Starting A Direct Specialty Care Practice From Scratch Because It’s Best For Patients with Dr. Diana Girnita

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Are you a medical professional seeking financial advice to design your ideal life? In this episode, we dive into the world of direct specialty care and its immense potential for transforming healthcare.

Our special guest, Dr. Diana Girnita, a trailblazing rheumatologist, shares her inspiring journey from the traditional healthcare system to launching her successful direct specialty care practice, Rheumatologist on Call.

Here are the key takeaways you can expect from this episode:

– Unveiling the Direct Specialty Care Mode
– Overcoming Fears and Navigating Change
– The Impact on Patient Care
– Building a Thriving Direct Specialty Care Practice
– Resources for Exploring Direct Specialty Care
– Many more!

Ready to unlock the potential of direct specialty care and enhance your financial well-being as a physician?

Don’t miss this enlightening episode of Finance For Physicians with Dr. Diana Girnita. Gain valuable insights, inspiration, and practical tips for incorporating direct specialty care into your own medical practice.

Listen now to this game-changing conversation and start your journey toward a fulfilling and financially empowering medical career

Remember, the power to shape your financial future is in your hands. Join us on this enlightening episode and let’s empower ourselves to use money as a tool to live our best lives as physicians!


Dr. Diana’s practice 

DSC Alliance Website 

Direct Specialty Care Alliance Facebook Group 

Diana’s article on Direct Care vs Concierge Medicine 

Direct Specialty Care Alliance Stories & Resources on YouTube Channel

Diana’s article on understanding direct specialty care 

Contact Finance for Physicians

Finance for Physicians

To schedule a call with one of our awesome planners, book HERE.

Full Episode Transcript:

Daniel Wrenne: What’s up guys? Hope you’re having a great day. I wanted to throw out a couple of things before we jump into today’s show. First thing I really appreciate some of the reviews that some of you have been leaving lately on the podcast Libraries. I wanted to share one. Kurt Covert left one recently on Apple Podcast and he said this best finance podcast for young physicians, radically relevant to the young doctor looking to use their finances to design their ideal life.

First of all, Kurt, I don’t know Kurt. I really appreciate it. If you’re listening, Kurt, that’s a fantastic review. It means a lot. And second of all, I think it’s important. Like I had the first few reviews were like my mom and my sister and my wife. Like, it’s really cool to see.

and those are cool and all, but like of course they’re gonna be positive. So it’s cool to see some other people, That are. Seeing positive results as well outside of those circles that I already had. So, these type of reviews mean a lot and I really appreciate it. they also help us to get the word out on the podcast to more people.

So if you’re enjoying this, please take a minute to leave a review if you haven’t done so already. The second thing I wanted to throw out, so I’m of course dedicated to this podcast. I’m also a partner in a planning firm called RIN Financial Planning, and so they’re actually our main sponsor of this show and really allow us to keep the lights on without having to sell out to all the financial products and services that you typically see on these podcasts and media sources.

So this podcast. And our planning firm both really have a similar mission, which is to help physicians use money as a tool to live their best lives. Now the podcast is, you know, me sharing that, approach with a larger group. However, in the planning firm, it’s more of a one-to-one model. So our team at Ren Financial Planning has had the privilege of talking with him, working with many of you guys, and we’ve really loved those interactions.

So based on this, we’re gonna be introducing something a little new that I wanted to share with you today. So we’re gonna begin offering a no-cost triage meeting for finance for physician listeners. The way this is gonna work is you would schedule a 30 minute meeting with one of our great CFPs. I’ll link to the, scheduler link in the show notes so that you can do that.

And in this meeting you’re gonna be driving the agenda. So our goal will be to talk through whatever really you’d like. maybe it’s some of your biggest financial questions or maybe you’d like to review your current finances. Either way, our role is gonna be to help you start to identify next steps and the urgency of each, and hopefully give you some suggestions of what those might look like.

So I’ll throw out some examples of. You know, things you might be thinking of that we potentially address. So maybe you’re starting to navigate this home buying decision and you’re looking for some input on that. Or maybe you’re thinking about considerations for going into practice, or maybe you’d just like a second set of eyes to look over your tax return or employee benefits, or even your investment allocation.

Maybe you just want a second opinion from your existing advisor. All of those would be good examples of the types of, questions or concerns you might have that would be really good for this type of call. so while we’re talking about it, I also wanted to point out in, in case it’s not already obvious if you haven’t worked with us one-on-one I think it’s best to view me as kind of like a random dude on the internet talking about finances.

I’d like to think that I know. Quite a bit about finance for physicians, but without you knowing me, it’s probably safer to just assume that like, you know, Who knows. and of course everybody’s gonna say they know a ton about a subject. So I think a better approach is to do your own homework and consult your own advisors, and do, the work upfront.

Same thing goes for our planning firm in these 30 minute conversations. I think it’s also important to point out like we’re not gonna be giving advice. To your specific circumstances. So it’s 30 minutes is in no way enough time to get to know you and understand you fully in order to do that. So I think it’s important to point that out, that, whether it’s me doing this podcast or our CFPs, having, you know, a 30 minute conversation with you, I would not consider that advice.

it’s just not gonna really be possible to be able to provide that. And it’s better for you to kind of think of it that way so that you’re positioning it more as like, You know, some input and, you know, you’re gonna do your own homework. our intent is in this meeting in particular really is just to help you start to uncover value, while giving you a taste of what it’s like to work with one of our CFPs.

of course there’s not gonna be a sales pitch that comes with it. We’re not gonna hassle you about, you know, coming on board. We’re not gonna bug you about following up. it might be just as simple as like a quick conversation and move on. you’ll, see a link to schedule that in the show notes.

if you decide to, check that out, when you go to schedule, I think there should be like a section where you, indicate where you found us. So make sure to indicate you found us from the Finance for Physician’s Podcast so that, that we know to adjust our agenda. So if you’ve been listening regularly, you know That I’ve been talking with a bunch of guests about the direct care model of practicing medicine. I’m a huge fan if it’s not already obvious. I’m a huge fan of this model. I believe it’s one of the best solutions out there to help to start to solve the healthcare mess that we’re in. this model, is really starting to take off.

we’re seeing a lot of growth, especially in like the direct primary care space. They’ve been, you know, growing for quite a while. They’re all over the country now. You’re seeing ’em in like rural areas. As well as big cities. So this has been going on for a while, but I think what’s really cool is now we’re starting to see more direct specialty care practices opening up as well.

So I talked with Dr. Andy Burkowski, several shows back, which I’ll link to in the show notes about his direct sleep care medicine practice. And today I’m gonna be talking with Dr. Diana Girnita, who is another one of the trailblazers in this new and evolving. Direct specialty care space. So Diana is a rheumatologist and has been working in the traditional system of medicine.

All of her career, I should say, had been working in traditional healthcare for all of her career. But like many of you, she became more and more frustrated with the system of medicine and eventually started to explore alternatives. Fortunately she was, had some interactions with some people in the direct primary care space and started to really learn more about this model and eventually started thinking about possibilities for her own specialty.

So as she learned more, she began to realize the positive impact it would would have on. Potentially her patients. and ultimately decided to make the jump and really made like a, a speedy transition into starting her own direct specialty care practice which is called Rheumatologist on call.

And I believe that was around four years ago and today they’re thriving. I think what’s most important to point out about Diana though is sh. She’s not doing it for the money, and I think it’s obvious you’ll hear in our conversation. I personally believe that you really have to have things in life that are more valuable than money.

Otherwise, you’re just gonna be like, you know, Scrooge McDuck, like just, you know, nobody wants, nobody wants to be there, I don’t think. And so for her, one of those things that is more valuable than money is her, is patient care. So she realized at some point along the way that she, she needed to make some big changes in order to provide the best care possible to her patients.

And so she was dedicated to serving patients first. In starting this new endeavor and then working out the finances. Secondarily, it’s not that you don’t pay attention to the finances, it’s more that they’re secondary to serving patients. I think that’s a admirable position to take. I, I think, I think the world would be a better place if there were more people operating like this, and I think it, it’s just important to point out.

So when, when values are driving the ship, like in Diana’s case, I think it makes a much, I think it makes it much, much more possible to tackle these big hurdles you’re gonna face when you start something big and new and scary like this. And I, and I think most of them really tie into the fear of, fear of the unknown, fear of leaving the steady income, fear of putting your ideas out there and potentially getting rejected.

Fear of what other people might think. There’s there’s a ton of fears that tend to really start to amp up when you start to consider a big scary change like this. But Diana was able to sidestep a lot of these common fears and, and really jump right in and fast forward today and her practice is thriving and she’s very happy with her decision.

And, you know, loves talking about it. And so what’s interesting is as other physicians started to learn about her success along the way they’ve started to reach out to her and have become more interested in themselves to the point where at some point along the way, she decided to start up a separate business, a network for direct specialty care physicians called.

DSC Alliance or the Direct Specialty Care Alliance to allow for a, a place where specialty care physicians can go and seek help and share ideas and ultimately help each other to grow their businesses in this new way of doing things. So in our conversation today, we discuss Diana’s professional journey from the traditional system into direct specialty care.

She shares how she was able to move forward into starting her own practice. Despite these big fears, she shares some of the biggest struggles along the way. We also discuss how after several years of doing this, she is feeling about the patience. And her, how she’s feeling about her own value associated with this new type of healthcare that is, is, you know something we’re not used to.

Diana also shares some of her favorite resources for learning more about DSE practices, so it’s a very interesting conversation for me. I learned a ton and I’m sure you’re going to too. So without further ado, let’s jump into our conversation.

Daniel Wrenne: Diana, welcome. 

Dr. Diana Girnita: Thank you so much 

Daniel Wrenne: for having me. I’m excited. We ha I think we have a lot to talk about because I’m very into this direct care model and for those of you listen and, you know, I’m very into it. I’ve, we’ve been covering it a lot and talked a lot of different people in the model and have been exploring different of doing it.

But what’s especially unique about you is you’re actually not only working in direct care, but you’re in direct specialty care. So you’ve kind of taken it to the next level, and I’m excited to hear about like how you got into it. And you’ve even created a network of direct specialty care physicians to help, you know, connect patients with providers.

And so you’re. Very up to some great work and I’m, I’m excited to kind of dig into your story and how you’ve gotten to this point. And maybe if, if we could, I would love it if we could start out, like, I imagine you didn’t start out in direct special day care because I. That’s just a pretty new thing.

Right? But how did you get into this world of direct care and where you are today? 

Dr. Diana Girnita: So you are probably aware, like many of us, that we spend some time in the traditional, I as I call it traditional medical system, that things started to deteriorate both for us. But also for our patients. And at some point in my life I had the feeling that I don’t have enough time with the patients.

I don’t have, you know, I have the skills, but I don’t have the time. And, I was struggling to keep up with my electronic medical records more than I was keeping up with my. Patients. And I thought that the avalanche of messages that I was getting from the patients were also coming because I didn’t have enough time to spend with them and kind of educate them.

So when I saw that patients were struggling to get to me, patients were struggling to come for appointments, and then they were struggling financially to be able to afford an appointment with me despite the fact that they were caring. What is called great insurance. there were so many limitations and at some point I decided that maybe for me it is time to step out from the traditional system and create my own.

Private practice, like a micropractice where I can do my, my job and, I would feel less, I would say less stressed about what was going on. And you know, in the process of thinking how can I help patients, I realized that my specialty. Okay, so, you know, so badly represented. We are about 6,000 specialists in the whole United States.

And, you know, at that time I was located in Cincinnati and I saw patients traveling for two hours to come to see me. And there was no way for me. To make their life easier. And even when I talked to my former employer about implementing telemedicine, no one was interested. That was before the pandemic.

No one was interested because there was no way to build for such a way. So, I really thought initially that telemedicine is a great opportunity. And then I started to form my own company. And my dream at that point was to serve people in the nearby states like Kentucky, Ohio, in Indiana. But then I realized there are so many other states that they do not have enough specialists.

So that’s my story as a, as a, in the beginning to become. Mm-hmm. To become an entrepreneur. But then, you know, building up my practice, I sat down and I thought about things and I realized that, you know, my specialty is so expensive, you know, the way that I knew that things could be done the way that patients would have to come in pay with insurances And then I realized that, you know, I don’t know anything about the prices that, you know, a price for my consultation, the price for my laboratory workup and prices for x-rays. And there were many patients that were asking me, how much is this gonna cost me? And I felt. So embarrassed that I had no idea even how much it’s gonna be my consultation.

So I was looking right and left. And then I’m, I have a friend that was very familiar with Direct Primary Care. And he introduced me, I mean, kind of reintroduced me to this idea. I knew someone that was doing primary care, a former colleague of mine that was in the residency. And I started to look into this model and then I compare this model to what I knew from back home from Romania.

You know, in Romania you have two system, the private system where you have absolutely all the information that you need. You know exactly when you go to. A private practice or a private clinic at the door, you have all the prices for the consultations, for the laboratory workout. So patients will know exactly what to expect in terms of financial expectation.

So, And I thought, you know, why is this not possible here and how is it possible for the primary care to do that and not the specialist? So that’s how I started to explore the idea. And that was about four years ago. And then little by little, as a very good friend of mine said, I started to realize that specialists can do this, can be in direct care.

Daniel Wrenne: so rheumatology is your specialty? Yes. And your practice is called Rheumatologists on call. Is that when you started Rheumatologists On call was four years 

Dr. Diana Girnita: ago. Yes. Yes, correct. I started to build up the company almost four years ago. And then you know, after struggling to put everything together I started in 2020 was the first year where I was seeing patients in the middle of the pandemic.

Daniel Wrenne: Yeah. Which in some ways, probably, I would imagine it helped. If you were doing telemedicine particularly with the whole adoption that as a potential service. 

Dr. Diana Girnita: Yes, but I was talking about telemedicine. Two years before the pandemic came and I was trying to, you know, open up the, the brain of people about using telemedicine for the use of the patients and for us as well.

But it was a big, big struggle to begin something like this. 

Daniel Wrenne: yeah. And change is, it’s hard sometimes get things. to change off often doesn’t happen as quickly as we would we would like. and now going into the big venture, I mean, four years ago, not, not too long ago were you nervous or scared or I think sometimes that’s a pretty scary jump to go from this system that’s like steady paychecks to this entrepreneur world of entrepreneurship of You know, unknown. Did you have any fear around that? And if so, like how was that managed? 

Dr. Diana Girnita: I have I had a lot of fear, I have to admit that I had I went into this.

As you guys say, cold Turkey. So I didn’t transition through because there are practices that will transition to cash pay from the insurance world. So they still take some insurances, private insurances, they still take Medicare, but they also accept cash. did it the other way. I just straight, I, I went straight to cash and it was not easy.

And it wasn’t easy because. you know, things were not set up. Everything was set up, but it was very hard to educate patients that what I do is extremely valuable, is not, is not in any way tricky. And it’s the way that patients were educated to, you know, to get services and to polish that kind of language.

To what you say to the patient, what you convey to the patient? It, it’s very hard once the patients come to to us, and I’m talking us about specialists that are doing direct care, they understand after, probably after the first visit that the value that we pro, that we offer and the care that we offer is.

Excellent. And we really give everything that we are supposed to give because we are not stressed by the environment. We are not constantly looking at the computer and we don’t have 30 patients waiting at the door to be seen. 

Daniel Wrenne: Yeah, you can spend the time with the patients that they deserve, and then also the transparency of what is being paid is right there.

And then on top of that, like when you’re paying for service as a patient, And as a provider when it’s transparent like that, it forces like the incentive is to make sure and add value to kinda like, you know, you want to be able to make it worth more than they’re paying as a physician. And also the patient is worried about that too.

They’re like, is this worth my money? And so that’s healthy. I think incentive. That gets created in that sort of environment versus in the traditional healthcare system, like nobody knows what anybody’s paying. It’s just like, kind of like monopoly money in some ways. And that doesn’t drive any of that incentive.

But it is difficult, I imagine to kind of, cuz you have to reshape people’s belief system or like kind of, people are not used to that as the way things work. 

Dr. Diana Girnita: That’s very true. Patients are and again, I don’t wanna use words that will be offensive to anyone, but I feel like in the current system that we live, we are brainwashed all together patients and physicians to work a certain way and to reach out to get care a certain way.

And when you bring something different like every. Product that is different from what you are used to, to use every day. It takes time. but the fact that you provide the highest quality of care that is turning back in, you know, 10 times, I would say, and the satisfaction that you have as a physician to really spend the time with the patients and see the outcome.

Of these patients, you really have the time to, to, to see how patients are improving and you have time to listen to them. Mm-hmm. And that’s the other thing, I think that we are not only you know, with one hand we put two orders and with the other hand we had a prescription. We are healing patients.

And it’s, it’s extremely important for the patient to build up trust. Patients do feel like the system betray them. And by saying the system, they only see us, you know, the system is us, we are the face of the system. Unfortunately when they think about medical care, they think about their doctors, they don’t think about anybody else besides.

Us because the, the main interaction that they have with the system is their physician. So how are they gonna know who to blame? They gonna blame us for things that they’re not happy and rebuilding that kind of trust, it’s extremely important for both sides. 

Daniel Wrenne: When you made the switch, was it, so you mentioned cold Turkey.

I know you went all in on cash pay, like from the get-go, which that’s, I love that. That’s, that’s my style. I mean, I would, I think if you’re gonna believe in something, you just gotta go all in. Did you also go all in? Like, did you just stop the system job? 

Dr. Diana Girnita: yes, I stopped one. So I work in academia.

I work in private practice. What I continue to do is I took some locums job to support my family. And that was extremely helpful for me and while I were building up my practice, So While I was building up my practice, I took some locums job, which were helpful. And I kept my academic appointment.

So that was also helpful because it kind of kept me connected with the system, but I was not depending on the system. Now for those, physicians that are interested to, jump into direct care, they also have to be prepared to find Side gigs, I would say, to support their income. Because that takes some time until you build up a practice that is viable and is able to provide you the paycheck that we are used to.

Daniel Wrenne: Mm-hmm. Especially, I mean, I can imagine, I don’t know what your position situation was, but I can imagine someone that’s like sole breadwinner for a family and. In that instance, it’s like literally, like you gotta have some level of income. And so, that baseline income that’s very high priority, important.

I remember when I started my business, like that was like number one priority. Like I gotta, I always would say like, first thing was breakeven, and when I described breakeven, I meant like paying the businesses bills and not paying me. Yes. And then second phase was like, Feed the family, you know? And that was like a pretty big accomplishment is like, we’re we’re feeding the family, we’re we’re, we’re doing good.

And then, you know, beyond that, it’s, you know, the, all the other stuff. But I think there’s also financing. People can get financing to help with things like that. And, At that stage, definitely. 

Dr. Diana Girnita: But many things you can figure out by yourself. I, I’m sure we are very, very smart, people. And there is also something about physicians.

We, we are very, very I would say we, we. Once we want something, we go for it. Yes. We work hard and we use all our resources to figure out things. Mm-hmm. It’s not easy to figure out finances, but it’s not something that you cannot do. and as you said don’t expect to pay yourself. Probably the first six months I didn’t pay anything, any, any.

Any dollar to my pocket, but I pay everybody else. And I was so, so happy that I was able to pay everybody else. I had my husband to support my, family, but the fact that I didn’t take any money from my pocket to put into the business, that is also, I think an accomplishment. Mm-hmm. 

Daniel Wrenne: Yeah. And, and it is It can be scary, but it’s a, it’s kinda like one of those good scary things.

Like you get a little nervous about it on the front end, but, you know, it’s like a healthy fear and the, that’s the kind of thing you lean into and it’s typically good for you, but it is a little scary. Was it like that was, Paralyzing. At any point, did you ever like struggle with the fear or did you have that sort same sort of description I described?

Like was it, did you kinda lean into it and you’re like, this is healthy? 

Dr. Diana Girnita: I had moments when I said to myself, this is very hard, you know, I cannot handle all of this. I. But at the end of the day or the next day, I woke up and I said, no, I started on this road, got this, and I’m gonna continue with this. It’s not easy.

It’s not supposed to be easy. Right. And I kind of took that as, as a, as a, as learning opportunities. And I really want people that are engaging into this to understand that, you know, we in the medical world, We only see the medical world, but we should look outside of the medical world, talk to people from, from outside, learn from them, and Understand that the challenges that you have, everybody has probably in every business is not like, we are unique.

We do face some unique challenges because of the, you know, mentality that is training us and, you know, is, is kind of shaping the mind of the patients that they can only get care with an insurance card, but, In the current system, once the patients see that they do not have access to medical care when they need it they will look for options.

What is happening in our days is patients are looking actively looking for options, options for. Finding a physician or finding cheaper medications, for example, or a way to pay for their procedures. They are actively looking and that’s why you see all this huge. Companies like Amazon and you know, the independent pharmacies like Mark Cuban pharmacy, they are showing up because they know there is a huge interest towards cash pay.


Daniel Wrenne: Yeah. And when it, when everything gets all. Stirred up like it is now. That’s when all these opportunities come about. And that’s where things like, I mean, direct care I see, I see as big time expansion potential as all this stuff gets stirred up and people are gonna be frustrated. The more people that are like frustrated with the system, they’re, they’re looking for alternative that, I mean, that’s already happening.

But people are still, I think a lot of people. In the system or even patients are still kind of like stuck in it and don’t really see another way. Did you, I’m curious, when you made the jump, did a lot of your colleagues or people around you, did they kind of give you the sideways there and they’re like, are you sure?

Like what? Explain that. 

Dr. Diana Girnita: Again. A lot of them were confused about what I was doing and You know, I, I believe that’s absolutely normal. Yeah. And a lot of them today are calling me to ask me, how can I do this 

Daniel Wrenne: Right. And you’re like, I’m doing it. 

Dr. Diana Girnita: Yes. And you know, there are still people that are asking me, how is this possible?

I never thought this is possible. And you probably, they’re probably right. You know, cuz you don’t think about options until you are really in that point, that breaking point that you want to change something. You, you understand that. You either accept it or you should work to change things. 

Daniel Wrenne: So how is it working?

Is it I mean, I know I get the feeling that you’re, you love what you do. Like, that kind of is contagious from how you talk about it. And I think that’s fantastic. Versus a lot of people in healthcare are. Kind of the opposite end of the spectrum. You know, they’re not excited at all about work.

but beyond that, like how is it going? Like, is it financially going well? Do you feel like, you know, sustainable business model in specialty care and even, you know, more, so than the traditional model? Or what are your thoughts on like the state of it at this point? It’s still pretty early.

Dr. Diana Girnita: I think it’s very early for me to make, take conclusion or draw conclusions at this point. What I can tell you is that it is working and mm-hmm it is extremely rewarding both for me as the physician and for my patients. What people that come to me will say is that they’re very, very grateful for the time that I spend with them, for the information that I share, for the care that I give.

And I can tell you that I’m sure I’m not doing anything different from what I used to do, but it was, it at the, speed up level that people were not having time to digest that. and I was not having enough time. For my patients, that’s for sure. Now if you wanna become a millionaire in the first year or the first couple of years, I don’t think that is possible and I don’t want people to have that kind of expectation.

It all depends what you want and how much you want to work. And, it also depends where you are. In your expectation, what are and what kind of. Practice do you want to build? Is it like a practice with multiple physicians? Is it a practice that it’s only you? So it all depends on multiple factors, but it is doable and it is something that will bring a lot of reward on both sides.

Daniel Wrenne: Mm-hmm. doesn’t seem like many direct care physicians are burning out. In fact, I think they’re like, Super jacked about. They’re very excited about the, the work that they do, which is such an interesting. I, I wonder if there’s a statistic on like, burnout among direct care physicians. I would imagine it’s like zero or low or whatever.

Dr. Diana Girnita: I don’t think we have statistics yet, but every single one that I talk to, they are not complaining about burnout. Every single one. Even the specialist that they are doing direct care, they will relay the same thing. Now because you mentioned about the vibe that I. Send out. This is something that I am told all the time that my optimist is contagious, and everybody that talks to me, they wanna do it.

And I think that. It is very important to give that kind of vibe, especially when you have transitioned through that and you can tell people that it’s possible to be done. And we as physicians with Lost Hope, unfortunately we are stuck like our patients, so it is important to have this kind of community that I.

I started to build a few years ago where people come in, they learn about it, they ask questions, they get support also from physicians that are doing it. And I think that we as physicians, we unfortunately, we, we lack that ability to connect and to support each other. And we should do that because everybody outside of.

You know, the medical system, they have their own communities that they support each other. Even the nurses, they have community that support each other. The nurse practitioners, they have a huge community. They support each other. So we as physicians, we should unite and we should help each other as well. (Mid Roll) 

Daniel Wrenne: So you, you created the Direct Specialty Care Alliance and speaking of communities and, and was that prompted you to do that? At what point did that happen? How did that play out? I’m, I’m curious. 

Dr. Diana Girnita: About three years ago when I started, I was, you know, I was so. Eager to find people like me or to find someone like me, to share experiences, to ask questions.

And initially I went towards the direct primary care community, but I understood there are some differences there. I was not able, as a specialist to offer everything that I. Primary care is offering. And although I was you know, I’m board certified in internal medicine, I could have done that and I know specialists that will do both internal medicine and their specialty.

So that’s a possibility for people that are considering that. But I wanted to remain the specialist and, um, understood there are differences and I, I was actively searching for people to, that will do what I do. And I started to find a few. But it was very hard to identify people. So I put together a Facebook group and I said, okay if you want to practice direct care or if you are a direct care specialist, come here.

Let’s unite our forces. Let’s share our experiences. Let’s learn from each other. And that’s how it started. Today, I think there are about 600 physicians in that group. Not all of them are practicing direct care, but many of them. They started direct care and I’m very, very proud of them. They started direct care.

Looking at the resources that we put together I started to. You know, we invite all the people that help me on the way, have webinars, and I was recording that. I put together an online course for other physicians to, to learn about this. I was getting, I don’t know how many calls every week, probably there were at least 5, 6, 7, 10 people calling me to ask questions.

And at some point I was so busy that I couldn’t take all these calls and I. And the other thing that I realized is that is that some physicians will do it, but. Probably 18 90% will not do anything with the information that I give. And that was, you know, time that I put in and the effort that I put in to explain to them what is direct care.

So I started to build up resources and at some point I said to myself, you know, tomorrow, Facebook disappear or they can erase the group. How are we gonna reconnect? So that’s why I said to myself, we need to have a legal structure. And that’s how I started direct specialty care. And in all this process, there were people showing up.

They came to us and I said to myself, so I need to create something for this specialist that. For other people, even primary care to find us or patients to find us. So I created a map where people can come in, put their practices there to be easier to be found by patients and other doctors 

Daniel Wrenne: so I’ve looked the website, I’ll link to it in the show notes for Direct Specialty Care Alliance, but there’s specialists all over the country and it seems like, I’m curious about the growth.

How long ago did you set it up in this formal entity? It’s about 

Dr. Diana Girnita: almost two 

Daniel Wrenne: years now. Okay. Has it been, I mean, was it like you and a couple friends at first 

Dr. Diana Girnita: or, so it’s me and, um, it was me and another doctor that I was Dr. Kenny. We were talking all along the way about what we should do, should we do this, should we do this?

We still talk you know, with others, but we plan to put together much more for the community and. I welcome any help. So far, we have been working very hard to, to build up this community, but I welcome anybody that can help us because it’s a lot of work outside of my practice and I really have to take that time to, to invest into this.

Daniel Wrenne: It’s gotten pretty, bri pretty big it seems. Do you know how many people are in it now? 

Dr. Diana Girnita: Right now we have about 60 people on the map, but you know, there are others. We verify everybody that we put on the map cuz we wanna make sure they have a valid practice and we wanna make sure that they are direct care.

A few practices are hybrid practices where they take Medicare, but they also offer. Cash prices. But more and more physicians are showing up. More and more practices are showing up every day. 

Daniel Wrenne: So you’re seeing the interest, does it seem like there’s momentum growing in the interest level?

Dr. Diana Girnita: Yes. The, the interest is huge. We offer the resources. Of course, there are people that are offering consultancy. We, I mean, that’s not the goal of our community, but important things to know is that we. Create these resources. We provide this kind of leadership and we really want people to be independent physicians led practices, to be independent and to grow and offer services.

And we also want to connect to each other because if I have a patient that needs another direct care specialist, I have to know where I’m gonna send this patient. Mm-hmm. Because bouncing back the patient into the traditional system, They go through the same process, they go through the same pain. So we are trying to help these patients among us in this community, if it’s possible.

Of course. 

Daniel Wrenne: Mm-hmm. Yeah, I’m sure there’s instances where you have to go outside that, but, but it does, it seems like, and especially direct primary care is growing, that’s been established for quite a while. But you know, I think both of those in tangent will. In the future have a, a ton of growth. I think, like I was saying at the very beginning, like the, the more frustration there is in the system the more expansion there’ll be in, in the direct care model.

I know you mentioned at the very beginning, one of the challenges you had or continue to have is about, educating, patients about, the new way of doing things or the, you know, the different sort of setup that essentially that’s marketing, I guess. I mean sales and marketing.

convincing people that this solution is, is a better solution for them. has that changed over time? Is that, I mean, I know you said once people, got into it or maybe had a visitor too, it seems like they kind of get it and it clicks, but have you seen any shift in the consumer awareness of it 

Dr. Diana Girnita: So yes, consumers, and the patients, they do look for options. I can tell you that probably 90% of the patients that I see, they find me. I don’t find them, they do find me because they are actively looking for an option. You know, when they get referral for a rheumatologist, the first thing that they do, they ask their primary care physician, where should I go?

And they tell a name. They go on their insurance, that person is not on their insurance. Or even if it is, they gonna be seen in six months. Most of the patient that I see are critical in a lot of pain. So imagine someone with rheumatoid arthritis waiting for six months to be seen. That is completely unacceptable.

And they look for options. And that’s how they find me. And I’m sure this is valid for all the specialties that I know. Patients will look for options. And the other category of patients, more and more patients are unable to pay the high deductibles. So again, they’re looking for an option to pay something cash.

That they can afford, because it’s a difference between paying a couple of hundred dollars for a visit and paying $2,000 for a visit because your deductible could be, you know, 8,000. Mm-hmm. And the visit will be bill the, you know, whatever the discretion of everybody else, but not on your, be on your favor.

Yeah. So it’s, it’s important for patients. To have this price transparency, and I think that will drive many patients to this kind of practices. Once they understand that the price is not higher, but the value is most of the time so much higher, then they will come to, to this kind of practices. 

Daniel Wrenne: We’re eliminating a lot of the layers of cost too. So it’s just And when you look at it big picture, it’s, it makes a lot of sense. so the majority of your patients are finding you themselves, like not, not referred, they’re just like, no. They Google Googling 

Dr. Diana Girnita: it or what? They Google it. Yes.

Okay. They Google it and, this is how they find you. There is also an important category of patients. Once you serve well patients, the word of mouth, it’s gonna pay back. So that’s also something that you have to understand. Once you give good quality care, you’re gonna get referrals from patients. A lot of the, the physicians in the traditional system will not refer patients to us because, their system will ask them to refer into the system.

So although this is not perfectly legal, it’s still, they are still going to refer in their network, you know? Yeah. 

Daniel Wrenne: That’s garbage. I mean, that’s just, I mean, it can work. Okay. But like, that’s just, 

Dr. Diana Girnita: but that’s what you are told, you know, you Yeah, yeah. You know how, what I’m talking about, you know? Yeah, I know.

You have to use your network that is built up by your hospital, right. To support the hospital. 

Daniel Wrenne: so most physicians working in the system are getting their patients from referral or provider, other provider referrals or the system. Sets em up with patients, which 

Dr. Diana Girnita: that is my experience so far. mm.

There are also physicians that are in the concierge practices that they understand the value of. Direct care. They don’t practice direct care because there is a difference between concierge and direct care. And many patients are confused by that. I actually wrote an article in Medscape, I think Almost two years ago about the difference between concierge and direct care.

And I call direct care that is concierge without the tag, the price tag of of the concierge care. And I don’t know if. There are physicians that don’t even understand that, so I don’t expect many patients will understand it. But concierge medicine will still bill insurance, but will also charge an extra fee from the patient to provide access to the patient when it’s needed and to speed up the workup.

And ev obviously they do provide. Very good care, but they do charge insurances and direct care. We do not have any contracts with insurance companies. We can use the insurance card, for example, for labs or imaging or for approving medication for the patients, but we do not have any contract with the insurance and we do not charge.

Insurance companies for our services, our consultations, or you know, even procedures. And we also can offer like direct primary care, we can offer very transparent pricing for laboratory services, for example, or for imaging studies. Cuz we have contracts, direct contracts. You know, my company has a direct contract with a laboratory service that will give patients.

Very discounted labs, and we share that price with the patient upfront. So the patient will not have any surprises that my labs will cost, let’s say $50. They know that’s the price of the lab. Instead of you go through the traditional system or you use your insurance card, and if the bill is, let’s say 1000, and you have to pay.

20% of that bill, you gonna pay 200 instead of paying $50, which is a huge, huge difference for the patients. But you just have to spend the time and explain to them that, and you know, most of the patients do not believe you in the beginning, but then when they get the bill from the insurance company, they ca they come to me and they say, you told me that I’m gonna be billed more than $50.

And this is something that we have to work on as physicians. 

Daniel Wrenne: Well, it’s promising that people are coming to you. I think that’s a very good sign that things are changing when people are looking it up on the internet. I mean, that’s just a signal of like, People’s thoughts and tendencies. The fact that they’re looking that, kind of thing up, that says a lot, the whole model itself.

And I think that momentum will continue be, especially, the traditional system is not that I’m aware of doing much about it. Like the problems are only amplifying. And it’s going to become even worse. And I think as a patient, I’m like, well, if I need to wait six months to get in, and I, it’s really important that I go see, see somebody that alone might, be prompting enough to be like, reaching out and searching and if I find a solution like yours is like, I can see you today.

It’s like, well, yeah, I’m all over that. have you noticed though, like. I imagine well, you’ve already said it. I mean, you’re spending more time with these patients and so you have a lower patient population. Have you had different relationships with those patients, like in the traditional versus in your prior experiences with patients?

Have you been able to like be more, you know, personally connected to those patients? 

Dr. Diana Girnita: I think the I, I will always. Keep the professional relationship before forming more of a personal relationship. But I do feel that patients feel more personable to me. Um, yeah, maybe it’s the reverse. Yes. I think that they do, uh, Feel like finally they’re not in.

And this is something that I hear all the time. They tell me that I feel like I’m not in a factory going in and out the door. Mm. And that is extremely valuable for me, that the feeling that you are able to send the vibe that you send to the patient, it’s, it’s incredible. And then I always look at the reviews that they leave me.

And that’s something that I had to overcome as a physician. I never thought that I should tell patients to go leave me a review. And this is what I would encourage all the physicians that go into direct care because we are very, very shy about asking for things. That’s number one. And number two all these websites that there are websites that they.

Post reviews about us. They’re open to everybody, even people that are not my patients. They could go, there never happened to me, but they could go there and could leave a review if they make a phone call and they are not happy and they could write whatever, and nobody’s, nobody is verifying them. But when you encourage patients to go and leave your review, you really see what they think about you, how they value the care that you give to them.

Mm-hmm. Because what is happening with all these review websites, usually those patients that are not happy, they will go to leave a review. Patients that are happy, they don’t have a reason to seek to leave you a review. So it’s important to build up that kind of, I would say branding in time. If patients are happy, just encourage them to, and even, you know, it never happened to me, but encourage patients to leave you a review.

Mm-hmm. Because you’ll understand also where you need to improve. If you have to improve things, you will have that opportunity. And on the other hand, For other patients, it’s extremely important to see the value that you provided to the community that you’ve served or to patients that you’ve served in the past.


Daniel Wrenne: Yeah. Well, think are all great suggestions. if I’m a physician, I’m considering making the jump, but I’m a little nervous about it and. I know the community is important and so checking out your network is a great suggestion and y’all have lots of resources and just people in general.

Or a resource, they’re already doing it. And I remember when I started my business, I’m kind of in like a, you know, unique aspect of the finance business. And it was kind of similar to direct care in when I started. And I was just like, can I find some people that are doing this this way? And finding that was like huge because you get in there and you start sharing ideas and.

Learning from other people, and especially on the internet, that’s one of the benefits of the internet. You don’t have to like waste their time too much just calling you and being like asking questions is kind of time consuming. And maybe I’m not gonna actually, like you said earlier, follow up on it and that then you’re kind of like, I don’t do, I really wanna take calls from random people, but like the internet you can kind of like get into communities and read other people’s experiences and.

You know, learn from those. So I think that’s a great starting point, but do you have any other suggestions for people that are considering this big potential career shift or, yes. 

Dr. Diana Girnita: So if they are not if they don’t know about it, they should read about it. On this website, dse alliance dot org, you’re gonna find a lot of articles, some blogs that I wrote or other wrote.

You’re gonna find also podcasts that we gave. Start there. I also I’m also building up. On YouTube channel where I invite other direct specialty care direct care specialists to share their their story. So the YouTube channel is called Direct Specialty Care Alliance. You just go there and you’re gonna see all these webinars or lectures or podcasts, how you wanna call them, where people share their stories.

And there are so many. Lessons in those lectures that you can start there and realize that you are not alone. Mm-hmm. That’s the other thing that when I started, I felt at some point, like, I am alone. I’m a party. I am, you know, people were saying, are you, are you against the system? Them. And I was like, no, I’m not against the system.

I’m trying to build up something that is parallel to the system, an opportunity for patients, an opportunity for physicians. So I’m not against anything. You just use this opportunity if you need to use it. But education is extremely important and I would start with educating. Myself before you can reach out to us.

There are many physicians. I actually had a podcast recently with one of them that actually send me a message. I share some information, and he did everything along the way. He watched all the YouTube videos, all the, he took the course online and he. Understood what is all about and one year into it. And he’s driving and I could not believe it.

I didn’t even know the impact that I had on this physician. Hmm. So he basically followed some simple steps and he figured it out. And, um, I reach out to him to give us some insights about how his practice is doing. I talked to him, I couldn’t believe it, how well he’s doing. And then I invited him to give us the podcast and I didn’t even know how much we actually impacted him.

Mm-hmm. And that is extremely valuable for, for all of us that are in this community to, to see this kind of success story. 

Daniel Wrenne: Yeah. And the cool thing about your networks is you have these specialists. So you know, a lot of people, I hear this a lot. Especially since I’ve been talking about this, it’s like, oh, well yeah, I’m in a specialty that’s like blah, blah.

But it’s like, no, well, maybe not. I’m sure that there’s instances where it’s not really possible. Like I think like a, I don’t know, like a spine surgeon or something like that. Of course, you know, it’s, it’s not gonna work in that or it would be difficult. But like there’s a lot of specialties doing it and they’re doing it.

Successfully. And so you can check out your network and see actual physicians that are in varying specialties. They’re, you know, thriving in their business and, and, you know, hearing their stories is great too. I, I’m gonna have to check that out. I didn’t realize you had the YouTube channel. That’s, that’s even better when you get to hear people describe their stories.

Dr. Diana Girnita: Yes. That’s the purpose of this YouTube channel to first of all, To share this idea with physicians, but I also included resources for patients. Like, you know, I’m talking there about what are cash pay doctors, cuz they don’t understand this direct care model. Mm-hmm. But if you tell them cash pay doctors, they understand the concept or how to find, know, medications, cheap medications, we have to go.

To the patient, educate the patient because ultimately we have to get out of the physician’s lounge to the patient. And this is very important cuz the, the scope of our practice is to get to the patient. Mm-hmm. And you know, patients will get to us, but we also have to educate them that they have our doors open.


Daniel Wrenne: Well, Diana, this has been fun. I have enjoyed this conversation and I love hearing what you’re doing. It’s great to hear the impact you’re having and I, I’m sure it’s been rewarding for you. It sounds like in a lot of ways you’re starting to see some of those like nuggets of the seeds that you’re planning and, and that’s, that’s always you know, keeps you going.

And so I wanted to say thank you. I, I really appreciate you coming on to chat with me. It’s, it’s been a good time 

Dr. Diana Girnita: and I would like to appreciate you inviting me and Thank you so much. It’s a, it’s a huge opportunity to, to be here.