1:50

Primary care is an innovative, alternative

1:53

path to insurance driven health care. Typically,

1:57

a patient pays their doctor a low monthly

1:59

membership and in return,

2:01

builds a lasting relationship with their doctor

2:03

and has their doctor available at their

2:05

fingertips. Welcome

2:07

to the My DPC Story podcast, where

2:10

each week, You will hear the ever so

2:12

relatable stories shared by physicians who

2:14

have chosen to practice medicine in their individual

2:16

communities through the direct primary

2:18

care model. I'm your host, Maryal

2:21

Concepcion, family physician, DPC

2:24

owner, and former fee for service doctor.

2:27

I hope you enjoy today's episode and

2:29

come away feeling inspired about the future

2:31

of patient care, direct primary

2:34

care.

2:37

Direct primary care allows me to give

2:40

patients access to highest quality

2:42

care that they deserve and also

2:45

gives my life back. I'm Dr.

2:47

Melissa Ratliff with Ratliff

2:49

Integrative Medicine, and this is my DPC

2:51

story.

2:58

Dr. Melissa Ratliff is a family physician

3:00

and native of Charlotte, North Carolina.

3:02

She spent her career caring for the people

3:04

who make up the city she loves. After

3:07

graduating from West Charlotte High School, she

3:09

attended Davidson College, where she was

3:11

a pre med student and majored in chemistry.

3:14

It's also where she met Stephen, the love

3:17

of her life. They got married

3:19

shortly after college, after which they had their

3:21

two boys, Jacob and Benjamin, who are

3:23

now adults and living in Asheville and Raleigh,

3:25

North Carolina, respectively. She

3:27

went to Eastern Virginia Medical School in Norfolk,

3:29

Virginia, then returned to Charlotte for her

3:31

family medicine residency at Atrium Health,

3:34

then Carolinas Medical Center. She

3:36

served as a family physician at Novant

3:38

Health Blakeney Family Physicians for

3:41

nine years, during which time she was

3:43

lead physician for a team of nine healthcare

3:45

providers. Prior to starting

3:47

her own practice, she was a concierge family

3:49

physician at Wellcome MD, helping her

3:51

patients reach their health goals. goals instead of just

3:53

treating symptoms and sending them on their

3:55

way. She earned both

3:57

her certified physician executive or CPE

4:00

certificate from the American association

4:02

of physician leadership or AAPL

4:05

and completed her fellowship in integrative medicine

4:07

at the university of Arizona, Andrew wheel

4:09

center for integrative medicine in Tucson, Arizona

4:12

in 2023. Welcome

4:15

to the podcast, Dr. Ratliff. Thank

4:18

you. Glad to be here. One

4:20

of the most fascinating things that I

4:23

love is people's journeys

4:25

into DPC. I mean, clearly anyone

4:27

who's listened to the podcast knows that, but

4:29

for you, it was very interesting for

4:31

me to learn about your post

4:33

baccalaureate journey. I was

4:35

a post bacc person myself. I did a

4:37

post bac year between undergrad

4:40

and medical school, and you had

4:42

done different post bac years. And

4:44

so in your journey

4:46

can you tell us about how

4:49

you went from undergrad into post

4:52

bac? And within that

4:54

journey, did you know that

4:56

you were eventually going to become a physician?

4:59

Yes, very much so. Yes.

5:01

So I was a chemistry

5:04

and pre med major in college

5:06

and was always planning on going

5:08

to medical school until I fell in love.

5:11

And then at that point it

5:13

was on. So it was like. How

5:15

can I be the

5:17

wife and mother that I

5:19

want to be and be a physician? The

5:22

female physicians that I knew didn't have

5:24

much of a life. At that time, this was in

5:26

the early 90s, and I

5:29

was scared. So I chickened out. I

5:31

decided not to take the MCAT that year

5:33

and decided not to apply to medical school.

5:37

And I decided to get married. So I got married

5:39

June right after graduation in May

5:42

and moved to Atlanta, Georgia

5:44

with my husband where he was in seminary. And

5:48

then I was questioning, well, what do I do next?

5:51

What am I going to do if not medicine?

5:54

So I began working as a chemist

5:57

doing soil and water testing and an

5:59

environmental lab and

6:01

quickly found out that that wasn't for me. The

6:03

bench work chemistry being under

6:06

a vent hood all day just was not

6:08

working. I was too. 2 social,

6:10

I mean, I like that interaction with people.

6:12

So. I decided to kind

6:15

of think about what I wanted to do. So

6:17

I. Attended a career

6:19

planning session

6:22

at the seminary where my husband was studying

6:24

and, they were used to having seminary

6:27

students go through their process. And so

6:29

here, there was this scientist person coming

6:31

through and and they

6:33

were like I don't know what to do with you really.

6:35

But everything's showing that you're supposed to be a

6:37

doctor. And I was like, no, but I can't.

6:40

I can't be a doctor right now. It's not

6:42

in the cards. It's not going to work

6:44

for me. So I kept pushing

6:46

that back, pushing that back in the back of

6:48

my head and decided,

6:51

well, I got to find something else I can do.

6:53

If it's not going to be chemistry, not going

6:56

to be medicine, what am I going to do? So

6:58

I took another course. I took a course at the

7:00

seminary and Thought,

7:03

well, maybe seminary, who knows,

7:06

not so much. And then after

7:08

my husband graduated, we moved

7:10

to a small town in North Carolina,

7:13

where he had two churches and

7:15

I decided I wasn't going to work. I was going to take

7:17

some time for discernment just

7:19

to really figure out what I wanted to

7:21

do with the rest of my life. And.

7:24

I started taking a couple of classes. I

7:27

was commuting one to two hours

7:29

to either UNC Charlotte or UNC

7:32

Greensboro to, to

7:34

take classes and primarily

7:37

they were in the psychological sciences because

7:39

I was thinking maybe PhD in

7:41

clinical psychology. And

7:44

I did that up until I delivered

7:46

my first child. And

7:48

then started thinking, well, now

7:50

what? I have a child and

7:53

I'm going to apply to grad school. So,

7:56

I did. I took the GRE, took the

7:58

psych GRE and I was

8:00

hoping to get in at Wake Forest, but

8:03

it wasn't in the cards. And I think

8:05

maybe that was kind of a blessing in disguise.

8:08

Who knows why things happen the way they do,

8:10

but. I continued taking

8:12

classes and my husband decided

8:15

that it was time for a move to a different church.

8:17

So we moved to Norfolk, Virginia. And

8:20

while we were there, I

8:22

became kind of antsy. We had our

8:25

second child and I was a stay

8:27

at home mom and really antsy,

8:29

love my kids to death. But you know,

8:31

I was, Really craving

8:34

some more intellectual stimulation. So

8:36

I took another couple of classes while

8:39

we were there and I

8:41

talked with my family medicine physician

8:45

at one of my appointments and she said,

8:47

Melissa. Seriously,

8:50

go to med school. Just at least look

8:52

at it. Consider it. Well, here

8:54

I was almost 10, 11

8:56

years out from undergrad.

8:59

How in the world was I going to go back to

9:01

med school? That meant taking the med, the

9:03

MCAT and all of that, well, I started

9:05

looking into it and sure enough,

9:08

my credits were going to count would, would,

9:10

would, would still count. So I was fortunate

9:12

in that respect. And

9:15

I took the MCAT. And

9:18

eventually got into med school there in Norfolk,

9:20

right around the corner from my house. So

9:23

that just played out

9:25

perfectly. But those,

9:27

those post baccalaureate classes

9:30

really prepared me for

9:32

med school, even though a lot of them were in the psychological

9:35

sciences. It was, it

9:37

was. You know an important part of

9:39

my career path.

9:41

That's so wonderful. And I think about,

9:43

I don't know if the listeners also have that experience,

9:45

but there were people in my class at Creighton

9:48

who had that. careers completely

9:50

like solid careers for like

9:52

a decade or more in some cases,

9:55

before they went to Creighton and became

9:57

doctors. And so I just

9:59

put that out there because when you talk

10:01

about it being in the cards, I

10:03

think there's also a part in like you

10:05

were sharing too what do you

10:07

want out of life? And if the

10:09

cards are in your favor, great. But if they're not

10:11

in your favor today, they might be there tomorrow. So

10:13

just a little bit of, hope and inspiration

10:16

for people who are like, Ah, I've,

10:18

I'm in a career, I can't do it, but I

10:20

would like to. So I think that's that

10:22

your journey is so inspiring. So

10:25

let me ask you there, when you

10:28

when you decided, and I think it's so

10:30

cool that your medical school is around the corner

10:32

from where you were actually living, you didn't have to get uprooted

10:35

and move to different state. How

10:38

did you handle being a

10:40

mom? Because how old were your kids

10:42

at that time? Were they in school?

10:44

Especially the first two years of med school are so

10:47

demanding when it comes to like, you have

10:49

to be in lecture. So I want to ask you about

10:51

how you handled, being a mom while

10:54

being a med student, especially in those first two years.

10:56

Yeah,

10:57

so

10:57

when I started med school, I had a three year old

10:59

and an eight year old, so,

11:02

they were both boys, so lots of

11:04

energy, of course, and,

11:07

they were involved in so many things. So,

11:09

yeah, I would attend scout meetings

11:12

and choir practice and,

11:15

soccer games, soccer practice, usually

11:17

with a book in my hand. And they knew that

11:20

I would take time every day

11:22

when I got home after class work.

11:25

To spend time with them, for

11:27

an hour or two in the evening. And then,

11:29

of course, I would go back into the bedroom and

11:31

do my little study in. But it worked.

11:34

It worked. And, when I look back on that now,

11:36

I'm really thankful that

11:38

I gave my kids that opportunity

11:41

to see that it was a good thing to go

11:43

after your dreams. And that

11:45

it's hard work, but it's worth it.

11:49

Amazing. And we'll talk about one of your sons, especially

11:51

later, but I'm sure that your

11:53

journey in becoming a physician

11:56

and what your kids saw absolutely

11:58

impacted their entrepreneurial spirit

12:01

in the future. So in their futures.

12:03

So let me ask you there. As

12:05

you were going through medical school, you

12:07

would talk to your family physician in Virginia,

12:09

she was like, come on now, you can, you can

12:11

do this too. You can be a doctor. Was

12:14

it in any, like, did

12:16

that conversation impact

12:18

you at all in terms of choosing

12:20

family medicine as a specialty? Or how

12:22

did you eventually realize like, family

12:25

medicine's for me?

12:27

So I was between pediatrics,

12:29

probably in family medicine. So,

12:32

when I was a young child,

12:34

my pediatrician was very important to

12:36

me. And so that's sort of

12:38

where I got the thoughts of being

12:40

a doctor 1 day anyway. So pediatrics was

12:42

high on the list. And then, of course,

12:44

my family doctor at that time, Dr.

12:46

Sinclair McCracken in Norfolk was,

12:49

was really instrumental in encouraging me. But

12:51

it wasn't until I really got into my

12:53

rotations and started figuring

12:55

out what I liked, what I didn't like. And

12:58

my, my first rotation was surgery.

13:01

And I was like, no way, this isn't

13:03

for me, but everything else I

13:05

liked. And I realized, family medicine

13:07

gives me that opportunity to do a little bit

13:09

of everything. Some peds, some gynecology,

13:12

a little bit of everything.

13:13

Gotcha. Now, when you

13:16

realized, and I, I, I, I

13:18

will have to say here that like, that is,

13:20

I feel such a common journey in terms

13:23

of peds or family, peds or family,

13:25

because you get to deal with families

13:27

in both. But I totally was in the same boat

13:29

when I was deciding peds or family.

13:32

And I, the same thing chose family. So Let

13:34

me ask you now, after you finished

13:37

residency and your first practice,

13:39

you were a physician who was not only practicing

13:41

herself, but was also in charge of a

13:43

team of nine people. So, let

13:46

me ask you about that before

13:48

we, start talking about your DPC journey. Because

13:51

when, when people are in fee for service,

13:53

especially in their first, like, first, one to three

13:56

years out of residency lot of people

13:58

are, they, they have their panel, they

14:00

see their panel, they have an MA front

14:02

office desk, whatever, but it,

14:04

it's pretty unique that you were in charge of nine

14:07

healthcare providers. So tell us about

14:09

that experience.

14:11

Yeah. So I think

14:13

probably a lot of that stemmed from

14:15

my maturity at that stage

14:17

in life. When I joined

14:19

the practice as a newbie,

14:22

I was. I was sort of already

14:24

put ahead of people who had seniority

14:27

by my, because of my age, my life experience.

14:30

And whether it was fair

14:33

or not to the ones that had seniority

14:36

leadership kind of selected

14:39

me to, to help lead the clinic

14:41

and, and I took it on. I

14:43

loved it. I loved building

14:45

teams, creating, workflows.

14:47

I loved educating physicians on best

14:49

practices. I really got into

14:51

it and thought that, yeah, I may

14:54

work my way up the administrative ladder

14:57

and really started pursuing

14:59

more leadership training. So I did my

15:01

certification as a physician executive

15:04

through the American Association of Physician

15:06

Leaders. And, I thought this

15:08

was my path until I started running

15:10

into roadblocks when

15:12

I would suggest things. No, no,

15:15

no, there's no money. No, we can't do

15:17

that. No stroke and cardiovascular

15:20

have priority, things like that. And I was like,

15:22

this isn't working.

15:23

And because you were

15:26

in, you were with a team of nine people.

15:28

Can you tell who, can

15:30

you share who those people were?

15:32

What roles were they? Were they fellow

15:34

physicians were they also support

15:37

staff who was on your team of

15:39

nine?

15:40

Yeah. So, so we had two PAs

15:43

and then seven physicians and

15:45

we had a staff of 40 employees.

15:48

And this is at a single location.

15:50

Yes, in South Charlotte. Gotcha,

15:52

gotcha. And when

15:54

you were when you were Facing

15:57

these, these roadblocks and

16:00

you were trying to do

16:03

your best, incorporating all of the lessons you

16:05

learned by getting your your certificate

16:07

of leadership and your,

16:10

you're bringing to the table, your expertise

16:12

as a physician as well as your life experience,

16:14

how did you cope with that and what

16:16

eventually made you decide

16:19

to leave that role?

16:20

I think I just sort of felt like

16:23

it wasn't sustainable for me to continue

16:25

this. I was exhausted

16:27

and, I felt like I was putting all

16:29

my energy and my passion into

16:31

something that wasn't moving anywhere.

16:34

And do you feel that because of the life

16:37

experience you had lived, you'd had

16:39

two kids, you've moved around different states.

16:42

Do you think that you got to

16:44

this place of like, I am recognizing

16:46

that this is not going to be fulfilling my

16:49

life in the way I need it to sooner

16:52

than if you had not had those same experiences?

16:55

Probably so. Yeah. And

16:58

then. What did you end

17:01

up doing after you left that position?

17:04

So interesting story

17:06

there. So I left

17:08

that practice in July

17:11

of 2021. And

17:13

in January of that year,

17:15

I started my new discernment

17:17

process on what I was going to do next.

17:20

So over that six to seven

17:22

months period, I was trying

17:24

to figure out what my next step was. I

17:26

knew that. Since

17:29

residency, I wanted to do the integrative medicine

17:31

fellowship. So that was one

17:33

priority for me on how I could do

17:35

that next. And then

17:37

my other priority

17:39

was wanting to do direct primary care.

17:42

So I was figuring out at that time how

17:44

I could do that. I knew

17:46

that if I wanted to do the integrative medicine

17:49

fellowship, it was going to take a large chunk of

18:40

my time and that I couldn't spend

18:42

my evenings charting and studying.

18:44

So, I had to be able to have a

18:47

position where I could study in the evenings,

18:49

but I would have more free time. So,

18:51

I looked into direct primary care

18:53

and the concierge practice. So,

18:56

my fear, though, was financial

18:59

in making the DPC leap. So,

19:02

My husband and I talked about it and we tried

19:04

to figure out how we could make this work.

19:07

It scared him to death because

19:09

of the two of us, I was the breadwinner. He

19:12

is a, a, a Presbyterian

19:14

minister and works part time.

19:16

So, we were dependent on, on

19:19

my income and having a child in

19:21

college and still paying med

19:23

school loans. So financial aspects

19:25

were a large, a large part of that. So,

19:28

so we sort of decided, well,

19:31

the best. The next best

19:33

thing to DPC is doing the concierge

19:36

practice. until I'm able

19:38

to do my own direct primary care. So

19:40

we started at a time planning how we were

19:42

going to map this out over

19:45

the next two years. And it did. It almost,

19:47

it took a little over two years till

19:49

I got to the point of opening my practice. I

19:51

decided, that I was going to do concierge

19:55

for a while and do the fellowship

19:57

together. So August

19:59

1st of 2021, I started

20:02

both a new job and integrative

20:04

medicine fellowship.

20:05

And how did that work out? Because with the concierge

20:08

practice being different than the

20:10

role you were previously in, were you

20:12

in charge of multiple people at the time? Or

20:14

did you have the time to,

20:17

finish your notes during work hours

20:19

and then also have the time to be

20:21

able to do your studies for

20:23

the integrative fellowship?

20:25

Yes, I had I had plenty of time

20:27

to get my notes done. I was not

20:29

inheriting a panel, a patient

20:31

panel from anyone. So, I was

20:33

building it as I went. So I started with

20:35

0 patients coming in the door.

20:38

So it did take a while to build up. So, yeah,

20:40

I had plenty of time to sit and study

20:43

and at my desk in my office.

20:46

While I was building on practice so

20:48

it worked out well.

20:49

And because that journey started

20:52

in 2021 and we're recording

20:54

this in 2024, what was

20:56

it that was, the,

20:59

the difference between, what

21:01

made the difference between, Hey, like,

21:03

I know I was thinking about DPC, but I

21:06

can just stay in concierge rather than opening

21:08

my own clinic.

21:09

So, so I really enjoyed being

21:12

able to develop relationships, have

21:14

longer appointment times with my patients

21:17

and since I had such a small

21:19

panel and growing slowly, I

21:21

really could invest myself with

21:24

them and learn more

21:26

about them at deeper levels. Interestingly,

21:28

I had patients follow me from

21:31

my previous practice to the

21:33

concierge practice. And

21:35

spending time with them at an hour

21:37

appointment, I learned things about them that

21:40

over the previous 9 years, I never knew

21:42

because I didn't have time any longer than 15

21:44

minutes with them at a time. So

21:47

it was, it was very it's very refreshing

21:49

to be able to, to develop those relationships,

21:53

but at the same time, some

21:56

of the. Some

21:58

of the aspects of concierge

22:01

didn't appeal to me. Yeah.

22:03

I definitely would say, if people are interested

22:05

in this difference between concierge medicine

22:08

and DPC and people

22:10

who've chosen to, like yourself,

22:12

to go from concierge to DPC,

22:14

another doctor I would definitely recommend listening to on

22:16

this podcast was Dr. Ingrid Liu out of

22:18

the Chicagoland area who was in

22:20

different concierge practices prior to opening

22:23

her own DPC. So definitely, I, I

22:25

love asking this question because in

22:27

terms of the differences between concierge

22:29

medicine and DPC, I, I

22:31

cannot illustrate that there is definitely

22:34

a difference especially when there's people

22:36

like yourself and Dr. Liu who have chosen

22:38

to not remain in concierge medicine because they

22:40

are totally different ways

22:42

of practicing medicine. Even though

22:44

our patients get concierge. like level

22:46

care. We are not concierge medicine

22:49

and direct primary care. So love that.

22:51

I'm hoping that that helps make that

22:53

distinction very black and white for people

22:56

who are listening. So when

22:58

you were like, Hey, I'm

23:00

in my fellowship, I have

23:02

this concierge practice. How did

23:04

you then Decide to, to,

23:07

to make that cut and say, the

23:09

one door has closed on concierge medicine

23:11

and now I want to open my own practice.

23:14

Yeah, so, so as I was referring

23:16

to earlier, it was a lot of

23:18

the financial stuff, being sure that we had

23:20

things in place. So

23:22

we had, we saved up at that point enough

23:24

to finish paying off my kids

23:26

college. So that was an important part.

23:28

We paid off the cars. We made

23:31

sure we had things in place

23:33

before I went from salary,

23:36

a paycheck to

23:38

nothing, because that was a huge

23:40

fear. But it did, it took some

23:42

planning

23:42

there. And a fear that, many

23:45

of us have, like, I, I opened with

23:47

zero patients and the

23:49

people who've come on to this podcast, I would say

23:51

for the most part people had zero

23:54

patients, there's been people who have opened

23:56

in areas where Bay

23:59

had not practiced before. And so for you,

24:01

still remaining in the Charlotte

24:03

esque area, you're 30 minutes outside of

24:05

Charlotte how did you decide that

24:07

this was where you were going to practice? Did that have

24:09

anything to do with where you were

24:12

living or where your husband was

24:14

ministering?

24:15

So because I have a non compete,

24:17

I had to go, I had to go 10

24:19

miles out from my previous practice. So,

24:22

so that was one factor. It

24:24

happened to also kind of

24:26

intersect with my previous practice,

24:29

which was Before the concierge. So

24:31

I had a cluster of patients actually

24:33

from Waxhaw that I used to

24:35

see. So that was a good

24:38

kind of mix, but it's also in the county

24:40

where my husband's church is now. So

24:44

there were lots of different things in the decision

24:46

on where on where to draw that

24:48

little radius of 10 miles out from

24:51

from my practice at that time.

24:53

I think about people like Dr. Krista

24:55

Springston who are like, I think, 0. 1

24:58

miles outside of the non compete radius, so

25:01

more power to you. I love this. Now,

25:03

when you decided like, hey, geographically,

25:05

this would work and you opened in

25:08

Waxhaw, can you tell us a little bit

25:10

about the community, how it's different

25:12

than the demographics of your community? previous

25:15

practices because you had some patients already

25:17

coming from Waxhaw, like you mentioned, but like, in

25:19

terms of the the

25:21

access to medical care, the

25:23

types of medical practices the,

25:25

the type of, income, insurance

25:28

level, tell us about Waxhaw

25:30

in particular.

25:31

Yeah, so Waxhaw is sort of a bedroom

25:34

community to Charlotte. It typically,

25:36

well, it previously was a very

25:38

rural area. People that

25:40

lived there their whole lives didn't leave the county,

25:43

always lived there, but as

25:45

Charlotte grew and expanded,

25:48

more and more people moved out further

25:51

out from the city. So they would either commute

25:53

back into Charlotte to work and then

25:55

wanted to live in a nice community

25:57

the rest of their, their time, right?

26:00

So, Waxhaw has sort of become

26:02

this equestrian community. So there

26:04

are lots of horse farms here

26:07

lots of very affluent families

26:10

in the area, as well as

26:12

lots of communities, small

26:15

neighborhoods of communities that have had

26:17

generations of family here that live

26:19

on like farms and still

26:21

working farms. So quite

26:24

a diverse population in the area

26:26

now. So average income,

26:29

I think I saw that you had written down

26:31

120, 000. I was

26:34

actually kind of surprised at

26:36

that. I would have guessed it was higher in the

26:38

area.

26:38

When I saw that amount that was

26:40

from I believe the 2018 census, but it's

26:43

definitely something that, you know, if you're wanting

26:45

to know that data for your practice and this

26:48

is going out to the listeners if there's

26:50

DPCs in all 50 states. So you can also,

26:53

you know, ask people who have

26:55

other physicians who've opened. Did

26:57

you find this information? Where did you find

26:59

it? To see if there's more up to date data

27:02

for your area. So that

27:04

said what about the healthcare access?

27:06

Is there a rural access

27:08

hospital in Waxhaw or what is, what

27:10

is the access to healthcare like for

27:13

the people who live there?

27:15

So there are two large health care

27:17

systems in the Charlotte area, and

27:19

each of those have a clinic

27:21

in the Waxhaw area.

27:24

There is an emergency room, a

27:26

standalone emergency room by

27:28

one of those health care systems in Waxhaw.

27:30

But otherwise, There are really

27:33

little to no independent

27:35

physicians in the area. So with

27:37

me being here, it's, it's, it's

27:40

very opening and encouraging

27:42

to those who want to escape those

27:44

large healthcare systems.

27:46

Absolutely. And, I, I love

27:48

that. not only were you able to

27:51

be a beacon of, change

27:53

and personalized health care, but

27:55

also you have your fellowship under

27:57

your belt by the time that you opened, which

27:59

is amazing. So, let me ask

28:02

you now, when you were

28:04

looking at Waxhaw, was it fairly

28:06

easy to find a space? So

28:09

I worked

28:09

with a realtor to help me find

28:12

a location and what

28:14

I was looking for was something small,

28:17

because I wanted to have low overhead.

28:20

And also wanted kind of an intimate

28:22

setting where it felt like.

28:24

A comfortable welcome

28:27

place. So I did,

28:29

I found a location in a counseling

28:31

office. So it's an office that has

28:34

five offices individually

28:36

rented out to different counselors.

28:39

And so I'm the only MD in here, but

28:41

it works out great because,

28:43

it's quiet environment. There

28:45

are sofas and chairs and it's

28:47

a comfy environment. There's a, like

28:49

a, an entry waiting area up

28:52

front that secured. There's like

28:54

a 2 way mirror because it is a

28:56

counseling office and But

28:58

I feel very safe and, and comfortable

29:01

in this, in this office park. In the

29:03

office park, there are other, practitioners

29:06

of like chiropractic, there's an

29:08

oral surgeon, there's

29:10

I think some, some other different

29:12

practitioners like massage therapy, physical

29:14

therapy, speech therapy. There

29:16

aren't any other physicians though here.

29:19

I think that it also speaks

29:21

to something that other that previous

29:23

guests have shared about is that you're in

29:25

an area where people expect to find

29:27

healthcare, like Dr. Erica Young shared about

29:29

this in the area of Georgia where she's practicing.,

29:32

What about when, if, if other people

29:34

are looking for professional park areas

29:37

or areas, even if it's a strip

29:39

mall where there are other practice

29:41

or other practitioners of different

29:43

health care, professions do

29:45

you have any tips as to,

29:48

how to evaluate the real estate

29:50

as well as are there any pitfalls

29:53

or cons or, Places

29:55

to be wary of or things to be wary

29:57

of for those people who are looking at similar situations.

30:01

Yeah, so, so one thing that was important

30:03

to me is that I wanted a one year

30:05

lease and some people were

30:07

wanting three and five years and

30:09

I really wanted to have that flexibility

30:12

because I didn't know how fast I was going to grow. If

30:15

after a year I wanted a larger space,

30:17

I was going to need to move and I didn't want to be locked

30:19

into a lease that I didn't need. And

30:22

I also wanted to be that I could work

30:24

with the people I was running from.

30:27

So I connected

30:29

with the people here at the office

30:31

when I first visited and toured and I

30:33

was like, I felt comfortable.

30:35

That was an important part to me because relationships

30:38

are important. And I wanted to have that in

30:40

place too.

30:41

amen to that. I'm like clapping over here because

30:44

the shortest lease, that you can get in

30:46

is, is great. Dr. John

30:48

Jacobson shared on his podcast about

30:51

this thing exactly. It's like, he

30:53

said why rent what, why

30:55

buy what you can rent? Why rent

30:57

what you can steal? And he

30:59

has not gotten to the point of stealing, but at the

31:01

same time when you're thinking

31:03

about overhead being low, you do not know

32:03

what the adoption of DPC is going to be like in

32:05

your community, especially when you're really

32:07

the only independent doctor in the area and

32:10

you're doing DPC. I think that definitely

32:12

allows you to have that flexibility without

32:14

the long term time investment

32:17

if that is possible. So love that. Now,

32:19

how about the, the space

32:21

in terms of how your space

32:24

is situated in terms

32:26

of number of patients

32:28

that you can see per day and

32:30

thinking about the growth of your practice. I want

32:32

to ask this because a lot of people

32:35

that have shared that they've opened with, single space,

32:37

they're renting a space or they're subleasing

32:39

a space. Have you envisioned

32:42

at what point, at what

32:44

breaking point, so to speak, your practice

32:46

would be needing to transition to

32:48

a larger space?

32:50

Yeah. So, so my space is an

32:52

11 by 11 office. And you can see

32:54

here, my exam tables right there, my,

32:56

my scale, this is pretty much it.

32:59

And it's just me right now. And

33:01

as I grow, I anticipate needing

33:03

a staff person. So if that's an in

33:06

person staff person, I would definitely

33:08

need to have a larger space. Right now

33:10

I'm considering virtual. Like at what point

33:12

do I, do I look at that?

33:15

But also at some point I would like to have

33:17

a lab or at least be able to draw

33:19

blood in my office. Right now

33:21

I'm kind of limited and I don't have space

33:23

to do it. So I send patients to lab

33:25

for.

33:27

Now let's talk about the growth of your practice because

33:29

you said you started out, new community

33:31

for you in terms of your patients were from Waxhaw

33:33

before, some of them, but you had not practiced

33:35

in Waxhaw before. How was

33:38

your, how was your opening

33:40

day? Did you already have patients who were like,

33:43

when are you opening? Because I'm going to join your

33:45

practice on that day.

33:46

Yes, of course, even despite having

33:49

a non compete, people were tracking me

33:51

down that Internet's a wonderful tool

33:53

in this world. So, yes,

33:56

the day after I left my

33:58

the previous practice I

34:01

did, like, my media burst

34:03

to announce where I was going to be and

34:05

immediately I had patients reaching out.

34:08

So on the 1st day,

34:10

I think I had. Probably,

34:12

and I should have looked this up to quote exactly,

34:15

but I think I had 20 people signed up. So,

34:18

so that was a good starting point. And,

34:21

and I had a really warm reception to the community

34:23

Waxhaw Business Association did

34:26

a ribbon cutting for me and the mayor

34:28

came. I had, a group of other people

34:30

in the community showed up. So it

34:32

was a really warm welcome

34:35

to the community. 20

34:37

patients. Congratulations. I mean, I know it's, it's

34:39

a belated, but that's amazing. That's,

34:42

I, and I, I love that. And I hope it gives people

34:44

hope in terms of people also facing non

34:46

competes. So I think that's wonderful.

34:49

So with 20 patients already

34:51

ready to join you and granted you

34:53

knew something about these people before because

34:55

they were following you, but how did

34:57

you handle the onboarding of 20

34:59

people? Because even

35:01

one person can be quite a lot when you're

35:03

opening your own practice. How did you handle

35:06

20 without staff?

35:08

Right. So, so I did it very

35:10

slowly, kind of staggered. Fortunately

35:13

I have access to the

35:15

portals to both the two large healthcare

35:17

systems. So I was able to pull

35:20

a lot of data, especially from the

35:22

practice where it was previously that was

35:24

in the large healthcare system. I could see

35:26

all my old notes. So I was able to,

35:28

to pull stuff in and, that was

35:30

a big, a big part of it. What

35:32

took the most time was just sitting

35:35

down with with each individual patient

35:37

for an hour because my appointments are so long

35:39

and I want to know so much about them

35:42

and it took time. So,

35:44

yeah, I was, I was, staggering

35:46

my schedule so that I could fit people

35:48

in and they were all very understanding.

35:50

I mean, these are people who. Some of them

35:52

I've been seeing since, I started

35:54

out of residency. So people

35:56

that were very committed and wanted to make this happen.

35:59

So they're like, Oh, no problem. I'll see you when

36:01

you got time for me. They were very understanding.

36:04

So rewarding, especially as a family doctor

36:06

or, just somebody in primary care who

36:08

that generational aspect to

36:11

care, the longevity of the relationship

36:14

really. That hones in on how

36:16

valuable that is. So with

36:18

that your, and I, I mentioned

36:20

earlier, we'd talk about your sons and the impact

36:23

of your entrepreneurial journey on their journeys

36:25

in life. But your son, Jacob

36:27

has helped you with marketing

36:29

of your practice. So, what did that

36:31

look like? And at what point did you say, Hey,

36:34

you're an expert in something that I need help with.

36:37

Yes. So it, it

36:39

was Thanksgiving of

36:41

2020. Oh

36:43

my goodness. It's all running together. It's 2022

36:46

Thanksgiving of 2022. We

36:48

were sitting around, I think after

36:50

eating all the turkey and we're tired and everything,

36:53

and all of a sudden Jacob pops up and says,

36:55

so mom, you're going to do this thing. And,

36:58

and he is all in. So he jumps

37:01

on his laptop, creates a spreadsheet,

37:03

creates a, an agenda of a plan

37:06

and, and is all in gung

37:08

ho because his business is

37:10

in digital marketing, doing counseling

37:13

and consulting for small businesses.

37:15

He's based in Asheville, but he's

37:17

had clients all over the country

37:19

now who've sort of found him as a,

37:22

as a, especially as an LGBTQ

37:24

friendly. Counselor, coach.

37:26

Yeah.

37:27

That's awesome. And I just love

37:30

also that, as we have

37:32

heard on the podcast, people call their DPCs,

37:34

their, their, their next child after

37:36

having human children I love

37:38

that one of your human children is helping

37:40

you with your non human child growing and

37:42

developing. So let me ask you

37:45

with his expertise. And his,

37:47

his spreadsheets and his, the checklist of

37:49

like what you guys were going to do. How did

37:52

he how did he use his

37:54

skills to interpret what

37:56

direct primary care is to

37:58

an area that wasn't familiar with direct

38:00

primary care?

38:02

Yeah. So, so there was a lot

38:04

of learning. And between

38:06

the two of us, we sort of, tried to figure

38:08

out how to, how to approach

38:10

things. We took, we took many

38:12

steps. We would, we would. Do

38:14

zoom calls just about every week

38:17

before I even turned in my notice that I was

38:19

leaving. So this was a very,

38:22

very organized methodical process

38:24

for him because that's the way he worked with his

38:26

clients. And I was very appreciative of that. And

38:29

we were very careful not to step

38:31

on each other's toes because it's really hard

38:33

when your family members working together

38:36

and on something like this. And I

38:38

totally respect his decision. His

38:40

knowledge and his vision for

38:42

how to build a small business. My,

38:45

my father is also an entrepreneur.

38:47

And so we, between

38:49

the among the three of us it's

38:52

sort of, it's sort of ingrained. On

38:54

how to, on how to,

38:57

to build a small business, but it also

38:59

takes a lot of work and,

39:01

and Jacob was really helpful

39:03

for me in doing that. He created my

39:05

website. I wrote the text,

39:08

but he certainly helped edit it and,

39:10

and organize it so that it was

39:13

very presentable. I was very pleased with

39:15

how it turned out.

39:17

Kudos to him. I, I definitely will say, it's

39:19

very clean and it's very I,

39:21

I can easily see how somebody looking

39:23

on your website is like, that's, that's

39:25

me. Like, I want that care. And

39:28

there is a button for every, section

39:30

of your website, like men's health

39:32

integrative integrative health therapies.

39:35

Like there's, if there's a,

39:37

yeah. Your services are broken down

39:39

so that they're pertinent to the avatars

39:42

who are going to be your future members.

39:44

So I, I really give him kudos for that.

39:46

Now, what about in terms of

39:49

marketing your practice, you have also been

39:51

present on natural awakenings.

39:53

So can you tell the audience what is

39:55

natural awakenings and how has that

39:57

helped your practice and its growth?

40:00

Yeah, so Natural Awakenings is a

40:02

health and fitness magazine that

40:05

primarily has

40:07

advertisers of more of the integrative

40:09

space. So, lots

40:11

of like massage therapists will

40:13

use that magazine, for example, to

40:16

help promote their practices, but it also

40:18

includes lots of articles on,

40:20

health and wellness techniques, what's the newest

40:22

trends, things like that. And so

40:24

I used their magazine to help. At

40:26

least give me an advertising

40:29

space. So that was the only magazine

40:31

that I chose to advertise in here

40:33

locally. There is a Charlotte edition. I think

40:35

there are probably editions all over the

40:37

country, but but with the Charlotte

40:40

edition, it would, I think it was distributed

40:42

around Three to four counties

40:45

in the area, so a large,

40:47

large space, and it's usually like

40:49

in doctor's offices or, the

40:51

massage therapist office, whatever and

40:54

with with signing up with them,

40:56

it also gave me access to writing

40:59

blog post. So I did that with

41:01

them, and then there were a couple other

41:03

articles that they featured me as the,

41:05

as an integrated physician in the area.

41:08

And you can definitely check those

41:10

out, I'll put them on your blog, but the

41:13

article you did about menopause, I mean,

41:15

this is, there's definitely people,

41:17

in no matter what community you live in who

41:19

are going to be interested in menopause. So

41:21

I think that's wonderful that you, had

41:23

a platform where people were interested in health. Where

41:26

you're also able to talk about integrative

41:28

medicine and you as a physician. So

41:31

with that, in January of 2024

41:33

you had started some zoom calls

41:36

great way to kickstart the year, but can you

41:38

tell us about how you created

41:40

this plan of even doing the zoom calls in

41:42

addition to your presence on natural

41:44

awakenings and how did those zoom

41:47

calls help your practice and help

41:49

people to understand what you were doing for the community?

41:52

Yeah. So, so the ad

41:54

in natural awakenings mentioned that

41:56

I was going to be doing these webinars for

41:58

the month of January and I called them

42:01

healthier you in 2024 and

42:03

it was a series five weeks cause

42:05

they were five Tuesdays in the month. So

42:07

each Tuesday evening for an hour,

42:10

I would spend time with a group of

42:12

people who ever chose to join

42:14

to talk about. Diet and

42:17

exercise and sleep

42:20

stress reduction and building resiliency

42:22

and it ended up being a really

42:25

good small group of people

42:27

that stuck through and actually attended each

42:30

of the sessions, each of the sessions for 5

42:32

weeks. So it was, it was

42:34

a real opportunity to kind

42:36

of have a version of group

42:39

visits. in

42:41

a way that it was comfortable with for people

42:43

in their homes.

42:44

Amazing. And I'm sure, especially

42:46

being in January when you started that

42:49

you, when you started that, I'm sure that

42:51

you got different buy in than if you had started

42:53

in June. one of the things that I

42:56

love looking at is people's logos. So,

42:58

I, and I, I want to, I actually don't know the answer

43:00

to this. It looks like there's a B in the

43:02

middle of your logo and it's a, it's a circular logo.

43:05

And I was trying to, to, to put is,

43:07

are those echinacea flowers? I couldn't, I couldn't.

43:09

Exactly. Okay. Awesome.

43:11

Awesome. I'm like, I was like, I think those

43:14

are, but I want to, I'll ask you. So that's awesome.

43:16

So tell us about your logo and how

43:19

you got your logo to

43:21

represent what you're doing for your community

43:23

and your practice.

43:24

Yeah. So, so my

43:26

name, Melissa means honeybee. So

43:28

that was, that's sort of always been

43:30

something that I liked as a symbol

43:32

for me. So that I knew going in

43:34

that that was one thing I wanted. But I met

43:36

with a graphic artist. Who

43:39

spent two hours with me

43:41

wanting to get to know me. I mean,

43:43

she asked me some deep questions and

43:46

we kind of worked through, what values

43:48

do I want to portray? What's important

43:51

to me. And, we talked about

43:53

how relationships. And

43:56

lifetime learning, being in, being

43:58

involved in education and being

44:00

an advocate for patients and

44:02

how courage is important to me.

44:05

And that also, I really like

44:07

being creative and I want to show my creative

44:09

side. So we came up with,

44:12

well, mostly she did after I talked with her,

44:14

but she, she designed the

44:16

logo that includes a honeybee at

44:18

the center, at the center. And

44:20

that kind of symbolizes a lot of different things.

44:23

So yeah, it happened to be

44:25

related to my name, but also

44:27

honey is so important in the integrative

44:29

world. It's wonderful healing

44:31

powers. And it, and it also,

44:34

is an important part in nature.

44:37

And, there are so many things, we wouldn't have

44:39

all these beautiful flowers and

44:42

everything in, In nature, without

44:44

these little pollinators working like crazy.

44:47

So, the honeybee is a very important,

44:49

important part. And it. And

44:52

the design also includes the, the

44:54

echinacea flowers over to the sides

44:56

of the bee, which is also used

44:59

a lot in as a, as a an herbal

45:01

to help with allergies, asthma, those kinds

45:03

of things. But it also is a

45:05

symbol of health and healing. And

45:08

that was very important. The round circle.

45:11

Is important in that it is a symbol of

45:14

building relationships and

45:16

being connected with one another. So

45:18

that's kind of how that, that sort of was

45:21

created.

45:22

So beautiful and definitely check out Dr.

45:25

Ratliff's logo. It is definitely,

45:27

when you see it, you can hear her

45:29

voice saying these things about how it represents

45:32

the person she is. So it's amazing. So

45:35

let me ask you now going into the future

45:37

this is, you are in your first

45:39

year of. Doing DPC,

45:42

owning your own practice making

45:44

it what you want it to be what

45:46

do you see in the future,

45:49

in the next three, five years

45:51

of your practice? Because,

45:53

I, I, I, I love asking

45:55

this because in three, in five

45:57

years, you're going to look back and say, like, wow,

46:00

my journey, like I nailed it or

46:02

it's totally gone a different direction.

46:05

Yeah, so, so I really want

46:07

to to build more on the prevention

46:10

part of my practice. I am still

46:12

primary care. So yes, I still manage

46:14

patients with diabetes, heart disease,

46:16

hypertension, all of, all of those things.

46:19

But I really want to invest

46:21

in the community as,

46:25

Doing preventive care, true preventive

46:27

care, where we're preventing all of those diseases.

46:29

So, I like to talk with my patients

46:32

about, diet and exercise and

46:34

sleep and stress reduction, building resiliency,

46:36

social connections, mood, spirituality,

46:39

all of those different things. And

46:41

I really would like to be, known

46:44

in the community as someone who's

46:46

really helping to knock out diseases

46:48

because we're, we're addressing all of

46:50

these things when people are young.

46:52

Amazing. thank you so much, Dr.

46:54

Ratliff for joining us today and sharing your story.

46:56

Thanks for

46:57

being here.

47:00

Thank you for joining us for another episode of

47:03

My DPC Story, highlighting the physician

47:05

experience in the world of direct primary

47:07

care. I hope you found today's conversation

47:10

insightful and inspiring. If

47:12

you want to dive deeper into the direct primary

47:14

care movement, consider joining our My DPC

47:16

Story Patreon community. Here you'll

47:18

have access to exclusive content, including

47:21

more interview topics and much more. Don't

47:23

forget to subscribe to My DPC Story on your

47:25

podcast feed and follow us on social

47:28

media as well. If you're able,

47:30

I'd greatly appreciate if you could leave us a review.

47:32

It helps others to find the podcast. Until

47:35

next time, stay informed, stay healthy,

47:38

and keep advocating for DPC. Read

47:40

more about DPC news on the daily at dpcnews.

47:43

com. Until next week, this is Mariel Concepcion.