Direct Primary Care: Dr. Minda Gold

Lisa Belisle: Hello. I am Dr. Lisa Belisle and you are listening to or watching Radio Maine, our video podcast where we explore and celebrate creativity and the human spirit. We are sponsored by the Portland Art Gallery in Portland, Maine, and today it is my great pleasure to have a very dear and wonderful friend with me in the studio. This is Dr. Minda Gold. Dr. Minda Gold is originally from New Jersey and she and I had intersecting and parallel family medicine paths for many years, but she most recently is doing some very fascinating work in the area of direct primary care. So I thought we would bring her onto Radio Maine and have a conversation today. Thanks for joining us.

Minda Gold: Thank you.

Lisa Belisle: I have to say that I have a kind of a shortish list of people who really impacted my family medicine career and I have to put my dad at the top.

Minda Gold: Sure.

Lisa Belisle: But you're pretty close to the top. I mean, you were one of my early mentors. I worked with you in your office in Damariscotta. I worked with you as a medical student, as a resident, so I'm pretty much in this field in part because of you.

Minda Gold: Well, thank you. And I will have to also say that your dad was an amazing mentor to me and I feel like I've been part of the Belisle family since I started medicine because of everyone in your family.

Lisa Belisle: Well, there's enough of us kids that he probably wouldn't notice if you showed up one day and we're like, oh, it's just me. I'm just one of them.

Minda Gold: Right.

Lisa Belisle: So I'm interested in why, I mean, starting out in New Jersey and coming to Maine and then basically we caught you. Here you are and you're in Maine all these decades later. What was the initial attraction to Maine and what has kept you here?

Minda Gold: I think Maine has always been my final destination. I lived in suburbia in New Jersey and mostly spent any free time in the woods building tree forts, getting out into the mountains if I could. Although many people have no idea that there's forest and mountains near New Jersey. And when I went to medical school at a tertiary care trauma center in Newark, New Jersey, I knew I wanted to do family medicine. They didn't even have a department. And one comment I got from an attending was, you're too smart to be a family doctor. And I didn't know really how to take that, but I knew I wanted to do family medicine. I had an amazing GP growing up and that was the path I wanted. So I interviewed throughout New Jersey, Pennsylvania, New England for residency, and I fell in love with the Portland program. I connected with John Randall, the director at that time. We had both been in an outdoor leadership program at different times and that really connected us. The residents were wearing Birkenstocks and I think I was the only one in New Jersey at the time that wore Birks and they had the attitude of how important family medicine was. It was really one of the first times that I just felt all of that energy around the importance of family medicine. So Portland was the place and after I did my residency, it was clear that I wanted to stay in Maine. It was just absolutely gorgeous. Even after a really tough shift on trauma surgery, you'd come out and see Mount Washington. And my husband also, he went through the whole process with me from acceptance to medical school through residency, and he also loved the woods and wilderness and Maine was perfect for both of us.

Lisa Belisle: It's interesting to hear you talking about the history of family medicine, which is really what you're saying, because family medicine is not a very old specialty per se. I mean it's really only about a half a century old, although it's been around forever. Caring for families and communities has always been important. But I find it fascinating that when we went to this specialty kind of care, all of a sudden if you were a surgeon, you kind of rated, you were very important, you were the real doctor and everybody else just kind of fell into a different bucket. And it's like, oh, well you couldn't be a surgeon. You're not smart enough. So you get to be a family doctor. Family doctors have to know so much. We have to be emotionally intelligent. We have to have data, we have to be up on the trends. We have to be able to talk to people. And I'm not saying that other specialties don't have those things as well, but the breadth of knowledge and the ability to hold all of that and be able to connect with people is not as easy as people might think.

Minda Gold: You're a hundred percent right. And I think also even extending to the medical milieu now, a lot of primary care docs or even family docs, many are in situations where they are the person who does the referral to a specialist. And I am fortunate enough to say that I trained at a time where we learned to do things, we did our procedures and we helped and we did deliveries and prenatal care and surgical excisions of things. And that's really the wealth and expansiveness of family medicine. I've had many people through the years, especially students say, how do you learn all that stuff? How do you keep all that in mind? And I think some specialists feel the same way. Well, they can't really be too good at anything. They're probably fair at a lot of things. And you do incorporate things because the human body works together and it's important to be able to incorporate all these things and the medications and the treatments we offer.

Lisa Belisle: I agree with everything you said. And also I think the value of truly being a family doctor, I mean all the things that have come through, we were considered gatekeepers. I think we're still kind of considered gatekeepers, the concern about the referral. We're just between the patient and the dermatologist, but that's not really where the value lies. The value lies in actually knowing the families and seeing people longitudinally. So I will see people on the street now and they will say, see this 20-year-old you delivered this child. And I'm like, that is a whole other generation. And I think to be able to say, I know your father, I know your mother, I know your grandparents, I know your children. The context in that just gives us such valuable information as physicians and healthcare practitioners generally.

Minda Gold: I see notes now come from a consultant and it speaks only of the person they're seeing, a 15-year-old struggling with anorexia, and it talks about her, and this was one of the major motivating factors to go into medicine. In training, I would see somebody and I would say, oh, this young child is coming in with an asthma exacerbation. Dad just went out to have a cigarette, smoking in the house. Wow, that's related. And I remember saying to one of the surgical residents, I think we should talk to the dad about smoking around this child. They have asthma. And the surgeon said, we are surgeons. We don't talk about smoking. And I was just like, we do talk about smoking. And similarly with the child with anorexia, knowing the mother, knowing the father, knowing the siblings and what struggles they might be having, all of that helps you take care of the person that's in front of your eyes. And I really think we're doing a disservice when we talk to people in isolation. We don't know about their family.

Lisa Belisle: I think I've been casting aspersions unwittingly on surgeons at this point.

Minda Gold: Oh yeah, why did I say that to you?

Lisa Belisle: I want to be really careful because I know lots of tremendous surgeons who are very good about understanding context. I mean, my father, before he passed away, he had a neurosurgeon who was the most personable, the most family oriented, communicative individual. And I have lots of friends and family members who really care about people in their context. But hopefully if you're going to have neurosurgery, you're probably not going to have that many incidents of neurosurgery. Whereas if you truly have access to a primary care practitioner, then hopefully that would be a longitudinal relationship. But it speaks to something that is, I think, why you shifted the way you do medical care. And that is that that was the way it was. And it has increasingly moved away from that in most medical practices to a more transactional, I'm going to see you three times and then I'm never going to see you again. But you've decided that you wanted to do direct primary care. You wanted to go back to what's more like the original model of family medicine. So talk to me about that.

Minda Gold: It's very interesting because yes, that's what I do and I've never really looked at it as that's the way we used to do it, but it is so direct. Primary care is returning to the model of the physician working directly with their patient. There aren't middlemen, there's no insurance company saying you can't address that at this visit. You'll have to put in another code. There's no one knocking on your door saying you've exceeded your 12 minutes, your 15 minutes, your 20 minutes with this patient. You need to move on. Your room with the patient is an open palette for that patient. And if they come in and their plan was to talk about a wart on their foot, but oh by the way, while they're there, they want to talk to you about something they're really emotionally struggling with or an issue with their child. It is possible and it's actually welcome to address the needs that that person comes in with that day. And we really look at it as medical care. We talk about medical care and who's your PCP and who's your insurance company. And we truly look at this as care. And a lot of the systems that have developed out there are so involved with metrics and numbers and RVUs and management and very top heavy with management looking at the financial issues, the bottom line, that the doctor who's really the one who's giving all the care is just restrained in so many ways. And in this model you lose all those constraints. I mean, some of the things I get to do, I get to do a home visit on a patient if it's easier for me to go see them than it is for them to come in. And I can't do them all the time. And they're generally for patients who are maybe in hospice or palliative care. I get to schedule an hour long appointment with somebody or two hours if needed. We're sort of one of the original founders of telehealth. When COVID hit and all the hospitals and doctor's offices were scrambling to put in systems for telehealth, direct primary care had been doing this. You can access us by phone, by email, by text, by coming in person. Those have always been options for direct primary care, which we call DPC. So it's really built around what works for the patient. One example that I love to give is you feel like you have a urinary tract infection. You try to call the doctor's office to get in and you're put on some phone tree and I'm just going to say it takes you 15 minutes to get a human on the line and then you try to get an appointment that day, you're likely going to be told to go to urgent care or somewhere else. If you get an appointment and you get there, then how long are you waiting in the waiting room? And let's say you're waiting in the waiting room for 30 minutes, and patients know that can be much longer. You get into the office, you're seen for seven minutes, you leave with a prescription, you go to the pharmacy and now you wait an hour for your prescription. Before you know it, this simple UTI has taken four hours and it's really dug into your workday and you feel miserable. And with direct primary care we can see you that day. We can talk to you on the phone depending on where you are. If you can't come in, we can advise you. When you come in, many DPC docs in Maine and even throughout the country have common medicines in the office. So you can leave with a prescription for 42 cents and go back to work. And patients leave happy, they leave fulfilled that their questions have been answered. I just remember the stress in traditional fee for service medicine where you'd call somebody, it would be eight o'clock at night and they'd say, I've been waiting all day for your call. And now the pharmacy's closed and they were all fired up because they had all of these concerns and they didn't think they were going to be heard or taken care of. And legitimately it's like going through Fort Knox to reach you, to speak to you. And I have patients now who will say, wait, you're answering your own phone. This is great. Or I just have a quick question for you. And you say, great, what is it? Or they call your medical assistant and it's one person they need to talk to. Patients even when they're really sick, are happy to be able to get the care that they need. And so it is the complete opposite of physicians burning out in medicine where they feel like their inbox is always full. There's always another task they can do. They're never appreciated. They're overworked. Patients are always complaining, I can't get back in to see you. I understand why so much burnout, and this is not everything is wonderful in direct primary care, but so many of those issues are built into what's the root? The root is I want to have a relationship with my doctor, I want to have a relationship with my patient. Let's do it.

Lisa Belisle: It's kind of interesting. I actually was in what was essentially a direct primary care model and I was leaving that model as you had transitioned into that model. And it was relatively early on in the process. And I would talk to patients and they would say, well, what do you mean you're not affiliated with an enormous system and you're giving me your cell phone? That for them was so unusual. And I would talk to physicians and they would say, well, aren't they calling you at all hours of the day and night? And at least for me the answer was no, because they know that they can reach me. It was very rare that I would actually get an inappropriate call at a random time because people felt comfortable that there was somebody who was going to be paying attention. And there was something really special about being able to do that work and have that practice and something really gratifying. And also I knew that if I needed to pay my own light bill, then I was paying very close attention to my finances. So it really wasn't a question of I wasn't paying attention to metrics. I was absolutely paying attention to metrics and quality and patient satisfaction, but it was me and that was my choice and it was my way of practicing and it was a great relationship with patients.

Minda Gold: And you were able to witness the patient's surprise when they heard your response to things. Many people still don't understand direct primary care. You really try to clearly explain it. A lot think it's concierge care, which in the DPC world we kind of call it concierge for blue collar, which is okay. But basically concierge is a membership based model and those practices still bill your insurance company when you come in. So it's kind of a retainer to have a doctor. But other than that, it's pretty similar to your standard offices. By paying that membership to them, they can spend more time with you because they need to see less patients. With direct primary care, we do not bill your insurance company for a visit. So like you said, your electric bill or your cell phone bill, there's a membership. You can call me 12 times, you can call me three times. You can come in once a year. That membership per month covers those visits. So it's great for people who have a very high deductible plan. When I started, I started seeing local artists and carpenters and fishermen who hadn't been to the doctor for 25 years, they couldn't afford to go. And they're like, well, I can figure out how to do this for $75 a month. And I also have patients that have what we call in medicine, excellent insurance plans. And that's usually based on a low deductible. That's nothing to do with the kind of care you're getting, but many people say, well, I have a great insurance plan. Why would I also want to have a DPC doc? And my response is usually, tell me what you're unhappy with in your current situation. And when they explain to me, I can never see my doctor, I always see someone else, I can't get on the phone. There's no communication. They basically write the script for me. And I say, well, with direct primary care, we've gotten rid of all those barriers. So it's just so nice to have, like you say, that relationship where you know the person. And I would say from colleagues, yes, one of the huge concerns is they have your cell phone. You're on call twenty four seven. I don't know why it took me 35 years in medicine to realize that patients often call after five o'clock when the phones turn over. Why do they call on call for the back pain they've had for two months? Well, because at 5:02 they get to talk to the doctor on call. And from 8:00 AM to five, they get to talk to the receptionist who's going to tell the medical assistant, who's going to tell the nurse, who's going to give it to the doctor, who's maybe going to come back through that ladder. And as you said, patients know that they can reach me during the day and they are so respectful of my time. A lot of times if they message me on the weekend on our communication portal, I am so sorry to contact you on a Saturday. It's just that I was thinking about my whatever. Please do not answer this until next week. They don't want me to burn out. They recognize that it's a crisis in the country that doctors are burning out and are overworked and underappreciated. So yes, you're on 24/7, but again, I rarely get a call off hours. And the other thing that's wonderful is the direct primary care network throughout New England and Maine in particular, we have a lot of docs opening up. We cover for each other and it's not an I covered for you seven days, so you cover for me seven days. It's literally a text. Hey, it's a great weekend. I want to go skiing. Can you cover for me? Sure. Put my number on your machine. So there's so much camaraderie and support from the other DPC docs. Something I never experienced in the traditional model.

Lisa Belisle: And again, this actually was the way medicine was practiced, right? I mean some things have changed for sure, but in the original model, when my dad moved to Yarmouth, Maine and he was part of a small practice, patients knew him, they knew that he had a large family, he would be on call, but they respected his time. They knew that. I remember he took my sisters and I into the office and back in the day, he would plate his own strep swabs. So he'd go in to read whether patients actually had a strep throat infection based on the agar plate in his own little laboratory. But patients knew that he had a life and it wasn't as transactional. And I don't think that what you and I are saying is that the current traditional model is not acceptable for anyone. Some people do fine in it. And also let's have an additional choice for people who really do value the person who's on the other side of the phone. It's not just like, I'm going to take whatever person is available right now. I want Minda, I want Dr. Gold to be caring for me. And if that is important to people, then that is just going to be a better model for them than what currently exists.

Minda Gold: I agree. There needs to be a choice for individuals and it is not the model for everyone. However, I think speaking to colleagues of mine who are in an employed fee for service model and especially as larger groups buy up different practices and make things more uniform, we're going to have the same policies at say Maine Medical Center as we are at Lincoln Health, a small community hospital. They are different environments. And up to this point, the smaller hospitals have been able to have their own bylaws and rules and regulations and they understand what's different about living in a small town in a small community hospital. I hear from my colleagues that many are not happy and I go as far as to say most are not happy and it's really sad. I love medicine. And they went into medicine for the same reason. They love it and they are dedicated to be great docs and have time with their patients. And I sit at a med staff meeting and it's all about numbers because that's what can be measured. How many people have received a pneumonia shot. And when they came in today to talk about their anxiety, it's not as important to ask them about their pneumonia shot. They want to know you're listening to them. And when you say, and have you had your pneumonia shot? To me it feels like, do you know why I'm here? Are you even listening to me? What is it that we want in any other area? We would never get away with this. If you went to buy a car and the car salesman tried to sell you a truck and you wanted a mini Cooper, you'd leave them. You'd say, listen to what I'm saying to you. So yeah, really getting off topic, but it is definitely an option. I think we need more.

Lisa Belisle: So one of the things that I find interesting is that you began your career during the AIDS epidemic. And for me, I was not in medicine yet. I think I was still in high school, but that was a big, big deal and now fast forward a few years,

Minda Gold: About 30!

Lisa Belisle: Yeah, we think about AIDS really differently. We have different treatments. Essentially it has become a chronic disease. It's now very treatable and livable and actually cancer is heading in that direction as well where it's not necessarily an immediate end of life situation. There are a lot of things that are now available. And so here we have, those are just two examples of technology that has enabled us to do healthcare better. So why the pushback? Sometimes I wonder about innovative models of care or not even particularly innovative, something that used to happen and now we're bringing it back in a different way. Why is it that people have such a hard time with something like direct primary care or maybe virtual care, telemedicine, when we get pushback from people like, no, no, no, we have to do it this other way. This is the only way. If we thought that way, we never would've come up with a different way of dealing with AIDS, right? So do you have any thoughts for me as to why it is so difficult to shift people's mindsets around the way that we offer care if we've been able to actually address medical issues differently, even over the course of our professional lifespans?

Minda Gold: I think it's always important to look back as we look forward, what works, what doesn't work. And unfortunately too many businesses and models are run based on the bottom line, on the financials. And yes, that's reasonable because you need to be able to survive and bring home a paycheck to support your family and the business needs to be able to cover their expenses and such. In medicine, it's so much more than the financials. And if you can make the financials work and provide a richer, more robust model that's addressing the complaints and the needs that people are expressing, then why not do that? You may go to the doctor and then get an email that says, please rate your appointment. And it goes everything from the receptionist to the person who took you to the room to maybe your interaction with your provider. And they're doing that because they're like, okay, what can we do? We need better scores here. I think we're just putting so much energy in the wrong place. A lot of people in medicine and in DPC say the medical system's broken. All of this technology, all of the advances we've made in treatment, many of those are really good. Like you say, treatment for AIDS is a chronic disease now. But we can't lose sight of who's our audience. We're taking care of people. We have AI now and we have electronic scribes. So you're in the room and in some offices you can look in the eyes of the person, you're talking with the patient and you don't have to take notes because there's someone listening. And I don't want to put that down. I think that's important for many people. It answers the question of, yeah, have a face-to-face encounter with me, but it's mechanizing the relationship still. It's having someone else write the note. Why? Because there are certain things that need to be documented. If you don't document them, you get dinged. And the focus should be what documentation is necessary so this patient gets excellent care. They're not equivalent. It's really sad, but they're not equivalent.

Lisa Belisle: I do have to agree. I think when we, having worked for larger health systems before and looking at these metrics and the things that they wanted us to pursue, a lot of it was because of what we called the payer relationships and it was the contracts with insurance companies or with Medicare for example. And I think often what would happen is these large organizations were trying to find a way to offer more efficient care. Let's look at it in the most positive possible way. We want somebody's hemoglobin A1C, which is a long-term marker of how your diabetes is doing. We want it below a certain level and we're going to measure practitioners based on that. So it kind of maybe starts in a great place that all of these things we're measuring are potentially going to be helpful. But I think by the time it ends up in front of the patient and the practitioner, it has gotten so distorted that the intention is not really the same. And it really does end up, as you say, becoming a barrier because if you spend all your time clicking the boxes to make sure that you're getting your numbers to look good, then what you're not doing is really understanding, oh, this person waited for two years to come in and see you, and they're probably not going to want to talk about preventive screening. They probably want to have this big mole that's been growing on the back of their hand and looks pretty ugly now because it's taken two years to get in. That's probably what they want to address and probably you should be addressing it anyway.

Minda Gold: I think the other thing with direct primary care that we focus on is transparency. And this is really horrific in the medical system, even though there are price lines that you can call and systems federally are supposed to list online how much things cost. As a physician, I struggle to get the price of something and anybody out there who has tried to get the price of something, I challenge them to show me the price they were given and then their bill and have them match. So in direct primary care we are transparent. You know exactly what you're spending a month and if you come in and you need something done, we can say to you, oh, that EKG, there's no extra charge. That strep screen, there's no extra charge. You want a flu shot? Okay, it's $12 or it's included in your membership. You need this medication. And as I said, we do dispense common medications. We can tell you right then and there, it's $6. You need a knee brace, I can order that for you. It'll be in tomorrow. It'll be 34.87. So all of these things that take up so much time and are such a mystery in medicine are laid out for you, which is what we expect when we're purchasing anything else. Back to the car model, how much are the floor mats? And so that is something that I never knew anything about when I worked for a larger system or when I worked for a fee for service model. And now I think we all should know. If I order a vitamin D test on someone, it's easy for me to print a lab slip. If they say to me, how much is that? I mean, I had no idea. I had it done several years ago, it was $144. It's more than that now. And I can say to someone in my office, if you do this, if you have this test and you pay by cash or use your HSA, you don't run it through your insurance, it's going to be 12.87. If you use your insurance, because of everything the lab company needs to do in order to get the insurance to reimburse them, it'll be 112. People see the difference. I can say to somebody, you need an MRI, I've researched this. If you are willing to drive 45 minutes, you can have that MRI for $680. If you have it at the local hospital, it's going to be $1,300 plus you're going to get a bill from the radiologist. I don't know how much that's going to be. So we pride ourselves in finding excellent care, excellent options, standalone facilities. So if you don't have to walk into a hospital to have a test, you're going to save so much money. And being able to assist the patient in navigating that system, which I never had the time to do or the knowledge to do in traditional fee for service medicine.

Lisa Belisle: It's so interesting because when you talk about helping the patient navigate the system, I think that ultimately in this day and age where people have a lot of access to information, they're probably coming in with a lot more knowledge of not only medicine generally or their bodies, but themselves specifically. And sometimes what they really want from you is, this is what I've been thinking, this is what I think. And what do you think? You've been in medicine a long time, give me your perspective on this, as opposed to, I have no idea what this is. My throat hurts, but I really don't know what it is. Most people have some sense of what might be going on. And the simpler things, and I do love that you're able to, for example, you can go to the website and you can tell the patient, oh, well just go and click these boxes. This is what you need to order. It's going to cost you $214 to have these tests. And guess what? You can have them drawn at Quest, which is where everybody else has theirs drawn if they go through a traditional healthcare system. And you're still offering really good care, but you're actually involving them more in their own care than if you were just to make decisions for them and just hand them things and say, here, do this, here, do this. And there's something really important about that, giving people back the access to the information and resources they need to care for their own bodies.

Minda Gold: And in that, keeping them happy. They're not resentful. They don't get the unexpected bill like you asked me to get these labs done and my bill's $634 and I have insurance. How come it's $634? Well, you didn't hit your deductible yet. And patients are very unhappy and they don't understand the system. And even when you try to get help, it's very difficult to understand the system. If anybody's had the experience of calling an insurance company to ask, why isn't my inhaler covered? If you get off the phone within 45 minutes, that's a great day. So we try to really minimize those interactions and have the discussion with a patient to say, this is why we're suggesting it this way. You are absolutely welcome to go to the pharmacy, have your insurance pay for it, or bill this through your insurance. We want you to know, like you said, the options of care. We want you to know the options of covering this service. And patients do come in with printouts and Harvard Health Letter and Mayo Clinic and sometimes from sources that I look at and say, well, this is, as we were trained, not evidence-based, something that I disagree with. But it gives us the opportunity to also disagree and for me to say, I support you if you want to pursue this or I don't recommend this and explain why. One of the things that's wonderful where I live, and I think in Maine definitely more than New Jersey, is the option of integrative medicine. And we have so many phenomenal caregivers there. We have acupuncturists and naturopaths and chiropractors and massage therapists and body work. And many of my patients know that I support many different aspects of medicine. So they're not afraid to come to me and say, what do you think about acupuncture for this? Do you think that would help? And it's also the kind of relationship where I can reach out to that provider and say, this is someone I'm thinking about, would you be able to work with them? People that I've vetted, that I feel are excellent practitioners. So that builds the trust and the care circle too, because little known secret, we don't know everything that's going to work for a patient.

Lisa Belisle: Yes, I suspect it's not as little known as you and I might want it to be, but actually I don't care if people know that I don't know everything. I mean at this stage in my career, if I still thought I knew everything, there would be something very wrong because I've been around long enough to know that that's just not possible. And I do love what you're saying about the integrative care. And I know when I had my own practice, a big part of it was doing acupuncture myself. And I was able to actually go in and it truly was integrative. I was able to weave together different aspects of different things that I could offer to them. And it was so powerful because I think what happens now in a traditional setting is even if you're a practitioner trained in integrative medicine, if you have a 10 or 20 minute visit, it's really hard to do either a longer conversation or an actual treatment for something. So I see a lot of people who give up their osteopathic manipulative treatment skills or their acupuncture skills or even some of their nutrition counseling skills because it just doesn't fit into the model. And so I think it is important because we just know that pills don't actually solve a lot of the problems that we have these days. And what people want is answers. They want their lives back, they want to be free from pain to the extent that they can, or they want to have a disease process ameliorated to the extent that it could be. So whatever it takes, as long as it's safe and it works, then that seems like the direction to go in.

Minda Gold: It's absolutely the direction that works for so many people. And I talk all the time with my patients about mind body medicine and it's not a cliche. When a patient says to me, my pain was so much worse last weekend, I was really stressed out. I'm like, yay. They put that connection together that when I get stressed out, my pain is worse, because it is something that they have to, with my education and encouragement, figure out. So back to access a little bit, there are now more direct care specialists. So okay, family medicine is a specialty. We're very protective about that. But there are vascular surgeons and endocrinologists and ENTs and other specialties that are actually finding that working in the big healthcare systems are preventing them from actually practicing the medicine that they feel is important and providing the care that they really feel their patients deserve. And they're going into independent practice and they're a resource to direct primary care docs who are the primary care doctors. It's been amazing. Again, it's this collegial attitude, like I can call the ENT that's an independent practice and say, hey, I've tried this and this. What do you think? And they may say to me, why don't you try this? And if that doesn't work, I'm happy to see them. And the vascular surgeons that are now on their own, if I see them tomorrow or Wednesday, is that soon enough? We recognize sometimes how tough it is for patients to get through to us, but how about when a physician calls another physician and wants to ask a question? And in your mind it's just a question, I need to talk to another doc to ask them. Well, their schedule and their revenue metrics sometimes prohibit them from actually getting on the phone with you. That's how it used to be. Used to be a doctor would stop what they were doing and come to the phone. Seems pretty much like common sense and good care for a patient, but it can't always happen now. And the doctors aren't in their office saying, yep, I hope I can block as many calls today as possible. What they're saying is, I hope I can get through my day, hope I can see all the patients I need to give them good care, get my notes done, and do you think I can work out twice this week? So I love having the direct specialty care too. And as DPC docs, we also know what larger hospital systems talk to our patients in a holistic manner and do see them in a timely fashion and reach out to us if they have questions. And so they're not all independent practices. Which urology group should we go to? And then I can also educate my patient to say, it's your choice who you want to see as an orthopedist. If you want to go locally, fantastic. This is who is excellent in this area. If you want to go to Portland, that's fine. If you want to go to Bangor, if you want to go to Boston to the hernia center, I will help you do that. So there's no constraints on me to say I'm in this institution and I'm supposed to keep everybody here. That might not be the best option for that patient. So there's no financial benefit to me to direct them in any direction. I love that.

Lisa Belisle: So you co-founded Full Circle Family Medicine for the past 13 years?

Minda Gold: Well, we ran Full Circle Family Medicine for 13 years.

Lisa Belisle: For 13 years.

Minda Gold: And then I've been doing the direct primary care for almost eight.

Lisa Belisle: For eight. So you've, I'm going to call it out of the traditional medical model, although traditional is arguable. The traditional medical model is probably what you've actually now returned to. Thoughts about what you would like your professional path to look like moving forward? It seems like you've experimented with all the different ways. Do you feel like you've found the way that is working best for you now?

Minda Gold: I love this model. I have always wanted to do international medicine and third world medicine. I had the opportunity to have a very short stint when we went to Africa, we visited an orphanage and I thought we were going to build a stone wall there or something like that. There happened to be a sick baby. And when they found out I was a doctor, they were like, we have this. And they handed me a stethoscope and I examined the baby and then they brought in seven more babies for me to examine. And it was so heartwarming. And then all of the nannies and the staff one by one came into the room, laid down on a table and lifted their shirt so I could listen to their heart. They had never had a stethoscope put to their chest. And I knew I wanted to do international medicine before that, but that really warmed my soul. So I do want to do that. And so I could see through direct primary care, maybe taking a sabbatical or longer chunks off a couple months at a time where I can go travel. And because I love medicine, I would still do medicine. I would definitely travel and visit communities and learn about the country I'm visiting. That also interests me tremendously. But yeah, I like to be able to give that gift of mine to others. Hold me to it, Lisa.

Lisa Belisle: Okay, I will.

Minda Gold: Alright.

Lisa Belisle: I mean, I've known you long enough, you're a force of a person. So if this is what you want to do, I know you will do it. But what you're speaking to is something that I often think about and talk about with anybody who will listen essentially. So thank you for honoring that with me. And that is that we're just past the point where most people are going to do exactly the same thing in any profession for the entirety of their career. And so what I think this gets to for me is, oh, here's another phase of Dr. Minda Gold. We all should be allowed the opportunity to be different people along different parts of our professional journey. What's exciting to me about where we are in healthcare now is this idea that we all have to go in, be exactly the same kind of practitioner, and we have to do it until we die, they're going to have to put us on the gurney and bring us over to the graveyard. That is not where we are. So if direct primary care is where you want to be, fantastic, try it out. If you want to be employed by a healthcare system for a while, that might be a good option for you. If you want to do international medicine, great. Virtual care, which is something I'm passionate about, and this is what I love about where we are in medicine. If we can embrace that, there are so many different ways to be happy as a practitioner now. And so that's why it makes me happy to have you give me that answer, kind of the way I feel about being a physician.

Minda Gold: I love that you used the word happy about three or four times in that explanation. That is so important in whatever career, whatever you want to do. If you find yourself mechanically doing it and losing the joy in it. And I'm not saying there aren't days that are absolutely horrible and you might question why am I doing this at all? But in the big picture, if you can be happy doing it and you can see how this is affecting you, how this is affecting others, that's what it comes down to. So you've found it. Let's ask ourselves that question on a regular basis.

Lisa Belisle: Yes. Well, I know that you're a very busy person. You have all the stuff that's going on. So the fact that you took the time to come and have this conversation with me, and not only have this conversation with me, but for all the people that are listening to our Radio Maine. You've always been so dear to me as a friend and a colleague, and I'm so thankful that you're in my life and you're in our studio here today.

Minda Gold: Thank you so much. It is truly an honor and it's especially an honor to see you, who I've seen grow through the years, to be doing this. This is so valuable to all of us.

Lisa Belisle: Thank you. I'm Dr. Lisa Belisle and you have been listening to or watching our video podcast, Radio Maine. I've been speaking with my dear friend and colleague, Dr. Minda Gold, who is a direct primary care practitioner. And I guess we'll call you practice owner. It's all you. So up in the Damariscotta area. And I encourage you, if you're somebody who has been thinking about a different care model and maybe if you live in the Damariscotta region, maybe you specifically reach out to Dr. Minda Gold. Realize that you have options. There are other ways that you can access your healthcare and take care of your own body. So thank you for joining us today on Radio Maine, and thank you for joining me in our conversation today, Minda.

Minda Gold: Absolutely welcome. Thank you.