Ronak 0:00 Dr. Ryan Gannon and Dr. Matt Kavalek are the founders of Blue Ocean Health, a direct primary care practice based in MedCoShare’s King of Prussia location. Today we have Dr. Gannon with us. Thanks so much for joining today and tell us a little bit about your background.Dr. Gannon 0:13 Thanks for having me here. Geez, where to start? I grew up in Connecticut. That's where I'm from originally. And I became interested in medicine, I played soccer from a young age my dad forced me to when I was younger, hated it, grew to love it. And that's because he's from Ireland. And I think my interest in medicine really stemmed from trying to figure out where I could gain any competitive advantage from a young age. And ultimately, I did some research and work with genetics and college, I ended up going to St. Michael's College in Brighton, Vermont, and really love the theory and the knowledge of the actual genetics and the science component of it. But absolutely hated the day to day pipetting and troubleshooting experiments. And ultimately, when I really considered my options and my interests, I thought medicine would be a really good mix of combining the science with working with people. And I like to think I'm a people person, and I thrive off of that type of energy and interaction, ultimately came to medicine. And I guess we can talk a little bit about Blue Ocean health and how direct primary care came to be. But that ended up coming a little later.Ronak 1:32 Yeah. How'd you meet Dr. Kavalek? Dr. Gannon 1:34 Yeah, so Dr. Kavalek, my current business partner, we were randomly roomed together in medical school. So we'd like to joke that that was the one thing our medical school did right. We went to New York Medical College, that was a great experience. And I'm just joking about that. But somehow way, shape or form, we both filled out some questionnaires. And they roomed us together based off of that. And found out pretty quickly, we both had really similar interests, mainly being nutrition, weightlifting, we both had a fairly strong background in that. And then we were roommates ever since then, and ended up doing med school together, and then ultimately ended up both attending Chestnut Hill family medicine for our residency program. Ronak 2:22 Nice. Yeah. And this is an audio medium. So listeners can't see you right now. But basically, you and Dr. Kavalek are like amateur bodybuilders, is what I would like to say.Dr. Gannon 2:35 Yeah, the whole medicine thing is just a cover of we're both we're both trying to make it in bodybuilding.Ronak 2:43 And you mentioned when we were talking a couple of weeks ago that, was it with Dr. Tia that you worked with before or there was somebody in longevity medicine that you had a stint with?Dr. Gannon 2:55 No, that'd be great. I'd love to speak and work with Dr. T at some point. We had spent a summer working with Andy Galpin, Dr. Andy Galpin out of Cal State Fullerton. And he, that's kind of an interesting story in of itself. That was at the end of our first year. And, both Dr. Kavalek and myself, quickly realized going through med school, it wasn't exactly what we thought it would be. And I'm, you know, a lot of people know, and for those who don't, in medical school, the amount that you get in terms of nutrition, training, the things that really interested us is absolutely minimal. If none, I think we had one class on nutrition. And that just really, that didn't make sense to me, because, I always viewed that as the foundation of health or at least an absolute pillar of it. We end up finding Andy Galpin, I think mainly through searching online, he was really gracious to have us out there for a summer and expose us to a lot of the research he was doing with world class athletes, he's one of the country's leading researchers in terms of muscle biopsies, and since then he's absolutely expanded and really just trying to put push high quality information out towards athletes, as well as individuals how to better improve their lives. But that really helped to expand on our views of what health encompasses as a whole and what would that look like if we continue down this path of medicine, which we're sure is still a little bit unsure at the time, but he really helped to shape our views. Ronak 4:36 Nice. That must have been an amazing experience. So just shifting back to what you're doing now. You run a direct primary care practice. How's that different than a traditional primary care model?Dr. Gannon 4:50 Yeah. The few ways to explain it. I like to think that you get the best of a primary care experience without the headaches both from the patient provider perspective. And the other thing I typically tell patients is, if you think of primary care in terms of the spectrum, on one end, if you had concierge medicine, sort of like an on demand type of medical care that if anything's going wrong, you can contact instantaneously, someone's going to get back to you. versus the other end, purely within the system, you may be stuck waiting for several weeks for an appointment. If you call you might be waiting half an hour, 45 minutes, maybe an hour longer to get a return call you're not, you're rarely ever getting all of the doctor, direct primary care isn't really a unique and good solution. I think it really balances the best of both those worlds. So it's a direct relationship between the provider and the patient. As an example, with Dr. Kavalek, and I, we don't have any other staff members that work with us. So patients directly have our number, if they have an issue, they text or call, we get them in quickly, within a day, certainly within a couple of days or the week, depending on their schedule, something concerning is going on. And the main benefit of direct primary care from the providers perspective, from our perspective, is that it truly gives us the time to sit down and get to know someone. So I don't care, you could be the best doctor in the world. But if you're part of a traditional practice, a sick visit may be anywhere from 5, 10, maybe 15 minutes is pretty gracious, you're getting out there. But there's only so much you can do. And my biggest fear would be, that's where mistakes happen. And it's just not quality care. So it's a great model that really affords us the time to actually sit down, get to know our patients. And it's just an entirely different experience, when it's a comfortable environment, things aren't rushed, and you really get to know someone which makes a world of a difference. Ronak 6:59 Yeah, I mean, I would say one of the issues that I deal with is, if there's a long wait time with my primary care, I end up just going to urgent care nearby. And the problem with that is you're going to usually get a different doc or a PA every single time. So they don't really know you, they don't know your history. They are just basically trying to take care of the symptoms that you're telling them.Dr. Gannon 7:28 100%. And I have so many thoughts on that, I think where medicine is at, mainly primary care in the country right now is that everything is so fractionated. And there's just too many hands in the pot. So for the majority of things that should really be handled by a PCP who knows the history of the patient, any particular medical conditions, what's worked in the past for certain symptoms, if they're new, if the recurrent and urgent cares, absolutely have value. If they didn't, they wouldn't be here. But they arose because we lost that connection between the PCP and the patient. And I think, a big part of what we're trying to do is restore that trust. I think there's a pretty big distrust with medicine as a whole, but especially primary care. And ultimately, it's just become so fractionated. That's one of the major issues we're trying to address.Ronak 8:28 Yeah, no, absolutely. A critic would say that a concierge model is basically, doctors for rich people. And then I kind of looked into the pricing and found out that's really not true. So what do you say to people that are more critical of doing something that's more concierge care versus the traditional health care model?Dr. Gannon 8:54 I think first and foremost, people always have autonomy. And I like that in a market, whether it's medicine or anything else, there's always options. So for those who choose to utilize their insurance for primary care, more power to them, I think that's great. I think for the individuals who are looking for a bit more attentive care, someone who has the time to really get to know them is responsive in a very timely manner, and has from what I've seen, or there's a saying that once you've seen one direct primary care practice, you've seen one direct primary care practice because it's truly reflective of the individual, their personality, their particular interests as a person, their areas of medicine. But it really has been shown to improve health outcomes number one, and which is first and foremost, the most important thing but number two patients don't have to break the bank. In my opinion be concerned from a financial perspective being how affordable the rates tend to be. As an example, most direct primary care practices tend to structure the pricing based on an age tier with the idea that medical complexity increases with age. And just as one example, for patients who are 20 to 44 years old, that's $50 per month with us, and that covers all aspects of care, including the communication, whether that's through texting calls, emails, video visits, as well as in person office visit visits. So there's no additional co-pays, there's no additional service fees, we could talk about, like ancillary services, at some point that is an additional fee, but that it's also very affordable. So ultimately, depending on the person, it may not be a good fit from a payment, financial perspective. But we really cater a market towards I certainly wouldn't say it's the affluent, I would say it's meant to be for the average person and the average family. And we, it's really hard to even describe our patient demographics, we have individuals who are having a really, really tough time but choose to have their care with us, we have individuals who are really affluent, and choose to see either Dr. Kavalek or myself over a concierge practice. It's a little bit all over the road. But ultimately, it's sort of an experience that you kind of only get to understand and grasp and feel it once you've done it.Ronak 11:48 So what's your pricing after the age of 44? And the reason why I ask is I'm 44. Now I'm turning 45. Yep. So I want to lock in this price. Before my birthday. Dr. Gannon 11:58 Yeah, so 20 to 44 is 50 per month, 45 to 63 is 75 per month and 64 and over 100 per month.Ronak 12:07 Okay, so still not too big of a jump. I think that's very affordable. So let's talk about access to care. You mentioned that you and Dr. Kavalek are available by phone by texting. Is it 24/7 isn't nine to five, like, what are your hours? Like? What's the process like?Dr. Gannon 12:28 In one sense, we're truly on call all the time, which is why some Doc's have a hard time. Maybe they're interested, but they don't necessarily want to switch to direct primary care. Because of that. I often get either texts, it's mainly text, most of our patients really like texting. Sometimes I'll get some late night texts. I'll typically respond, I don't consider it a bother anything. Our etiquette is that we'll always get back to you within 24 hours. Having said that, we're always back within a few hours. If it's an absolute emergency, it's always 911. If someone's calling me late at night, I'm gonna pick up but God forbid, there's something that they're concerned about they’re like, hey, do I should I go to the emergency room for this particular issue? I'm concerned. And I think it's just huge to have some guidance. You know, everything's okay. Right now, I'll see you tomorrow, or nothing to be concerned about from that perspective. If someone's calling me it's 10:30-11:00 pm at night because they need their medication refilled for next week. Maybe that's a discussion and just in terms of the etiquette. And there's always a little bit of education with that. But having said that, I'm more than happy to answer most texts, depending on how late it is from sleeping or whatnot. Ronak 13:50 So do you guys have to alternate your vacation days? Because I can't imagine both of you going away at the same time?Dr. Gannon 13:55 Yeah, well, the beauty is with the two of us, we always have a doc covering the practice, right? So that's what we've done in the past, having said that, as you continue to care for someone, and you really get to know them, when someone with one of my patients is texting or calling me, I have a very good understanding of what's going on. So a lot of the times we'll actually still, take texts or calls because it's truly not a bother. I had a family vacation in Ireland, this last December, and in that circumstance, Dr. Kavalek did cover for me.Ronak 14:38 That's good that you have another partner where you guys can rotate. So what services are included in the DPC membership?Dr. Gannon 14:47 So you can think of everything that you would get in a traditional primary care setting. As both family medicine trained physicians were going to offer. So that ranges, anything from caring for chronic disease management, most commonly being high blood pressure, diabetes, asthma, high cholesterol, etc, as well as acute concerns, if someone had a, particular injury, if, a particular concerning labwork came back, and we need to work something out or do or do further testing, based on both our interests and personalities, we also work with individuals regarding their nutrition and exercise. Another big component is hormonal replacement therapy for us for both men and women. So that's something that we both do. So pretty much everything that you get at a primary care setting, right, plus our additional interests.Ronak 15:48 Yeah, and I actually have that family member that has joined you guys. So I know a little bit about the preventive care that you guys are doing. And I'll say it's pretty amazing. And like, once you reach I mean, I think it's permanent in any age, but like, once you reach 40 and above, it's more about prevention in my eyes. Optimize your life and your health, versus just taking care of illnesses, right? And, typically, right now, they recommend you do your annual, do you guys go above and beyond that? Or what do you recommend to your patients for preventive care?Dr. Gannon 16:23 Oh, man, it always depends on the particular individual and their underlying conditions. So the way I think about it is I always meet someone where they're at. This kind of touches on something that I think is also a bigger issue in medicine purely because of the lack of time. But for a lot of things, it's not necessarily a knowledge issue. I almost think of my role is more as an advisor, as well as an accountability partner, rather than a doc. As an example, for a lot of my patients to help gain awareness into their overall eating patterns and habits, I'll have them do a food log, where anytime they put something in their mouth, liquids, food, they're writing that down for two weeks, and then they're sending that to me, so we can fully review because a lot of times, it's just an awareness thing that people, you know, we're going through the motions, but we don't necessarily know our habits and what we're doing. Yeah. And I think that behavioral aspect is a huge underlying part of a lot of what ends up being chronic conditions. And that's the basis of how I think about it. And then, of course, when someone does have high blood pressure, diabetes, or what have you, we're going to address that. And that still speaks to the fact that again, it depends on the individual. I have a lot of patients who are turned away from various primary care practices, are there prior PCP because they wanted an alternative solution and didn't necessarily want to go on medications right away. And, again, my view is that the autonomy always comes first in that individual decision. I'm more than happy to. There are great supplements for example, or lifestyle factors, especially for diabetes and high blood pressure.Ronak 18:23 Yeah, I mean, I think accountability is a big thing. And, the Hawthorne effect where you'd behave better if you know you're being observed, or you think you're being observed, I can, I think that's something that I need, right? Because when there's no accountability, you just feel like doing whatever, whenever, especially for me, like, if it's a long, stressful day where I've been on the road, sure, a couple hours and fighting that traffic on 95. You know, the last thing I want to do is go home and work out and eat a salad. Right? So, you talked about chronic disease management. So can you tell me a little bit more about how you deal with heavily diabetic patients or high risk patients with heart disease?Dr. Gannon 19:10 Sure. So, for one, one impression, I certainly don't want to give is that. Sometimes, we have people seek us out because they're under the impression that as direct primary care providers, we're outside of traditional medicine. And I like to think, again, that we combine the best of all worlds, so my job is to continually keep up on my knowledge base, but that encompasses both medicine but also other fields outside of medicine. And I think the best example where, what I tried to do for a lot of my diet, individuals with diabetes that I care for is, diabetes in the traditional primary care setting is often purely just treated based off the blood sugars, we often throw insulin at individuals with the idea that we're trying to improve our numbers, right? Our lab works on hemoglobin A1C, which is the reflection of the sugars over the past three months, as well as, when our patients are checking their sugars throughout the day. The problem is that we've known for a pretty good length of time that if we reduce someone’s sugars, we’ll improve their microvascular complications, meaning the disease associated with the eye associated with the kidney, but will worsen macrovascular, a big vessel complication. So, strokes, heart attacks, and the reason is because of too much insulin. So on one hand, what we found over the past 50 years that we've treated diabetes, we've improved all the problems associated with high blood sugar, but we've worsened or we certainly haven't improved, the issues associated with high insulin. So the main issue is, you got to get sugar out of the body. And there's a particular diet method called the Bernstein method. So this was a doc. I think he's in Long Island, I could be wrong, but I believe he's in New York. And he developed a particular pattern of eating where even with individuals with type one diabetes, who they don't produce any insulin, their bodies aren't capable of that, he’ll have them get down to only a few units of insulin per day, which is unheard of, as well as when you look at their bloodwork their markers, so they're A1C may be normal, so they don't have diabetes based on their bloodwork, right, but they still for all intensive purposes, or they have really high risk of coming back up. And I think it's such an amazing thing to see, to have individuals with type one diabetes with that tightly controlled blood sugars is unheard of even almost on insulin. But it goes to show you the power of behavioral modifications and using what we're able to do with our own bodies. And part of that program is a lot of exercise. So I'm not going to lie, it's difficult. And one of the things that they do is a lot of aerobic activity, which your body is able to take the blood sugar in the air to take the sugar in the blood and put it into the muscle, which is where a majority of the blood sugar is stored. So these individuals may do an hour or two of some form of cardio per day. But the ability, our bodies are this amazing reservoir. And a lot of what we do in medicine is to mimic the effects of exercise. That's what we try to do with a lot of medications. But I think as a whole, the Bernstein method is a great tool at our disposal, that if I didn't have the time with someone, or the ability to even look this up or look for alternative methods and educate myself. There's zero chance I'd be able to do that in the traditional setting. And there's certainly examples for high blood pressure. I have patients through a combination of exercise, sauna, and various supplements like taurine, garlic, cocoa powder is a great example. No antihypertensive medications were able to get them to normal blood pressure. Ronak 23:32 Oh, wow. And I think this is the real benefit of becoming a member, right? Like you wouldn't get this advice in a traditional primary care office. So the nutrition aspect to it, the preventive care aspect to it. It's really not there, because if the docs are only spending, let's say, 10 minutes with the patient, there just isn't time to get into all these things. Dr. Gannon 23:55 Yeah. And that's speaking more to that, I think, not the majority, but a significant percentage of referrals purely happened due to lack of time. So do Dr. Kavalek, and I, we both started our practice directly out of residency. But in our training, if you had an individual who, if you're supposed to see 15-20 people per day, that's a light patient load for the day. And if you have someone who comes in and they have three or four chronic medical conditions and concerns, and you're rushing as fast as you can, because your first patient showed up late, and there's something acute or worrisome going on with a different patient, and then as you're heading out the door and they say, well, what are we going to do with my knee pain, which you didn't talk about? You purely don’t have the time, you're going to write a referral to the orthopedic doctor. And I think the incentives are, they're aligned differently. So the incentive and in direct primary care is, I think, to really do the best by the patient. I think the patient also has a little bit of buy in, kind of metaphorically, but there's some skin in the game. Whereas in residency, if I had a really busy day, a lot of times, I was hoping patients wouldn't come in. And I knew purely based off of that if I were in medicine, I wouldn't be able to practice and that type of setup.Ronak 25:19 Right, right. So what do you think is the future of DPC?Dr. Gannon 25:23 I think it's going to explode. To my knowledge when we had started. So we've been open about two years now, I think we were the fourth practice in Pennsylvania. I think the last time I looked there, there's just under 2000 practices like this in the country. It's much more popular in rural areas, it tends to work really well. But now we're also seeing it being incorporated into more suburban areas, more cities. And I think it's just the perfect storm, and the combination of insurance is getting tougher. I think, individuals, I think people as a whole are looking for alternative solutions, as well as just alternative models of care, and someone would be a bit more invested in their health, right. And I think all these things are coming together that this will be one of the main ways that primary care is practiced.Ronak 26:28 Yeah, I mean, that's pretty incredible that you guys were number four in the state. What advice would you give to docs that want to start their own DPC?Dr. Gannon 26:38 You just gotta do it. Yeah. Sometimes I think I could give all the advice in the world. And I think I tend to be a little bit of an over-thinker and a little too much into introspection at the end of the day, you just gotta pull the trigger. The beauty is, there’s so many examples of those who have laid the groundwork. And at this point, it's just a matter of checking off the boxes and just following the checklist. You went to medical school, you did your residency training, you've done things that are incredibly hard, you can certainly start your own business.Ronak 27:11 Nice. Did you have any issues with marketing or educating patients to like this model? Dr. Gannon 27:19 Yeah 100%, I would say that's probably still our biggest hurdle. And we're always willing to do the first month of care is on us. Because again, like I said, it doesn't click until someone's been in the chair with us, and they've had the time to explain what's worrying them. They're not immediately rushed out of the office. And then when they leave, and I text or I call them, we're following up next week about their blood work. And then they have the aha moment, and it solidifies everything in their mind.Ronak 27:55 Yeah. And is it just directly to patients? Or do you work with companies as well?Dr. Gannon 28:03 Yeah, yep. So those are our two biggest demographics. So we provide both primary care services for individuals and families as well as we work with companies. So our goal is to both improve the health of the employees. I'm a really firm believer that healthier employers are likely happier employees, they're probably more productive as well. And there's a lot of unique ways to incorporate this within companies. You know, we work with one particular company who pays for the memberships of all their individual employees, and they get the same level of care and access to us as our regular patients. There's other individuals that we know as well who can work from the health benefits, and that tends to be the most confusing part about it. But to try to reduce the cost of the employer from that aspect while having a really good service that their employees love. So we do both.Ronak 29:09 Yeah and again doctor this was amazing. Where can patients find you?Dr. Gannon 29:13 Yeah. We're both on social media at Blue Ocean health DPC, as well as our website www.blueoceanhealthdpc.com. Ronak 29:24 Perfect. Thanks for coming on.Dr. Gannon 29:26 Yeah, thanks for having me.
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