Tea Nguyen, D.P.M.’11, left an employed position in 2018 to launch an insurance-based practice that would allow her better control of her time and autonomy. Less than two years later, she says, the business “was in shambles” and she was deep in debt.
“I was digging myself into a hole, but I couldn’t keep borrowing money to keep that up,” she says. “I didn’t want to have to learn billing and coding, but I couldn’t quit. I had to look for a different way, so I started to question the system.”
That insurance-based system of American health care allows insurance companies “to tell us as physicians what we’re worth,” she came to believe. In 2020, she hired a business coach to help her pivot to a direct care model in her Aptos, CA, practice. In a direct care practice, patients pay the provider for services, including via a membership fee, rather than using insurance. The provider does not have to wait for insurance review and approval prior to caring for the patient. For Nguyen, direct care gives her the autonomy she had sought. Reliant upon insurance reimbursements, she felt she needed to see as many patients in as short an amount of time as possible, contrary to the desire to connect with patients that she had described in her application to DMU’s podiatric medicine program.
“How could I give quality care by seeing patients for only six minutes, creating a revolving door where they aren’t getting better and I don’t have time to educate them?” she says.
She now spends close to 60 minutes with patients and no time dealing with prior authorizations and claim denials. Patients enjoy faster access to appointments. Because they’re paying a membership fee and have a closer, more personalized relationship with her, she says they’re also more invested in taking care of themselves.
The transition wasn’t without its challenges, but they are far exceeded by direct care’s advantages. Nguyen now finds wry humor in the memory of receiving, on one day, three separately mailed checks from an insurance company, each for less than 10 cents. She’s found direct care to be so rewarding that she started a podcast, “The Direct Care Way,” and a coaching service for other podiatric physicians interested in the approach.
“Allowing insurance companies to tell us what we’re worth is insulting after years of medical training,” she says. “This lets me realize my deep-rooted belief that I have value to give patients personalized, holistic medical care.”
