03 - 00;44;39;10
Unknown
I think it's amazing. So talk about a little bit what you, what you're doing with that like and the and the purpose and all the details. So it's really just kind of trying to get primary care back to its roots of being patient centric. You know, more traditionally it's called concierge. Like there's been a trend to rename it as a direct, you know, direct primary care.

00;44;39;21 - 00;44;59;14
Unknown
There's also like direct cardiology, there's lots of direct services. And direct just means direct to consumer. Like you're not going through the insurance. Right. I kind of started doing this in 2020. Not as a, as an official practice, but everything was locked down. People can see their physicians, and I get calls from friends, neighbors that were like, hey, you know, interesting.

00;44;59;14 - 00;45;12;17
Unknown
I think I'm sick or I'm having this. I can't get into my dog. I don't know what to do. So I actually just started going to their house. Like I was like, oh, go check you out. Right. And, I didn't really have a, like, a, like an hour practice setup then, but I have a license, right. You know, so.

00;45;12;19 - 00;45;30;20
Unknown
Right. I did that a little bit. And like, towards the middle of the, of the pen, I was like, you know, like, I actually really enjoy this. And, it's really nice to be able to see people in these settings and maybe I should do this full time. Right? Then the pandemic went nuts, and it was like two and a half years of of just working shifts like crazy.

00;45;30;20 - 00;45;55;26
Unknown
I'm sure, coming through the end of it at the end of 23, I was like, okay, now it's time to give this a shot. And, that's when I launched officially in like, I think it was July of 24. So the the model is that they pay you a monthly fee and you are basically there, you know, seven days a week, more or less, to help, like be the first line of communication.

00;45;55;29 - 00;46;14;26
Unknown
Yeah. Basically it's a membership model and, that's it. And like the flat rate covers me, and I don't like copays. I don't limit the number of visits. I don't limit the phone calls. It's open access. Right. And it's really about the communication. And, it's kind of nice. It's I like to communicate with my patients freely, too.

00;46;14;29 - 00;46;38;12
Unknown
And, I didn't like the feeling of when I first started, I actually wasn't fully direct. I was trying to bill insurances, but it kind of like trying to chase this or think about, oh, I can bill for this or I can upcharge this or I can, you know, like they talk about that a lot in medicine. It's like, well you can build this as a level four or you can charge because you talked about XYZ and like, you know, it's like you're kind of chasing the money more than caring about the patient, you know?

00;46;38;12 - 00;46;57;15
Unknown
Well, I think it's okay to, to make the money, but it becomes very complicated on your end, too. It's like you change it like a standard fee every month. And I mean, tell me if I'm wrong. I mean, the one I use is just great because it's almost like that advisor that knows. And then. Yeah, you need to come in.

00;46;57;15 - 00;47;14;28
Unknown
We need to do blood work, and then you need to go here. You know what I mean? The first line of of people. Yeah. I mean, and it's just really nice because I get to sit down for there's no rush. I basically the way to break it down is like in a traditional practice setting, you have to carry a panel of about 2000 patients or more.

00;47;14;28 - 00;47;32;21
Unknown
Wow. To keep the appointments full, because you only get paid when you see the patients, right? Right. And when there's that many patients and you do get to know them very well, but you don't get a lot of time with them, because spending more time with one person means you maybe snubbed another person, or a person is waiting an hour to see you and it happens.

00;47;32;21 - 00;47;50;18
Unknown
You know, you run behind because things come up that you expect and you have to address it. But in the direct care model, I have hour long appointments or more. You know, I can schedule what's needed because I'm not worried about filling every slot. You know, like I'm getting a set amount per month and I don't like I do what's needed for the patient at the time.

00;47;50;18 - 00;48;13;27
Unknown
There's a patient I've seen, three times this week. Wow. Because they have an illness. And, you know, it's kind of funny. Like, I have seen them in their house and, like, they're like, oh, I didn't mean to take them. So I'm like, no, I mean, this is what I'm here for. I think the whole goal is to keep you out of the hospital and, you know, well, I just know with mine like this, the simple being able to shoot them a text like, yeah, hey, this is what the, the situation is and just get a response.

00;48;13;27 - 00;48;36;12
Unknown
And it may not even be anything complicated, but if you went through the normal medical channels, that would be a month long process versus just boom. Like, this is what I think. You know, I saw so much of that in your, I remember one really clear example is working over, in Orange Park, and, I had a woman come in with really severe dizziness and had been going on for, like, a week.

00;48;36;12 - 00;48;55;08
Unknown
And by the time she come in, she's so dizzy, she's throwing up everywhere. So I'm like, I gotta work here for a stroke, right? And it's not that I mind doing the work up, but to that patient that's three Cat scans, right? That's a lot of radiation. And once you get a certain amount of Cat scans in your life, it does increase your risk for cancers.

00;48;55;10 - 00;49;09;11
Unknown
Right? So we try not to do a cat scan if you can avoid it. And at the end of the day they were fine. And she ended up having vertigo. And you treat the vertigo and she's fine. But, she had told me she's like, I try to get into my primary. I just couldn't. I bet the doctor is probably a quality doctor.

00;49;09;11 - 00;49;23;26
Unknown
Like if she could have gone in on the first day, probably would have given her some magazine and that and said, hey, if it's not getting better, go to the E.R., which would have been the right thing to do, right? And she probably would've been fine, right? And it would have saved her 1500 X-rays worth of radiation, you know, time and effort.

00;49;23;26 - 00;49;43;00
Unknown
And I remember because when you said, you know, I'm a little bit older than you, but I do remember my mom taking us to the doctor, and it was just old school, like, hey, I got a problem. I'm coming in, and I remember just sitting there writing a check, like when it was done, like, yeah, there was no insurance in all of that, which of course insurance has.

00;49;43;00 - 00;50;10;17
Unknown
It's, it's desperately needed in a lot of circumstances, but I just think it's so awesome, this, this new type of practice that's coming up. I'm sure you're going to do amazing with it, I hope so, I it's really been great so far. I really enjoy it. You know, I just, it's just great to be able to sit down with the patients for, like, a longer period of time and even schedule stuff, because I'm now I'm able to focus on more, you know, movement, nutrition, mindfulness to talk about mindfulness a lot.

00;50;10;17 - 00;50;31;10
Unknown
You know, these are things that everybody wants to know to make their lives better. And it results in less, you know, less prescriptions, less time in the hospital, like more prevention. Yeah. And, it's just hard to do that in the 15 minute appointments. And it just like kind of having that, that you say that with a very funny phrase, straight phase, like, it's impossible.

00;50;31;12 - 00;50;48;09
Unknown
Yeah. 15 minutes. It is. And it's hard to do it in an hour. Right. I you know, I saw somebody earlier this week and we have a lot of health maintenance things to get through. You know, and we started to kind of touch base on, you know, nutrition and, you know, we were getting into it. I'm like, hey, you know, I've already.

00;50;48;09 - 00;51;12;28
Unknown
And I go to her. I said, we've already gone through a lot of information. I don't want to just like have it all drowned out. So I'm like, let's get all this done. And then once we'll come and we'll talk and and like, we'll kind of meet monthly and move over to nutrition and, yeah, you know, it kind of a word you that it in a, in the medical setting now like they're doing a pretty good job of trying to make sure that all the different especially like they have nutritionists involved, dietitians and, you know, they're like, oh, you can go over here and talk to them for free as part of a network

00;51;12;28 - 00;51;29;03
Unknown
and about just us, something like that. But it's just, for the patient, too. That's time off work. And it's hard to get around to all these different appointments. And it's just the system as we've grown as a, as a, as a medical community, you know, you can't compare the farm like the pharmacy in 1980 to now. Right?

00;51;29;05 - 00;51;42;07
Unknown
Like that's the amount of drugs and the amount of treatments and the amount of not even close. Yeah. So as that's become more complex, it's kind of the system has grown and grown and grown. And that's where, you know, and that's kind of it's hard to navigate. Oh, it's hard to navigate even if you know what you're doing.

00;51;42;12 - 00;51;59;23
Unknown
That's where primary care is so important, because you need to have that person in your corner that is helping you. What do I need to do and what should I do? Prevention or treatment? You know, that's why I think this this type of practice is so awesome. Well, I want to wrap it up here and I really want to I want your story.

00;51;59;23 - 00;52;23;19
Unknown
So interesting. I love talking to you, doctor. What advice would you have, for somebody who's in high school and thinking, I want to be a doctor, how do they figure that out? What? What? Remember back to your days. Like, what would you be your advice to somebody thinking about doing it in a high school setting? I would say if you're thinking about, first of all, keep your grades up right, so you can get into the university.

00;52;23;19 - 00;52;38;03
Unknown
You want, do some shadowing, you know, reach out to your local docs. Many of them are very happy to take you into the office and just say, hey, why don't you just spend a day with us and see if you like it? And, all those you can get exposed to, see if it's something that you want to do.

00;52;38;06 - 00;52;56;25
Unknown
You know, and, you, like you said, it's not for the love of money. It really isn't like you have to enjoy medicine. And medicine is really a great career. I mean, it's not the practice of medicine that burns people out. It's everything else that comes with it. So you have to really love it. And if you do, it's it's worth it.

00;52;56;25 - 00;53;11;06
Unknown
I mean, if I went back in time, I'd do it again. Yeah. You know, so I'd say for high school students, keep your grades up, make sure you don't have any bad habits, do some shadowing, you know, and then when you get to college, just kind of make sure you're getting this prereqs, you know, hit the ground early with those third grade.

00;53;11;07 - 00;53;36;23
Unknown
Is there certain schools like you mentioned the one you went to wasn't big on pre-med, but is does that really make a big difference? It does. It does, it does. I didn't know until I was in medical school. Just the knowledge part of it. Yeah. No. How like basically they do judge based on what university. Okay. Coming from like if you have a 400 coming from Duke they're going to be they're going to be like wow this guy.

00;53;36;26 - 00;53;55;16
Unknown
Right. But if you have a 400 coming from like my school, they're like, well you only had 20 people. Yeah. So it's it's not that they just dismiss me. It's just that, it's like they really they do weigh the schools differently. So pedigree and reputation still mean a big deal. And the medical when it comes to academics.

00;53;55;16 - 00;54;14;12
Unknown
Absolutely. Okay. Absolutely. Interesting. That's very interesting. Well, good. This was a great discussion. I really appreciate you coming in. This is awesome. I know our viewers are going to love to hear, straight from a doctor. And I wish you the best in your new practice. I'm sure you'll do great. Thank you very much. So much. It's good to be here to meet you.

00;54;14;12 - 00;54;28;18
Unknown
The Hometown Jack's podcast is recorded and produced by First Coast Mortgage Funding. Located in the heart of Jacksonville. Do you want to be our next guest? Visit our website at Hometown Jack's podcast.com. We can't wait to hear your story.