Onsite, Online, and On Point: DPC in the Workplace with Ryan Steff, NP

On-site clinic culture and employee trust 0:00

How do you think having you guys on site has helped with sort of the culture of the plant, the productivity, how the employees see their lives? I think culture-wise it adds a benefit because it shows there's people that care about them. It's not just another job, you know, so it gives them pause to say, hey, I'm going to quit and go down the street and go work somewhere else because you've got just a huge benefit with us being here. I mean, because. The benefit to the employer is we're trying to keep people healthy and healthy people come to work.

And so, and then when people do get sick, they can get to us immediately. We can get them back to work quickly. So I mean, it's a win for everybody. I mean, and they really, they really enjoy it that they can just kind of reach out. They can walk over if it's an emergency, you know, if they got something big going on, like we can usually get them in right then or shortly after. So. I think it shows that everybody just cares about them. This is Doctor Talks. Real talk from real doctors on the issues that matter to you most.

Hey guys, welcome to My EMD Select Unscripted. Thanks for joining us. We have a great guest with us today. My good friend and nurse practitioner, Ryan Steff works for me at an onsite clinic, two states away. And it's kind of a cool story. So we're going to get into it and it. It's a fun point to say, you know, what happens when you take direct primary care and everything that we can do for our patients and we put it directly into the workplace and really beyond. So with that in mind, Ryan, tell us a little bit about yourself.

Tell us how you ended up working here and, and the journey along the way. It's good to have you, man. Hey, thanks for having me. And yeah, I mean, I've been a nurse practitioner now for 14 years. You know, I started my journey off doing cardiology and then ended up in the ER and I love the ER, but then going through COVID just burned us all out. And that's how I was. You know, searching, trying to find something else, something that I feel good about, something where I can see my kids, you know, every day.

So trying to find a different way of living. And, you know, that's where I found you and we've been together now for almost four years. Can't believe it's only been four years and I can't believe it's already been four years, man. We've got, you know, we've got a unique setup out there and it's, Ryan's been in the driver's seat the whole time. So tell me, so a little background story here. We, you know, we're based in Tyler, Texas. We, there's a large food manufacturing company that's also based in Tyler, Texas.

And we were taking care of them from our brick and mortar location here in Tyler. And then they decided they wanted to put an on-site clinic in their Tyler location. So we said they were going to hire a nurse practitioner and do it themselves.

Ryan Steffu2019s background and burnout in the ER 2:56

And we decided that probably they should stick to making food and we should stick to doing the medicine. So we put My MD Select Concierge Direct Primary Care Medicine. We put a clinic in their location. They built us out a little bit of space. It is us there. We'll get into sort of some of the dynamics that that takes. And then shortly after that became, well, then we got kind of through COVID, which was crazy. We opened that up like in February and COVID hit in March, but kept that plant running.

They didn't have to close down a day for COVID. It was, it was a smashing success and we were exhausted. And then they decided they wanted to, they were building a plant in the state of Alabama and they wanted us to have an onsite clinic there as well. So we got on looking for the right kind of guy that wanted to do the right thing for all the right reasons and a burnout ER doctor speaks to my heart. So having Ryan run that thing in the Alabama location has been great. You know, we were doing good work.

Saving money, taking care of people, all the things direct primary care does, better outcomes, happier employees, happy bosses, a happier bottom line, all the things that we can do with a, with an employer group. And it just, you know, it ratcheted it up. And then, you know, we had Ryan before the clinic was even ready. He was part of the build it out process and getting it going. So. What's your experience been like? You know, you went from insurance clinic world to the ER world to, you know, a direct primary clinic, but in surrounded by your, your patients eight hours a day.

Tell us, tell us what it's like running an onsite clinic, a couple of states away. No, I mean, it's been really great. It's taken, it took us for the first year to really kind of get going and kind of get a flow of the patients. And I mean, it takes that time. It was a new facility. So we were going through a lot of employees, so people coming and going. So it's taken a while to really establish, you know, a core central amount of people that we take care of. And just, it's been fun building those relationships.

I mean, you know, we're dealing with a population, they work six, seven days a week. So they don't have a lot of downtime to go to the doctor or do, you know, the day-to-day things. So being here, you know, it's really helpful. And then at night, you know, if they got something going on, they can call, they can message. So, I mean, it's been really fun that we've been able to take care of them, take care of their families. It has been a little challenging because we're here and so they want to kind of lump us in with the company and they, you know, we have to build trust over time.

And so it takes a little while to get the trust. But once we've done that, they come for us for everything now. You know, it's convenient, you know, that they can come and see us because otherwise a lot of these people would not go to the doctor,

Building the Alabama onsite clinic 5:57

you know, and this is a population that high blood pressure is real prevalent diabetes, pre-diabetes. It's just a lot of the things that we can kind of catch and keep, you know, major medical issues from happening down the road. So, I mean, it's, it's a lot of fun. We're doing a lot of teaching. We're doing a lot of prevention and that's what this group needs. You know, what's, you know, population, the population we're working with, you know, very blue collar workers, line workers, they're busy, they're making ends meet.

They're not doing the preventative care you talked about. And then when something does flare up or break or they get sick, they just go to the ER, right? I mean, they, you know, the ER doesn't ask for money upfront, which is a win. And they're just trying to put the fire out. So then get back to work anyway. So it's been great to prevent some of those, educate our patients on the value of not only the prevention, but also you weren't really having an emergency, you just needed a doctor. So that's what we're here for.

And to be able to do their urgent care, so much of the urgent care we take care of, so much of their, you know, if urgent care happens at work, that's called worker's comp. And so we're on site and, you know, can take care of that as well. To a point, if it's beyond what a primary care doctor should take care of, we obviously, we passed that on, but tell me about sort of the, the workers comp piece and how that works being on site, working with the HR, working with the safety group. What's that experience been like?

It's been a good experience. It's a team effort. It's different than I've ever been because I've always been pretty much office-based, hospital-based, but now we're in a large plant and it's a different world. And so, you know, people get injured. You know, typically it's more strains and sprains and it's, you know, you kind of bring them in, evaluate, you make sure, you know, nothing significant is going on, but it's something we can follow out. And that helps the employer from getting, you know, really increased rates as far as insurance wise.

So we really kind of help both. We help the patient, we help the employer. So it's, it's really a cohesive group that we kind of work together and make sure everybody's taken care of. One thing that I love is that you know we're not beholden you know the classic occupational medicine situation is you just run the the doctor runs the patient through the protocol wait some number of weeks okay maybe we do need imaging after all okay and then wait some more weeks and then maybe we need some physical therapy and then wait some more weeks and we're just like Yep.

Nope. That shoulder needs an MRI, but we also have negotiated a lower rate that we can save the company money on. And so whether it's a workers comp or a non-workers comp shoulder MRI, we can take care of that for cheaper and faster. And then ultimately the patients get better care. They get faster care that they get back to work faster, which they like. But also obviously it's benefits the company as well. Just being personal and, you know, direct primary care docs for these folks.

Serving blue-collar workers with preventive care 9:08

And whether you're hurt at work or not, we don't really care. If you're on the plan, you're ours. There are some patients that don't take the insurance plan, so they're not necessarily our patients. And if they get hurt at work, we take care of them on a sort of outside of the, the membership. But that's really few and far between because once people become eligible for the benefits and they understand what we are offering. Most people want a piece of that pie because it affects the culture. Tell me, you alluded to the fact that they trust you now, how do you think having you guys on site has helped with the culture of the plant, the productivity, how the employees see their lives?

I think culture was it adds a benefit cause it shows there's people that care about them. It's not just another job, you know, so it gives them Paul's to say, Hey, I'm going to quit and go down the street and go work somewhere else because you've got a, just a huge benefit. Well, let's be in here. I mean, because. The benefit to the employer is we're trying to keep people healthy and healthy people come to work. And so, and then when people do get sick, they can get to us immediately. We can get them back to work quickly.

So I mean, it's a win for everybody. I mean, and they really, they really enjoy it that they can just kind of reach out. They can walk over if it's an emergency, you know, if they got something big going on, like we can usually get them in right then or shortly after. So. I think it shows that everybody just, it cares about them. They've got someone there that if something happens, they know where to come to. And what I like about it is, you know, cause we have such relationships with, you know, so outside of having an onsite clinic, which is not the norm, right?

That's not how we have, you know, well over 20 employee groups right now. And for the most part, we have great relationships with the HR, the safety managers, whoever's run in that, that process. And we're doing it all from, you know, an independent brick and mortar site in their town. And, or virtually, and we're going to touch on that, but you've obviously got to a very good relationship with the leadership in that plant. And then of course they have multiple plants in multiple states and we've got those same relationships on-site and off-site.

So tell me about the patients that, so what's fun about a food processing plant is the FDA is very worried about what comes in and out of the plant. And so there's like a fence with razor wire on the outside. The family members cannot come see you inside that plant, but we don't have a brick and mortar in Valley, Alabama. So that leads to how do we take care of the folks that you can't get to you? And then it also leads to the fact that Johnson's Foods or the food processing plant also has a plant in Georgia where you're taking care of them from your Alabama location.

Tell us a little bit about how that works. So we use Spruce, you know, and so that's our main communication. So that's what we use to, if they need an appointment, if they have questions, they need to send a picture of a funky rash, like it's our catch all communication for everybody. So, and that's what we, you know, the new members join in, we get everybody to download the app. So even the family members, the wives, the kids, you know, if they're old enough, they can message in on their own. So we can set up virtual, we can see each other through video chats, we do a lot of telephone chats.

Workersu2019 comp, urgent care, and faster imaging 12:40

And so there's a massive amount of things we can do and take care of without ever laying hands on people. But there's always times, there's something big, you gotta go follow up. And that's some of the challenges with doing virtual, but for the most part, we can take care of everything from the telephone or from the video. I mean, it's really nice. And a lot of the family members have started to really pick up on that. You know, we've got their spouse, their husband, you know, that's been come see me for a while.

And they're like, okay, I need to get on that now too. So, I mean, you know, we're, you know, from Alabama, we're, you know, we're, I'm taking care of people from the other side of Texas to Georgia. So here in Alabama. So it's a way of the, we can touch a lot of lives with a limited footprint, you know? So it really just, it kind of helps take care of more lives. I mean, we're talking preventative care, urgent care. You know, if you think about it, what percent of, you know, for the, for the providers out there, what percent of your decision-making and y'all's, you and your patient's shared decision-making has to do with your physical exam.

I mean, sometimes it's powerful. Most of the time it's, you know, not that informative. We're talking about their, how they feel, their sugars, their blood pressure, their cholesterol, their lifestyle, their weight, you know, where they want to be. They can tell us what their blood pressures are at home, what their weight is at home. And so we, we get them to go to a lab and we get their labs and then we call and follow up. We do this, you know, it happens to be that Ryan's taking care of folks that are in you know, family members in the town where they don't have access to brick and mortar.

But even here, I'll do once a year, I want to see my folks here in our clinic, at least often much more than that. But if I draw their lives and I saw them three months ago and their physical exam hadn't changed, they don't have any complaints and they're on, they're busy. We do follow ups over the phone or in video chats all the time. So it's virtual medicine, obviously, since COVID has become a new thing. Direct primary care doesn't have to worry about how I get reimbursed for that. I don't have to worry about all that stuff.

So it turns into whatever is the most convenient thing for the patient and whatever is going to get the best care. So it's been powerful. We've been in, we've been at times when we had Ryan help us with our private patients in, in Texas. So. He's gotten really good at it. It's really fun. And then sometimes you're like, you know, nope, nope, nope. You need to go to a doctor or you need to go to the ER or, you know, let's, let's, let's take that next step. But at that point, we're still navigating for them.

We're still where they don't know what to do. We can help them know what to do. So it's been super, the virtual piece has been super rewarding as a provider and our patients tend to love it. There's things like even doing primary care, preventive care. I mean, there's a lab core quest. I mean, almost in every town, you know, and then there's not many people that can't get a blood pressure at home. And because I've gotten plenty of people that send me logs of, Hey, my blood pressure has been around this week.

You know, what do we need to do? So. It's, you can do a lot. I think just as technology is advanced, we can do more and more. I mean, and that's, it's really helpful of just touching more lives because there's so many people that just, they say they don't have time to go to a

Virtual care for families and remote locations 15:58

doctor and some people don't. And then some people it's hard to make time because we're all busy. Well, going to the doctor can be a half of a day. You know, if you're going to have to drive across town, wait for an hour, sit in the room for another half hour and you've got to do, you know, then he wants you to go to the lab. So you got to go sit over there and then, you know, it's a, you miss a half day of work. Nobody has time for that. And then when you get done, he's like, yeah, eat, eat better exercise more.

I'll see you in a year. You're like, that wasn't really all that helpful, brother. And here's three medicines you don't want. So our patients still get those long visits, no wait, you know, the ER, the unnecessary ER visits that we can avoid for our private patients and our occupational patients alike that, you know, These larger employees, especially they're, they are self-insured. So when their employee goes to the ER, cause they're sick, cause they want to get better so they can do their boss a favor and go to work the next day.

Even though the ER can't fix a virus, you know, we avoid that. They call me and I say, no, I got you. Let's take care of this. Let's do this. And so they don't waste their night in the ER. They don't spend several thousand dollars off the company's bottom line. And we get them back to work as fast as possible. Everybody wins but the insurance company and in our, in our world. And it just, that's reassurance that we're doing things right. You know, catching things early, prevent, prevent downstream stuff.

You know, art, what I like about some of our, the companies that we take care of. Cause you know, in our private, on the private patients. Those patients are health minded, they're looking for a better way, they're trying to get their family healthy, they're ready to work for it. What I've loved about a lot of our employees that we take care of is, This is the first time they've thought about preventative medicine ever. It's super rewarding. Like, oh, the plan covers for a mammogram. I guess I should get a mammogram.

You know, like not even on the radar. So it's been, that's been really, really fun. And then, you know, in your case, you started at a plant that was brand new and the turnover was like a hundred percent. But now that you've been there long enough, you've got some really seriously long-term relationships going in. It's fun to watch from our end. We have a meeting every day where we talk about, you know, all the patients that all the providers see at all the locations. And I've gotten to know the names of some of your folks pretty well.

And watching their journey has been super rewarding from, you know, Texas, which is great. So as you know, so the, the other thing that we're wanting to do, what I don't like about an onsite clinic is that we can't lay hands on the family members. That's one thing that we're, the next vision for us for Ryan is to get you out of the, the, the plant full time and give you a brick and mortar location where you can take care of the family members, private patients, other businesses if they want, like the, We'd love to extend your reach, which is fun.

In the meantime, we're taking care, taking amazing care of a population that would, even with a good insurance plan, just wouldn't be taking care of themselves. How do you see the future of, you know, I'll call it occupational medicine. Occupational medicine usually just means workers comp. So we'll say taking care of these employer groups because the employers are desperate to offer something that matters and insurance plans right now pretty

Why direct primary care improves access and outcomes 19:40

much all suck. So it's super, it's crazy expensive for the employer. It's a kind of a crappy product for the employee. Nobody ends up super happy. And then you add direct primary care on there. How does that, you know, from your perspective, how has that changed the game and what is, you know, what's your favorite part of how this thing is working out? Well, I mean, I think, you know, the future is, I think this will continue to grow and become more commonplace, you know, as it's been slowly to kind of work down to the smaller companies.

It's really kind of started off with, you know, big manufacturer, larger companies, but I mean, every day you're seeing, you know, the small mom and pop, you know, guys, you know, they have a similar plan because at the end of the day, if we can avoid, you know, hitting the insurance every time, you know, they sneeze or avoid these ER visits, it really helps the bottom line. So if the employees are more satisfied, they have better health coverage, they're more likely to stay in their position. They're going to be happier.

And so you don't have to constantly fight the insurance companies. And, you know, it really just overall employee satisfaction, I think goes up because I mean, insurance is not getting any better. I mean, we see every day, you know, one, you know, different facilities are, we're going to start refusing to pay certain insurance companies. And, you know, we're just not going to pay you not anymore. We're not going to pay Syngman anymore because they won't pay us anything. So, you know, I think it's a way of just completely cutting all that foolishness out.

I mean, we can really kind of get in and actually take care of people. And it just makes life so much simpler for us, for the patients, the employers. It's just a simpler, easier way of life. You know, I know everybody outside, you know, probably looks in and go, why do y'all do it this way? Why is this so, you know, that's gotta be hard, like so much easier. Yeah. No, I don't have to spend, you know, time trying to get MRIs pre-authorized. I send an order and they go get their MRI and it's, we don't have to worry about it.

You know, cause we're dealing with a lot of people, like you said, this. Either never been to the doctor has been 20 years as they've been to the doctor. So, you know, we can kind of get them in, get them engaged. And so I think that's one of the biggest things, you know, it's hard to get people engaged. If they've never really been sick, man, you know, we're the worst patients. Yeah. We don't want to go to the doctor for anything. And so, you know, I've seen these guys, you know, they're 56 years old and they've never been to the doctor since they were, you know, 20 and, you know, fell off the roof somewhere.

So, you know, it, it makes a huge difference. I think just all the way around. I think in these employers, they're competing for good, happy employees, right? If someone, if one of the, you know, the patients that are established with you, that have that relationship, that are feeling better, that feel like their boss has given them something that matters from a benefit standpoint, that's improving their lives, their family's healthier, And someone across town and this very industrial town that you guys are located in offers them 50 cents more an hour, which is a decent amount of money.

And, you know, in a competitive work environment, they are not leaving. That is not happening there. They've been there and done that. Now it's important that the employee, but an employer also that's forward thinking enough to pay for us to come in and save their plan and help their employees. And it actually helps their bottom line, but they're obviously forward-thinking enough to pay their employees a competitive wage so it it usually finds that happy spot for employers that are You know that are out there right now listening to this that and employees you can tell your boss for You've got

The future of employer-based direct primary care 23:28

a bad plan and your employers like I'm sorry. It's not an awesome plan, but it's also ridiculously expensive plan It's all that we can do you know it let them know that there's You know, your average insurance broker probably doesn't sell direct primary care as an add-on or as a benefit to your plan, but we can get these employers hooked up with brokers that can put these plans together. We can be added directly on. The employees, our neighbors, our friends, everyone deserves to be taken care of this way.

So gosh, Ryan, man, that's awesome. Thanks for what you do. Thanks for putting up with, putting up with us this long. That's great. I'm two states away. So that helps a lot. Any other thoughts, man? No, I mean, it's, you know, I just wish it was more commonplace. You know, it's just that we have more people that had the opportunity to really be a part of it. Cause people are just much more happy, you know, when we start really touching on things and start, you know, even looking at hormones and doing things that the routine, you know, PCP that just don't have time to even look at.

And so being in drug primary care, we can, we have that time, you know, especially my population is, you know, you come see me tomorrow if you want to, you come see me the next day. So we're, we're established, you know, to take care of people. And it's, it's, it's refreshing, you know, then not have to be beat down by the system. Preach it brother, preach it. Well guys, thank you so much for putting up with us today. Thanks for, you know, if you're a provider, thanks for taking care of folks. If you're a patient, keep fighting the good fight.

You know, health and longevity is becoming more and more clear priorities for folks and we're We want to expand the gospel of what direct primary care can do to help you reach your goals in a city near you. If you would like to reach out to us, talk to us. Our info will be in the show notes. If you're interested, talk to Ryan. We'll get his email and some contact information in the show notes as well. He does have a unique perspective. Like I said, we don't have on-site clinics for every one of our businesses.

In fact, this is the only one and it's not the norm. a company of that size that was going to try to do it on their own. We had to intervene, right? But we love taking care of our patients, whether they walk up off the street or they're employed by one of our groups. Once you remember, you remember and you get taken up the right way for the right reason and we love it. So thank you guys for listening. Until next time, you guys go out there, be healthy, fight the man and let us know if we can do anything for you.

Thank you for tuning in to Doctor Talks. We hope today's episode has enlightened and inspired you on your path to optimal health. Each day is a new opportunity to make choices that empower your well-being. For more insights and strategies, subscribe to our podcast and visit our website, www.doctortalks.com. Stay connected, stay healthy, and join us next time on Doctor Talks. Real talks from real doctors on the issues that matter to you most.