We had the good fortune of connecting with Deepti Mundkur MD and we’ve shared our conversation below.
Hi Deepti, can you walk us through the thought-process of starting your business?
Alright, so let’s dive straight in! Today, most physicians work as employees in healthcare systems and experience constant meddling by non-medical personnel in their daily practice of medicine. The result is a horrible experience for both the patients and the physicians. Insurance company CEOs are making billions of profits while the United States of America struggles with poor access to quality outpatient care for the common man. Though we live in an age of instant texting and same-day home deliveries, our access to a family doctor remains severely limited. TYPICAL PATIENT EXPERIENCE Let me walk you through my own experience as a patient in today’s healthcare system. I am lucky to live in San Diego – one of the most beautiful cities in the world. It took four months for me to get my first appointment with a family doctor in 2019. Despite using a reputed healthcare system and having the platinum package health insurance, I waited four long months for my first outpatient doctor visit. At the 4-month mark, as I wait in the doctor’s office, the assistant asks me if I would like this visit to be an annual physical or just a visit to establish care? The common man is usually perplexed by this question since it is unclear what the difference between the two types of visits would really be. So even before I see my doctor, I am already experiencing the depersonalized nature of today’s medical care where the interference of insurance billing and terminologies are disturbing the sanctity of a pure doctor-patient experience. Finally I get my 10 minute rushed visit with the doctor. Of course, the doctor is too busy to look away from the computer screen. He glances at me a couple of times through the visit while I am not sure if I should keep talking when he is not looking at me. Finally I get a few issues addressed after spending half the time discussing the definition and criteria of an annual physical versus a visit to establish care. I left the clinic wondering if I chose the right family doctor. Since that visit, I have tried to reach my doctor on multiple occasions. Each time I call to make an appointment with my doctor, I hear a long welcome message with some random clinic updates and have to press 1, then a 2 and a 3 to hear the droning music while I wait for another 30 minutes until I am connected to a call center. Now the call center asks me 6-7 questions to eventually tell me that my doctor is not available and that I will have an option to see a different doctor in a week or wait longer to see my own doctor. There is no way my symptoms can wait for weeks until the earliest available clinic appointment. Since urgent care is expensive, I am left with no choice but to wait. The next evening around 8:00 pm, when my symptoms are unbearable, and all nearby urgent care clinics are closed, I begin my journey towards healthcare debt as I put my first step into the Emergency Room. Little did I know that my symptoms which should have been a $30 ordeal, now would cost me $2000. All this happened because – outpatient care was not available to me in a timely manner. This was a classic example of an emergency that could have been avoided. But there was nowhere to go. Now that you have heard my experience as a patient, let me tell you my experience as a physician in this same unforgiving healthcare system. A TYPICAL PHYSICIAN EXPERIENCE Typically family physicians train for 13 years to learn about the human body extensively so that they can help their patients prevent disease and control disease in a timely fashion. Physicians really want to spend time with patients to take detailed history, examine thoroughly, explain the physiology and pathology in detail to their patients, answer all the patients’ questions regarding the disease and provide treatment for patients’ to lead a healthy life. In reality though, my typical day involved an assembly line of 20-30 patients. I want to spend plenty of time with each patient to understand their symptoms, prevent disease by examining their lifestyle, perform a thorough physical examination and diagnose accurately. But once I walk into the exam room, I am automatically forced to rush through the visit since my next patient visit starts in 15 minutes. While my patient is trying to explain the symptoms, I am trying my best to juggle between listening to the patient and staring at the computer to check all the boxes accurately for insurance reimbursement so that the patient doesn’t end up paying out-of-pocket for my services. Moreover, I have to finish my notes by the end of the day to “close the patient encounter” for billing purposes. If I fail to perform these steps, I am sure to be blacklisted by my employer. During this brief encounter with the patient I have to complete prior authorizations for Insurance, answer for the mysterious insurance denials of CT scans and MRIs, explain medication co-pays and more. I can never answer this simple question posed by my patient – “How much does this test or medication cost me if I use my insurance?”. I don’t know the answer to that. This leaves the patient highly unsettled and dissatisfied with me. My morale was at an all-time low since the practice of medicine was not at all as professionally rewarding as I imagined it would be. There was just not enough time in the day for all the paperwork let alone scientific thinking. THE BREAKTHROUGH Until March of 2020, I was a physician who worked in a system that made me and my patients feel helpless. I was determined that there had to be a different way to practice outpatient medicine without compromising on the quality of care while still keeping it affordable. Thanks to a select few physicians in the United States of America, who have dared to challenge the insurance-model of medicine in their quest for a pure doctor-patient relationship, I stumbled upon the Direct Primary Care model where I can be my own boss, make personalized house-calls, and practice medicine ethically with evidence-based medical guidelines and not some for-profit insurance company driven guidelines. My patients can text me if they like and I answer all the calls to my clinic. There is no call-center or other staff at my practice so the patients always get to speak to me. I can give same day appointments, dispense low cost wholesale price medicines, arrange for low-cost cash-pay labs and imaging, and to top it all – I never have to deal with insurance paperwork. This model gives me plenty of time to really listen to my patients without having a distracting computer screen in front of me. Direct Primary Care (DPC) was a liberating choice and I jumped at this opportunity. With the guidance of the DPC physician community, I was able to start MyHappyDoctor on my own without any Masters in Business or business background. I am now officially a happy doctor like the name of my brand MyHappyDoctor because I am not bound anymore to the shackles of corporate medicine. Direct primary care brings me the joy of a pure doctor-patient relationship that I could only dream of before 2020.
What should our readers know about your business?
In my dream job, I pictured myself forming timeless bonds with my patients. But in my actual job, I spent hours on data entry, insurance calls and paperwork, with no time to spare for my patients. Both me and my patients were left with confusion and uncertainty as we attempted to navigate the insurance-driven industrialized healthcare system which was causing unnecessary life-threatening delays in healthcare and severe financial harm to my patients. Failure to consistently meet my patient’s needs made me question the purpose of my career in medicine. So, I did the bravest thing I have done in a very long time — I quit working for my employer to start working for my patients. I am now excited to be a happy doctor with zero distractions. On the first of July 2020, I announced the launch of a new and exciting Direct Primary Care Practice in San Diego called “My Happy Doctor”. “My Happy Doctor” is a fully mobile primary care practice providing an affordable concierge-style long-term personalized doctor-patient experience. Often patients who are dissatisfied with the insurance-based system, reach out to me for help. Once patients become members of my practice they can text me, receive unlimited tele-medicine visits and monthly house-calls as benefits of the membership. This monthly membership is my sole income and I do not get any reimbursement from insurance because I do not contract with any insurance companies. So you can see that I work for my patients because my patients pay me. In my practice, Insurance companies do not get a chance to manipulate my time, focus and energy. Instead of talking to middlemen, I serve as a quarterback for my patients and my patients feel like they have a doctor in the family. Insurance companies do not get a chance to deny any of my professional medical recommendations because I do not ask them for permission to help my patients. Common medications and lab tests often cost less than the price of candy – around $5 on average. I can arrange for affordable cash-pay imaging which is especially useful when insurance mysteriously denies to pay. My patients get access to all this and much more for an affordable membership fee starting at $50/month. So, what’s the catch? There is no catch. I believe medical services should be affordable and convenient for everyone. I keep a low overhead and eliminate middlemen to pass on the savings to my patients. All my patients have the privilege of direct interaction with me for any and all of their healthcare needs. Such affordable pricing for concierge style medicine is unheard of in the current healthcare system. My patients never have to deal with “call centers” or “wait-times” during their interactions with “My Happy Doctor” because it is always going to be me – the same Board-Certified Internal Medicine physician who answers every call. There is nothing lost in translation since there are no middlemen or unnecessary staff. I fax, I email, I text, I make calls to the pharmacy, and I even arrange to deliver medications for free to patients homes in San Diego. My patients know exactly what they will pay me for the membership, or for the cash-pay labs, medications, CT/MRI scans before they get any of the tests done. My oath is not just to “Do no harm” but also to “Do no financial harm” to my patients. Apart from the affordability of outpatient care, the fact that I can prevent medical emergencies by providing timely care helps eliminate healthcare debt for my patients in the long run and that is incredible savings. I also happen to know the flaws of the current healthcare system having worked in the system for years, and can guide my patients to efficiently navigate the current system. I can now be their fierce advocate like I always wanted to be. My hands are not tied by my employer or insurance companies anymore. This model just makes sense for my career because it enables me to practice pure and personalized medicine since it is a simple doctor-patient relationship. I can bring back the old-fashioned doctor-patient relationship and work for my patients directly without involving third-party interference in the decision-making. There are no assistants or nurses or insurance agents or managers interfering in my doctor-patient relationship because I want my patients to have a flawless outpatient experience that they deserve. The membership benefits include same or next-day appointments, extended no-rush 60 minute visits in a world where 5 minute doctor visits have become the norm. I use a modern medical record system that equips me with HIPAA secure telemedicine and texting functionality. This brings convenience to patients without compromising on privacy. This setup reduces my time spent on paperwork to a bare minimum and I get to spend more time with my patients, whenever they need it, without making them jump through the hoops of a traditional insurance-based medical practice. I believe in quality over quantity. So I won’t be seeing 2000-3000 patients because I do not want to compromise the experience of my patients. My mission is to empower more physicians to start direct primary care practices so that our communities can get timely, affordable primary care and as a result save themselves from healthcare related debt. Every day I get messages from physicians who are trying to break out of the confining walls of the insurance based system and want to practice direct primary care. I share my experience with these tired physicians because I know what it feels like to be helpless while looking for ways to bring back the sanctity of medicine. Starting this practice was inexpensive and easy. All I had to do was prepare myself for a loss in income for the first year or two while I build my patient panel. This is a small price to pay for a long and satisfying career in medicine. This is a small price to pay knowing that I can now stand by the side of my patients for 30-40 years instead of making excuses for my employer or insurance companies. During the journey of setting up my direct primary care practice I have noticed that most patients often reflexively ask if I would take their insurance. This is because the insurance based model has been systemically normalized over the years for the benefit of middlemen. Patients often wonder why they have to pay for the membership when they pay a monthly premium for their health insurance. In response to this I give my patients the analogy of car insurance. We don’t use car insurance for maintenance purposes or oil change because those services are inexpensive. Similarly with primary care, if you pay the price of a gym membership to get 80% of your healthcare needs managed in a timely and efficient manner, why would you need to use health insurance? Sometimes I have had patients ask me if they will lose their insurance benefits when they become my member. It is unfortunate that an innocent patient feels like they might be doing something illegal by paying for their own medical care. Once again a sad reminder of normalization of the existence of middlemen in healthcare. Being new to owning my practice and learning the business side of running my practice, I initially kept a keen eye out looking for hurdles to direct primary care as I researched this model. I wondered how this amazing concept is not mainstream yet. I have the answer now. It is because this model doesn’t benefit middlemen. It helps patients and doctors but does not help any third party. I want the world to know that physicians take an oath to help save patients lives. The middlemen do not take this oath. CEOs of insurance companies do not take this oath. Office managers and call centers do not take this oath. If I have to save patients lives, I have to do it myself – with my own model and with zero interference from non-physicians. I look forward to the day when tens of thousands of direct primary care practices are run by physicians and tens of thousands of patients get all of their outpatient care personalized for them in a timely fashion so that emergency medicine physicians are caring for true emergencies with resultant reduction in hospitalizations and reduction in health care debt. Of course the middlemen are not going to like it. But, every drop in the ocean counts and every physician can choose this path to save patients’ lives because that is the only thing that truly matters.
If you had a friend visiting you, what are some of the local spots you’d want to take them around to?
When my friends and family visit San Diego, this is the itinerary I recommend – Swim and Kayak at La Jolla Shores Beach and explore the Sea caves along the coast. Watch the Seals and Sea Lions at La Jolla Coves Park. Bike around Mission Bay park or enjoy some water sports in Mission Bay. Go sailing in San Diego Bay – maybe a Sunset Cruise with dinner in the Bay. Explore the museums at Balboa Park. Spend a day at San Diego Zoo and Safari Park. Explore sea life at Sea World and Birch Aquarium. Get a glimpse of San Diego’s history at Old Town State Park. Enjoy the live music! Catch a breathtaking view of San Diego Bay from Cabrillo National Monument at Point Loma. For the thrill seeker you can go paragliding from the cliffs of Torrey pines glider port. Hike the picturesque coastal trails at Torrey Pines State beach and park. Take a stroll on the pacific beach boardwalk and pier. Explore the bars and restaurants in Gaslamp Quarter. Checkout the pure white sands of Coronado beach and the history Hotel Del Coronado. Recommended Restaurants – Breakfast favorites – Snooze Cafe, Broken Yolk Cafe Tacos are a must try when visiting San Diego – my favorite Tacos places are – Puesto’s, Taco Stand and Rubios Fresh Seafood at El Pescador Fish Market Karl Strauss Brewery at La Jolla For those with a sweet tooth you must try Extraordinary Desserts
Who else deserves some credit and recognition?
I would like to thank the community of Direct Primary Care Physicians who I had the fortune of meeting virtually through Facebook. This group comprises of about 2000 physicians all over the United States of America who are dedicated to empowering motivated physicians to start their own direct primary care private practice which stands on the pillars of transparency in medical care, upfront affordable pricing for patients, evidence-based medicine and a pure doctor-patient experience with zero interference from any third-parties. Physicians learn very little about the business aspect of running a private practice during residency and fellowship training. I found that the time, advice and guidance from these physicians was invaluable to my quick success. Thanks to them I began my journey towards improving patient access to timely outpatient care in California.