Dakotah Asher, PA-C, RT (R) Journey from FFS grind to DPC's patient-centered design

The Path to Primary Care

Dakota's journey into healthcare wasn't straightforward. Like many high school graduates, she felt pressured to choose a career path quickly. 'We're kind of forced to think that we all have to go to college immediately after we graduate,' Dakota reflects. 'There are really no other options, and if you don't go to college, you're looked at as not doing anything with your life.'

A suggestion from her father after a hospital visit led Dakota to consider radiology. She enrolled in a health science bachelor's program with a concentration in radiology, but during her clinical rotations, she discovered her true calling. 'I realized that I love patient care,' Dakota explains. 'I was able to connect with patients on a deep level.'

The Physician Assistant Path: A Perfect Fit

After taking a few years to travel and mature, Dakota found herself drawn back to healthcare at the age of 25. Her research led her to the physician assistant profession, a career that offered the perfect blend of patient care and medical decision-making.

'I discovered the physician assistant career field just by researching,' Dakota says. 'You know, we provide care just like a physician does, but the schooling was a lot less time and a lot less money financially to go to a PA program.'

'I specifically went into PA school wanting to focus on primary care because in that field, in this area of medicine, you're just really able to make deep connections with patients, really impact their lives,' Dakota explains. 'You know, you get to follow them through many decades of life.'

The Reality of Traditional Primary Care

Armed with her PA degree and a passion for primary care, Dakota entered the workforce full of optimism. However, the reality of working in a traditional, insurance-driven primary care setting quickly dampened her enthusiasm.

'I quickly realized that you cannot provide great care under insurance guidelines and restrictions,' Dakota recalls. The financial realities of insurance reimbursements, particularly for PAs who receive only 80% of what physicians do for the same visit, created a system that prioritized quantity over quality.

'In order to earn your keep, as you would say, I had to see a very high volume of patients in very short time periods, you know, about 15 minutes per patient,' Dakota explains. 'And a lot of the patients I was dealing with needed much more time than that.'

Discovering Direct Primary Care

Dakota's search for a better way to provide healthcare led her to the concept of direct primary care (DPC). This model, which operates outside the traditional insurance system, immediately resonated with her vision of what primary care should be.

'I started researching if there was a way to provide primary care without insurance. And that's where I found the direct primary care model, and it was exactly what I had been looking for,' Dakota enthuses. 'It was speaking my language. It was providers who were like-minded like myself in a community that wanted to provide better healthcare, but just needed more time to spend with patients.'

Taking the Leap: Starting a DPC Practice

Armed with this new knowledge and driven by her passion for better patient care, Dakota made the bold decision to leave her traditional practice and start her own DPC clinic. It was a daunting prospect, especially for a young provider only two years into her career.

'It happened a little bit sooner than I had kind of anticipated, you know, being a young provider only two years into my career and starting my own business was a huge undertaking,' Dakota admits. 'But I was up for the challenge.'

'I actually had about 85 patients that followed me once I left my previous practice,' Dakota recalls. 'So I started out with 85, which was pretty good, you know, to not even have the doors open yet and have that many people signed up.'

Building a Patient-Centered Practice

From the very beginning, Dakota's focus was on creating an environment that put patients first. 'It even boils down to the colors that we have on our walls are very calm and soothing. We play music in our office,' Dakota explains. 'I have six people that work for me, and they all are customer service-oriented because I really view primary care as customer service.'

'From the moment they walk into the door, they're met with a smiling face, all the way back to the nurses, to our providers, and then to the exit point of checkout. I mean, they really feel almost like royalty. And that's what we want.'

The DPC Difference: Time, Access, and Comprehensive Care

At the heart of Dakota's DPC model is the luxury of time. Instead of the rushed 15-minute appointments typical in traditional practices, Dakota and her team spend anywhere from one to two hours with each patient.

'We have about an hour to two-hour appointments with patients, really getting to listen to them,' Dakota explains. In addition to primary care and lab work, Dakota's practice offers weight loss management, hormone replacement for men and women, and is even planning to add aesthetic services like Botox.

Growing Through Word of Mouth

One of the most remarkable aspects of Dakota's success is that it has been achieved almost entirely through word-of-mouth referrals. In just four years, her patient panel has grown from 85 to an impressive 1,400 patients – all without any formal marketing or advertising.

'We don't do any advertisement or any marketing. All of our patients just come from somebody who knows somebody who knows somebody who comes to see us and then they get referred to come and see us,' Dakota explains.

'We even have some physicians in our area that are in a primary care practice that even send patients to us to come see us for primary care because they just know the quality of care that we are able to provide is different than what they are able to.'

Advice for Aspiring DPC Providers

For healthcare providers considering the switch to a DPC model, Dakota's journey offers valuable insights. 'Honestly, there's no "don't" shockingly,' Dakota says. 'Some do's: it's really, you have to be compassionate about healthcare. That's first and foremost.'

'If I wasn't passionate about what I do, the hard work that I put in in the beginning to be a solo provider... it would have been really difficult for me to do that.' She also notes that while marketing can be helpful, providing excellent care is the best way to grow a DPC practice.