Direct Primary Care Book by Paul Thomas MD

Direct Primary Care: The Cure for Our Broken Healthcare System

This week, I had the privilege of publishing and releasing my first book, Direct Primary Care: The Cure for Our Broken Healthcare System. Here’s the blurb I wrote for the book on Amazon:

They said it couldn't be done. It wouldn't be possible to fix our broken healthcare system. It wouldn't be possible to fix a healthcare system that undervalues primary care and human relationships. But here we are, a courageous group of primary care doctors, tirelessly working to create value for our patients in communities across the country. This is the story of the Direct Primary Care movement, and how it could revolutionize not only primary care, but the entire healthcare system. The book begins by describing the current crisis in primary care and goes on to define the scope of Direct Primary Care. It closes with concrete examples of how the Direct Primary Care model is working at Plum Health DPC in Southwest Detroit.

It’s been a long journey from “idea” to “published”, and there’s still a lot of work to do promoting the book and getting it out into the world. I wrote the book because I believe that healthcare should be affordable and accessible for everyone, and I also believe that the Direct Primary Care model gets us closer to that goal. So, in the book, I set out to explain and describe the ethos of the Direct Primary Care movement and the work that I do in SW Detroit with Plum Health DPC.

Kindle/eBook version:

Screenshot from Amazon.com with the Kindle version of the book.  Direct Primary Care: The Cure for Our Broken Healthcare System .

Screenshot from Amazon.com with the Kindle version of the book. Direct Primary Care: The Cure for Our Broken Healthcare System.

Screenshot from Amazon.com with the Paperback version of the book.  Direct Primary Care: The Cure for Our Broken Healthcare System .

Screenshot from Amazon.com with the Paperback version of the book. Direct Primary Care: The Cure for Our Broken Healthcare System.

Within 72 hours, these titles will be merged into one page on Amazon!

Author Page for Paul Thomas MD on Amazon.com

One of the things that I had to do to publish the book on Amazon, was to set up an Author Page for myself, Paul Thomas MD, on Amazon.com. My bio reads something like this:

Dr. Paul Thomas is a board-certified family medicine physician practicing in Southwest Detroit. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit and Wayne County. His mission is to deliver affordable, accessible health care services in Detroit and beyond. He has been featured on WDIV-TV Channel 4, WXYZ Channel 7, Crain's Detroit Business and CBS Radio. He has been a speaker at TEDxDetroit and is a graduate of and Clinical Assistant Professor at Wayne State University School of Medicine. You can find out more at PlumHealthDPC.com.

It’s pretty neat and motivating to get working on the next book! I have a lot of ideas that I want to write about, mostly involving Direct Primary Care, and this was such a cool process.

The Process of Writing the Direct Primary Care Book

I wrote the book in about one week in January 2018. I thought I’d have it published in March. Boy was I wrong! After writing it, I sent the draft to some brave alpha readers, who read it and gave me feedback. That brought me to February. I then edited the draft with those suggestions and came up with a second draft, which I sent to some beta readers.

From there, Amanda and I edited the entire book and had the final draft. This was March. I still needed a cover design, formatting, promotional quotes from people I knew, and so many other things that I was naive to prior to starting this process.

In the spirit of Thanksgiving, I have a million people to thank, from those alpha readers to those who helped me design the cover through those who wrote blurbs for the book and my publisher. It definitely took a village to get this over the finish line. A very special thank you to Zain Ismail for writing the foreword.

Reception So Far

So far, the reception to the Direct Primary Care book has been good. We have been number one in the “Physician & Patient” and “Administration & Policy” categories on Amazon.com, which is exciting, and we broke the top ten for “Medical eBooks!”

Direct Primary Care: The Cure for Our Broken Healthcare System  trending in Medical eBooks “Administration and Policy”.

Direct Primary Care: The Cure for Our Broken Healthcare System trending in Medical eBooks “Administration and Policy”.

Direct Primary Care: The Cure for Our Broken Healthcare System  is trending in Medical eBooks “Physicians & Patient” Category on Amazon.com

Direct Primary Care: The Cure for Our Broken Healthcare System is trending in Medical eBooks “Physicians & Patient” Category on Amazon.com

Thanks so much for reading, I appreciate all of you, and enjoy the book!

- Dr. Paul Thomas, MD, Physician with Plum Health DPC and now author of Direct Primary Care: The Cure for our Broken Healthcare System

We’ve been getting a ton of support on Social Media, like our Facebook post. Follow us on Facebook, here: https://www.facebook.com/PlumHealthDPC/

We’ve been getting a ton of support on Social Media, like our Facebook post. Follow us on Facebook, here: https://www.facebook.com/PlumHealthDPC/

We’ve been getting a lot of support on Social Media, like on our Instagram Page, follow us here: https://www.instagram.com/plumhealthdpc/

We’ve been getting a lot of support on Social Media, like on our Instagram Page, follow us here: https://www.instagram.com/plumhealthdpc/

Heart Health on SEEN Magazine

Today is Valentine's Day and it's a great time to talk about heart health aka cardiovascular health. We were invited to write a blog post for Detroit's SEEN Magazine and it is now live and currently on their front page! Head over to their website to read the full article, here.

Thanks for reading,

- Dr. Paul Thomas with Plum Health DPC

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Digital Marketing for my Direct Primary Care Doctor Colleagues

Starting a Direct Primary Care practice is a tall task, by any measure. Doctors emerge from residency with little to no business training. Starting a DPC practice is starting a business, and for many doctors, this is their first attempt at something like this. The journey from 'idea' to 'successful practice' is fraught with pitfalls and difficulties. 

Knowing how hard it is to start a business and how hard it is to start a DPC practice, I wrote a blog post for my colleagues. It is my sincere hope that they are able to grow while minimizing mistakes, errors, and difficulties. One area where I see that doctors could make significant improvements is their digital marketing. 

Specifically, DPC docs need to know how to build a sales funnel for their services. You see, when a doctor is employed by a large health system, her name is on the back of the insurance card for thousands of patients. That same doctor, when she breaks free from the insurance-based system, has to find her own patients. Where will these patients come from? 

Direct Primary Care (DPC) doctors must leverage social media, email marketing, networking events, etc... in order to grow their practices successfully. This piece that I wrote on the Hint Health blog will facilitate this growth, and it focuses on building a sales funnel for your practice.

Thanks for reading, and have a wonderful day,

- Dr. Paul with Plum Health 

Plum Health Blog Post for Hint Health.png

Limitless or My Thoughts on Optimizing Productivity

This week I watched the movie "Limitless" starring Bradley Cooper. The film follows a struggling writer who can't seem to get anything done. Even though he has a book deal, he hasn't written a page, not even a word. He finds himself lingering at the bar, talking about what he might do rather than just doing it. 

Then, Bradley Cooper's character meets an old acquaintance who introduces him to a medication - NZT - that improves his brain's capacity to access information, concentrate and focus. Within 4 days, he finishes his book and within a month, he is the lead consultant on the largest corporate merger in American history. 

I found it interesting that the very first thing Bradley Cooper's character does when taking this mental capacity-enhancing medication is to clean his entire apartment. He literally throws away all of the things he doesn't need, washes his dishes, organizes his book shelf, tweaks the layout of his apartment, and sets up a desk that is most conducive to being productive. 

Hollywood hyperbole aside, I think this movie touches on some really important take-aways. First, how do you organize your life? What does your physical space look like? Are you able to be productive in that space? What about your schedule? Are you creating space in your schedule so that you can capitalize on your peak brain capacity, your peak productivity?

For me, I am most effective when I exercise first thing in the morning and then schedule myself 2 - 3 hours of un-interrupted work. I can really zero-in on the one or two most difficult tasks for the day. This is the time that I'm "in the zone" or experiencing a "flow state" - I am engrossed in my work and able to interact with complex thoughts and decisions. 

The time of day and how you mentally prepare for your peak productivity may be different for you. For example, you may be more productive in the night-time hours, after everyone else in your family has gone to bed. The point is this: it is incredibly important to think critically about how you structure your day and your life for optimal productivity, and even happiness. 

I believe that this has important applications for medical conditions, namely depression, anxiety and ADHD. Let's tackle ADHD, for example. With ADHD, the two mainstays of treatment are medications and cognitive behavioral therapy (CBT). And, in CBT, the focus is on time management, organization, and making short- and long-term plans. 

Here's why CBT is relevant for patients with ADHD, taken from CHADD, the national resource on ADHD: "CBT is relevant for adults with ADHD in two ways. First, in recent years, CBT programs have been developed specifically for adults with ADHD. Some of these programs aim to help adults overcome their difficulties in everyday executive functions that are needed to effectively manage time, organize and plan in the short term and the long term. Other programs focus on emotional self-regulation, impulse control and stress management".

As for Depression, if you are dealing with depression, and you are not structuring your day to include exercise, you may be missing out on a powerful form of treatment. Exercise can be a powerful antidepressant. However, the evidence is limited at this time. According to an article in the American College of Sports Medicine's Health and Fitness Journal, "Only two studies, both from researchers at Duke University, compared the effectiveness of exercise with pharmacotherapy. No differences between exercise and antidepressant medication were noted". 

Final takeaways, you have the power to improve your mood and your productivity by organizing your life. Think critically about how you structure your schedule, physical space, and mental space, and create your schedule around your peak productivity.

Thanks for reading, and have a great day!

- Dr. Paul with Plum Health in Detroit, MI

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A Golden Apple in My Office

This week, I was taking care of a family of 6 in my office! There was a lot of joyful movement and one of the toddlers grabbed an item from its resting place- it's an Apple, a Golden Apple, that I keep on my shelf and it's a reminder of my mission, vision, and values. 

When I was in medical school at Wayne State University, I was awarded with the Golden Apple Student Award for having an understanding of the Art of Medicine as displayed by the care and understanding of patients. It was a tremendous honor, and it's something that I carry with me, as well as something that I want to give to my patients and reflect in my practice.

Often, my patients will ask me about the best course of action going forward, and sometimes the answer isn't always clear. You see, there's the science of medicine, the reproducible, empiric evidence with its best practices and treatment recommendations. These guidelines are important to know and important to follow in most cases. But, on the other side, is the Art of Medicine, and because every one is unique, an individual, with unique medical concerns, treatment choices aren't always clearly defined. 

When difficult choices need to be made, I often ask my patients which course of action they'd like to pursue. This may be a unique aspect to my practice, but I know that it's important to engage in shared decision-making with the people that I care for. When decisions are made together, we can be on the same page about treatment, compliance to the plan is higher, and people feel like they have more control over the condition and situation. 

Thanks so much for reading and have a wonderful day,

- Dr. Paul with Plum Health



Starting a Direct Primary Care Practice in Detroit: What Inspired Me

I initially discovered direct primary care while on a road trip in November 2012. I was driving back to Detroit from a residency position interview at the University of Minnesota. I believe it was a libertarian-minded podcast featuring an interview with Dr. Josh Umbehr, discussing his startup in Wichita, Kansas, called Atlas MD. 

It was refreshing to hear a Family Medicine doctor speaking so passionately about saving people money, delivering better care, and practicing in a unique way. The message resonated with me, but at that time I was pursuing a faculty position at a residency program because I enjoyed teaching so much. Suffice it to say that I filed this “Direct Primary Care” concept in the back of my mind.

Between my second and third years of residency, I went to the Michigan Academy of Family Physicians (MAFP) annual meeting in Traverse City. It was July 2015. There I met Dr. Clint Flanagan of Nextera Healthcare in Denver, Colorado. He spoke unequivocally about the value of being a primary care doctor and the tremendous value that we provide for our patients. His passion for the profession also came through in a way that I hadn’t experienced before.

These two leaders in the field served as a contrast to the typically burnt out and grumbling physician that I had met thus far in training. Even the best doctors grumbled about paperwork, prior authorizations, late patients, packed schedules, and all of the other difficult parts of being a primary care doctor.

At that point, I knew that I would pursue an alternative practice model. It only made sense – less-than-fulfilled physicians practicing in a less-than-ideal system surrounded me and I knew that life could be better on the other side. Additionally, I always had this inner drive to deliver medicine in a more equitable and just system. Direct primary care seemed to align with my values as an individual and as a doctor, but I needed to dive deeper.

So, as an elective rotation, I drove out to Wichita and Denver, and spent a week learning from both Drs. Umbehr and Flanagan. I kicked the tires, took copious notes, and tried to bring the best of their practices to my community in Detroit, Wayne County, and Southeast Michigan.

Now it's September 2017 - almost 5 years after I had initially heard of "Direct Primary Care". Now, I'm living DPC every day, taking care of people of all ages and stages in my clinic in Southwest Detroit. I'm even caring for people while on vacation - I helped about 10 of my patients while I was traveling abroad over the last week. 

I am able to do this - to be the doctor that I was meant to be - because I am a Direct Primary Care doctor. This post is about inspiration, and what inspired me, and what continues to inspire me.

I am inspired by the fact that I can help people with real health care needs either in my office or over the phone, or via video chat or email. I am inspired by the fact that I am able to serve people who haven't seen a doctor in years, because we've lowered the cost barriers and therefore have made our service more accessible. I'm inspired by the fact that we can do so much good in such a small space.

I'm also inspired by the potential for Plum Health to grow, and to serve more people in our immediate community and across the region. I'm inspired by the happy patients that I get to work with everyday.

I've had great mentors along the way, specifically from the pioneers in the Direct Primary Care world, and I'm grateful for their help in getting me to a successful and sustainable DPC practice. 

Thanks for reading this reflection, and have a wonderful day,

-Dr. Paul with Plum Health DPC

Dr. Paul Thomas of Plum Health DPC, in the Plum Health office!

Dr. Paul Thomas of Plum Health DPC, in the Plum Health office!

My Thoughts on The Dip

Today, I finished reading "The Dip" by Seth Godin. In the book he talks about when to stick with a project and when to quit. I picked up this book for a few different reasons. First, it was recommended to me by a colleague in my small business community. Second, I felt instinctively that I was facing a decision point in my business, and I needed an external voice to validate what I've been feeling over the past few weeks.

"The Dip" is a relatively short book, and a key takeaway can be found in the section subtitled "Never Quit". Mr. Godin urges his readers to quit, which may be surprising at first. But his main point is this: "Never quit something with great long-term potential just because you can't deal with the stress of the moment". 

Starting a Direct Primary Care practice in Detroit has been one of the most difficult challenges that I've faced in my young career. With undergraduate study, MCAT preparation, medical school, and residency training, there is a great deal of certainty. The equation for success in these regimented environments is simple: study hard, get good grades, perform well on exams and you will succeed. There is a comfort in these structured environments, because I knew that if I studied for "x" amount of hours, I would earn "y" result.  

But with business and running a Direct Primary Care clinic, there is a great deal of uncertainty and a less direct relationship between effort and reward. For example, if I put too much effort into one marketing channel (Facebook or YouTube) and not enough into another marketing channel (email or in-person events), then I may not attract as many new clients. There is no specific formula for success. 

Even though there isn't as much of a direct relationship between effort and reward, I know that Direct Primary Care has excellent long-term potential. I truly believe that it delvers better health care at a lower cost, and that demand for this healthcare delivery model will grow, perhaps even exponentially as economic forces in the broader economy change.

That doesn't change the fact that there is a lot of stress in the current moment! The uncertainty about growth, next steps for the company, and broader adoption in the marketplace cause me a good deal of stress, and I was looking for something that spoke to these aspects of my business. Reading "The Dip" was like having an excellent pep-talk from a personal business coach. 

Intuitively, I can sense that I am in a dip, as described in the book by Seth Godin, and reading his book validated my feelings on my business at this point in time. It also gave some pragmatic wisdom with which I can rededicate myself to my business. After 6 months of operation, I can start to analyze what's working and what's not working. As Godin writes, "The opposite of quitting is an invigorated new strategy designed to break the problem apart". 

He goes on to describe a challenge I'm currently facing: acquiring more customers in the marketplace. He urges his readers to focus on the broader market rather than the individuals. I.e. don't call one lead 10 times, which he sums up nicely here in this passage, "If you try to influence one person, persistence has its limits". It's difficult to change the mind of an individual, and you want to avoid pestering people. 

But, the market is different than individual people. One line that struck me regarding this subject was his assertion that "most of the people in the market have never even heard of you". And this may be a good thing! He relates the story of Sergei Brin of Google and how it was better if customers found out about Google later on rather than right now. This gave Google more time to iterate and improve the product, which would then create better customer experience.

For now, I will continue to focus on improving my services and clinic flow, because I know that as each day passes, the experience of my customers improves. I will also be rededicating myself to email marketing, as I've let this slide over the past few weeks, so check your inbox!

Thanks for reading about the struggles of starting a Direct Primary Care practice. I'm looking to include some of these writings in a future project, so if some of the blog posts here seem random, know that they're adding up to something bigger in the future!

- Dr. Paul Thomas with Plum Health DPC