Unveiling the Secrets of a Successful Concierge Medical Practice with Dr. Erika Kappes

Transcript YouTube English auto-captions. Hey guys this is Dr Mike Wang welcome to another edition of bootstrap MD the podcast for physician and health care entrepreneurs uh super excited about this next interview from time to time we love to highlight Physicians who are out there in the field making it on their own becoming their own boss and this is next person is certainly a no exception she's a board certified psychiatrist and Private practice owner in Alexandria Virginia she completed undergrad at University of Virginia attended medical school at Virginia College of osteopathic medicine in blackburg she was commissioned as an army officer prior to attending medical school and then went on to complete her residency at Walter Reed in Bethesda Maryland where she served as chief resident she was then stationed at Fort Stewart Hunter Army Airfield near Savannah Georgia where she worked in multiple embedded behavioral health clinics inpatient settings and A behavioral health consultant to Army leadership after leading leaving the Army she returned back to Virginia and opened up her own conier Psychiatry and Wellness practice she now has a team of four of the providers a phys psychiatric PA to therapist and an acist who they all collaborate to provide Premier level care to their patient base she also operates in the capacity of a medical director and also leverages her knowledge of nutrition and Integrative Medicine to teacher staff and Deliver optimal patient care I know we're going to learn a lot from her today to introduce Dr Erica capz Dr cap thank you so much for having me wonderful well you know this interview has has taken so many twists and turns uh I canceled on you you've canceled on me didn't get a recording on it and just so many different things and I I know that the Universe there's a reason for all of this so uh yeah so I know this is going to be a great interview and and love to share nuggets of information to our audience so uh without further Ado let's talk about this because you know unfortunately these days less and less Physicians are wanting to strike out on their own start up their own practice maybe you can talk about your beginnings of of how you were able to do just that yeah so um thank you so Much again for having me this is great um but I you know coming out of the army I would say I was sort of in in this institutional mindset of having to you know work in another big company where I get my paycheck every two weeks and get told what to do and have very limited flexibility um so I did do that for a little bit outside of the army um for a couple months and I knew right Away that it was not going to be a good fit for me long term I even considered leaving medicine altogether or going back to residency in a different field as if that would solve the problem um and then I decided no I actually want to stay in my own field and create something um that I have been thinking of for a while so which is a boutique you know mental health practice a beautiful space where people come and Have a an amazing experience um and a really flexibility to do what I want to do with it and so I reached out to people who were had similar practices that I were very I was inspired by one of them you know Dr Brook Chalet who I know you've had on your podcast and she helped Mentor me um as well as some other Physicians as well Um who were doing similar things mentored me how to get started a lot of is just getting that first step going because I I they think I really didn't know even how to start that first step um so one day I opened my doors in one room and um two years later I'm in a bigger office suite with five offices newly renovated with the team of uh four other providers and myself and and doing very well and I love my work so it's been a really cool experience and I'm curious did was there any uh like entrepreneurs in your family that maybe not necessarily in in medicine or perhaps in your upbringing did you do any type of entrepreneur activities as as a teenager or college student anything like that the answer is no and I think you know I I love my parents they're fantastic and brilliant people but They I think struggled at times with understanding even what I was doing um you know like why don't you just get a ninetto five or or join a different practice or things like that um and so I think for a lot of people who are used to maybe more government jobs or theate standard 9 to5 it's possibly a generational thing as well it's hard to wrap your mind around starting something from nothing essentially and and and Knowing that it's going to take off but being patient to let it take off and that's you know that's tough for a lot of people that patience but no I didn't come from any kind of background like that I think to be honest with you I think my family was pretty shocked um and I really didn't think I you know I thought I had to wait for the perfect time as we've talked about before have more practice in business and I I realized it's really not the case you just got to get started um surround yourself with people who also are doing similar things um that that that's what helped me and reaching out to people who you know have sort of like blazed that trail already um but once I got into it I was like oh my gosh this is so much fun it's such a creative process um I I I mean I've had a blast um sort of forming this Practice creating it adding to it changing things um for me me that's really exciting I me not everyone feels that way but for me that's been a really cool experience in what way did the military perhaps uh shape you in the direction that you're going and and and I'm thinking both positively and and perhaps even negatively and the reason why I say this is uh my father-in-law is a Navy man been in there 30 40 years uh and Actually when he retired it actually had you know difficulty kind of making that transition to a civilian work anything like that you know kind of uh you know alter your thinking or perhap shaped you in the direction that that led you to to start up your own practice Yeah so I I Al I also struggled with coming out of the military and I wasn't in there for a career I did I I you know did the hpsp scholarship which for Med Students it's you know the military pays for you to go to medical school and then you do residency typically with the military so I did might not Walter Reed and then I you give four years active duty back based on what you trained in so I did Psychiatry which is a fouryear residency you give four years back active duty if you were like a fiveyear surgery residency you would do five years and that kind of thing um but Um I came out of it feeling very untethered even though the military was not something longterm for me as in it didn't I wasn't able to nourish more creative Outlets I am a very creative person I think I was like an art curator in a different life maybe um but I didn't wasn't able to like let explore that as much in the military so I was eager to get out but Once I got out it's kind of like oh boy what do I do now I'm I'm in this huge sea and I have no idea how to navigate myself um I also was I always felt like I was on the precipice of what I wanted to do as an open something do my own thing but I didn't know how to do that and we definitely didn't learn that in residency medical school or the military um the military set up to maybe Like keep you doing something similar to the military um so a lot of people go work for the VA and there's nothing wrong with that but that is just not for me um and so I think I came out of the military feeling a little bit lost and untethered on the positive side I I did you know you build up some resilience being in the Army um in my case because you don't have a lot of control over your life or Your dayto day so I think maybe that resilience was helpful during this time of the transition but it was a tough transition for me so I think for anyone coming out of a career in the Army it's probably or the military it's probably an even harder transition um I was able to tether myself finally once I sat down and made a plan of where where I want to see myself in a couple years but That took a little bit of time to even get to that point as well when you decided yeah this is that that's great to to you know to understand you know that the kind of conflict that that you had for for some time and finally finding something that you could really you know uh stabilize you in the direction wanted to go so let's talk about those early early years or early times when you you know you had the decision you you Had a practice was it uh you know in your head that you this is what you envisioned or you know were there people out there you know we we mentioned Brooke uh Chalet out there that you kind of modeled after or did you you know think of this I know what I wanted to do and now I want to seek out mentors or experts who've already kind of blazed that trail yeah so I think I had an IDE I I remember having an idea of what I wanted to do and then I found uh Brook Chalet we' become um she she was my a sort of a consult business consultant I would say on some level coached for me for a little bit and now we've become friends uh you know I consider her a friend of mine and we support each other from different coasts um but Anyways um she you know I saw what was doing I knew that that was something I sort of wanted to do so I really researched all the practices in I would say the country that were doing similar things that I wanted to do and then I just cold called people I mean I I called a practice in New York City with a woman who um Dr namavar Who was doing some interesting things up there and I just reached out to her coldly and she was lovely I mean she said like let's get together on Zoom let's talk so people will respond if you ask for help um or or even inquire about what they're doing um so I I found some really interesting people and then I started crystallizing what I saw for myself and doing one little step at a time and as I gained more confidence in what I was doing and Honestly getting more business I then was like oh this is actually where I see myself you just keep like changing course um I see the space being like this I see the experience being like this I want to add more services acupuncture I want to bring a PA on um who helps um seeing patients and and sees them at a different rate as I do so just sort of like making different business decisions um and and I've thoroughly enjoyed that um piece just sort of like every time there's you get new information you pivot and do something different so I think it's been pretty fun yeah you highlighted one of my favorite words as an entrepreneurship and really a skill that you need to learn and that is Pivot and to be able to be flexible to not and not to be tied down with with perhaps you know old school thinking or the way that you think it is And and oftentimes you know I learn not just from my mentors but even from my own clients and patients who like you know we launch particular treatment and you know nothing really happens and then you know we pivot to to something seems to be more palatable to to to the audience and I think like even like the people who work for me I mean if you ask them I mean I hope to God they'd say they love working here it's I Mean it's it's a I find it a great place to work I've made the experience really enjoyable but they you know they have ideas too that sometimes I haven't thought up of you know my mind is full of all kinds of different things but for example the the PA Lauren who works um with me who is just like amazing um she'll come to me with marketing ideas and she has different marketing ideas than I have and I'm like yeah I never thought of that let's try that um let's reach out to this group let's you know so she's really helped Market our business in a way that I hadn't even thought of in a in a a prior and so it's been great to get other points of view and I'm always open to that which is one thing I love about business like you can kind of do all all kinds of things um you you have a lot Of freedom to to practice and and design things the way you want to and I'll be honest with you even getting to that mindset was like hard coming out of the army because I was like oh wait I Am My Own Boss you have to keep reminding yourself of that want to stay up to date with entrepreneurs join the lounge to say stories the latest physician investor and Entrepreneur info emailed directly to you join the lounge at bootstrap md.com thelounge I I'm sure the general isn't asking the private for you know uh uh military you know but but it is it is important we have a you know we have our monthly staff meetings and so often you know we'll we'll ask you know each one they may not say it individually they might email it to me or talk to me privately and Basically the question is is you know um I want you to name is there something that you're currently doing or is is there do you feel that there's a different method where it could help your job better you know whether become more efficient you know the way that we room patient the way that we answer phones the way we deliver information because you're not in that you know I mean so I ask everybody I mean you know from the medical assistant on on up doesn't really matter it's all of their information is valuable yep and uh you know they want to work they want to have a long hopefully they want to have a long uh working relationship with you as well and you know oftentimes those questions you know those those concerns don't get answered by you know higher ups it's unfortunate but It is very important as an employer to be able to be given that uh opportunity yeah no exactly and and I think you know people want to feel like they're part of something interesting and and part of a creative process as well so um I take everyone's you know recommendations you know very seriously and consider implementing them if if I feel like they're they're in line with the practice Yeah so Let's talk about that because one of the things that we we we mentioned uh previously is is your your ability to assemble a team some things along the way that could be useful to our audience yeah so yes so actually another thing coming out of the army um you don't get to choose your team in the Army so you look around that's who you're with regardless of what you want so That that was you know that's what I was used to so when I opened the practice it was just me and one room and I pretty you know pretty quickly realized I had to bring on extra people so when I started doing that um it was a challenge for me because I had to really instill this level of trust in them like I will this will turn into this by the way I'm sitting here I'm pregnant so OB at the time so obviously like the writing is at the wall that I'm going to go out for a little bit and there was no lease sign for new space yet and you know there was a lot of things still sort of like hanging in the balance so I had to say like please trust me I this is what this will look like eventually and this will all be you know this is what my vision is and I need you to have that shared vision and it can be tough for people to really trust like that because you know I I think I said it the last time one of the most addictive things in I guess the world in America is a paycheck every two weeks so like the same paycheck every two weeks um so when you so when you are um coming away from that it can be very scary and I totally acknowledge that because that was my experience as well so and I had to say like you know I I know that this is how this is going to look but please trust me so I had to I had to really find people who had a shared vision and that is um that took some time and that you know really like sifting through who could stick with me even if there were times that weren't as busy as others and so I found that team they're wonderful every all of my people who work with me are just amazing people so um it's been a great experience but it did take a little bit of uh it was like a trial and error at first so so me talk about did you any hiring tips or hacks that uh you felt led to you to that that perfect uh you know team that you've um I mean honestly go with your gut I think sometimes like We ignore our gut when it comes to like personality difficulties um and you have to like really listen to that intuition and sometimes you know myself and my business partner would would interview and he is extremely logical and a numbers guy and he's amazing um but we may have had different like intuitions maybe like I'm you know and so you really have to like be on the same page um and If you have if you notice red flags in your gut you have to go with it um in my opinion like if you sort of notice things that like AR you aren't sure that's going to work out um the the relationship of you know contractors or people employed is a very like can be difficult relationship and it's you know you want it if there is any friction there so Um it just I I guess my recommendation is go with your gut if you feel like something is off yeah and one thing too that I I I probably shared last time with you is you know when you're building up your team don't just rely on yourself to do the interview absolutely I've had it where we were inter we were interviewing a a PA and um I quickly I thought the interview went really well Um she said everything I wanted to hear and then we did a quick kind of tour around you know you know the office and meeting some of the staff and uh you know I when the the applicant left I talked to a BRI my my other PA at the time it says what did you think about her she says I didn't like her at all and What do you mean by that he says look how she treated Janette janette's our our medical assistant she B she did not even acknowledge that person in the room only wanted to converse with her and myself and uh you know and so there obviously there she probably had some status you know um ideas of who who to talk to and perhaps the quote underlings aren't the worthy talking to I said y I did not notice that yeah you picked up on It right away um and so having other people getting different perspectives sometimes they know you know on interview they know most people know how to interview and they know what what to say but you know what they're saying behind the scenes is maybe a different story absolutely and so I actually learned that that exact thing a couple you know months after I started interviewing is like have multiple people interview um so now I do that like I have different you know if I if we were going to bring out someone else I'd have the PA interview point of the therapists but I definitely don't just rely on myself or even um my business partner Cody even though I trust his judgment it's just that like sometimes we're so deep in the weeds with things so it's good to have that Outsider yeah so Let's talk about to let's take forther explore you got the team you you got the Avengers assembled how you work in a cohesive unit what are some of you use yeah so um like I said you know I think you know just really you know taking everyone's Viewpoint seriously I mean I think I hope that they would say they love working with me I I give a lot of flexibility with scheduling when people see patients on people don't see patients um As long as they're meeting the standard that I see for this practice um which they know because that was like like outlined to them when they came on board and that's one of the reasons they like the practice um as long as that's going on like I don't micromanage I try not to micromanage I I do check on the clinical work at times and I'm always around for um especially with the physician's assistant with any clinical questions and I'm always available for anything whether it's you know concerns um things that need to be adjusted clinical questions um so I think that's a huge thing as well being available to people like quickly and not just like oh I'll call you back tomorrow like I'm I'm always available for people whether they just want to talk or whether they want to talk about business related matters or or patient related matters um so I think that's been really helpful and I and I think that if you would ask any of uh my staff they would say that you know I'm always around for anything that they need um they they also have an expectation of a standard and like I don't even have to voice that like they know because I model that standard myself that's great I mean you know they need somebody to model after I've had situations where I I I deal with clients uh you know business clients and You know I had I had this one doctor said you know what they they're not making Pas like they used to uh you know in terms of work ethic and everything like that but then I know there a pattern he went through a PA like almost every month and if you're if it's if it's not it's not the PA it's you and yeah probably you yeah it's the king of micromanaging um to some extent obviously you know I like to start When I'm hiring I usually have them on a trial basis you know for three months or something like that whether you like us and we like you and then once you're able to do it it really is important you know at the end of the day when it comes down to it it ultimately it falls on you it's not necessarily employe it's you know was it the way that I gave or was I clear did I not give directions and Oftentimes you know not to say everything is is your way a lot of it it falls on the employer or the boss um you know at the end you you want them to be proactive you know you got to get away there's no way you can run a practice when you're micromanaging everything go insane I don't have enough time in the day to do that yeah and you have to give them and you have to give them responsibility and and Sure there'll be times where you you want to check up you know at there and and make sure that everything is is there but we have it so each person is accountable you know accountable regular basis and they have to report you know what what was done at the end of the week or end of the quarter what what have we done to to get exactly accomplished yeah yeah exactly and You know for the PA obviously you know I you know from the clinical side of the house I'm you know I'm I supervise her and so um you know I I really was watching you know to make sure her clinical Acumen was you know up to Snuff obviously like personality is great but you also want someone to be technically very good at their Craft um so that was a and she's you know she she's amazing but Um that you know obviously you have to check on that when you first hire someone because that does fall under your license so 100% 100% for sure so let's talk about uh again I I like talking about those early days sometimes they can could be pretty painful but I think a lot of lessons can be learned uh from those uh you know we have a number of people listening they're looking to start up their clinics you know um let's just talk About kind of the things that we often have to talk about like uh expenses and money um I think last time you did you told me you weren't uh inherited some big Fortune to start up your own no I wish uh what are what what what were some ways that perhaps you know did you did you boot strap your way did you take loans um are some things and what should we be spending money on you know when we yeah so I am did not yeah I didn't come from wealth or anything like that but um I also did not take any loans out I um started small and didn't spend a lot of money on overhead at the beginning um so I live in the DC area rent is extremely expensive around here um you know so there was a little intimidating but I started out small one very cool room essentially um that I decorated in a really funky way so People were like oh this is kind of neat they they thought it was very intentional even though I'm like this is all I could get right now um but uh that was okay and then I just because I was paying so little on rent to start out with I was able to save a lot of money and then um once that we were ready to move into a bigger space we were able to afford that as well As completely furnish the space which obviously was a massive expense but I had saved I I didn't let my like um lifestyle style flexs based on the money I was making I think a lot of people do that they start making more money suddenly they're you know driving $100,000 car and buying Chanel shoes like I wasn't doing all that I I was I recognized that there was something I was you little you know banking for for the future happen Cody my Business partner is like a money is a numbers guy so he also would keep me in check with that um because he runs he off he you know was tracking the books and everything um but I think you know you want to make sure you know what your long-term vision is because we all are have a tendency to want to fleux our lifestyle based on making more money um and It's really that's where you get in trouble you can't save like that I did not take any loans I think that you know some of my uh friends did and I think that's reasonable but just for me I didn't need it because I wasn't bringing in any huge machines at the time um I think for some places like aesthetic practices you do have need to have ringing lasers and all that kind of stuff which is you know great but You do probably need loans for these types of things um but for me I was you know Psychiatry practice the way I started I didn't need all that yeah and I tell them you know because as you know I run Med Spas I didn't get my first laser until eight years in practice right not necessarily have to be the first thing that that you want to do so you spent money not too much on the furniture and the decorations um now I did but this was after I had money can get the right so um what was your first besides your business partner what was your first hire or which so my first hire was Dr Ferell she's a um she's a therapist and um a couples therapists and you know an individual therapist so I so she would take all my therapy patients and we started marketing couples therapy um because Insurance isn't covers couples therapy anyway so It actually fell perfectly in line with the practice um and then we brought on an acupuncturist which I actually did have to invest some into like the very nice bed that we got and all of the acupuncture supplies um but that was just you know that that was you know quite a bit of I would say expense but I it was you know because I had saved money it was it ended up being totally fine and Then when I knew I was going out on maternity leave I knew I needed to bring another medical provider in so I brought in the PA and then another therapist as well what about ancillary stuff your PR desk or any any of those yeah so I actually spend a lot of money on that I did um most of that Cody and I would basically run the calls ourselves oh wow um so I at the beginning we didn't spend a lot of I mean the startup cost for me like Brooke you know Dr Chalet was her advice was like just get going with it you know obviously do the basics and just get going with it and I think that if I had waited around to have everything perfect I never would have gotten going you know gotten gotten off the ground um it would have been like wait for the perfect you know time to Do this or the perfect website if you wait around for that it just time goes by so fast you never get to it yeah yeah there there's never a perfect time I make x amount you know n can for this and sometimes you just need to do it no you just need to do and you know eventually you know like like I told you like next week our new version of our website's coming out it's going to be beautiful but Obviously like that took me some time to get the bandwidth to you know redo that once I had the new space set up so it's not as important initially I mean yes you want it from marketing you want it sort of nice for marketing but if you really want to refine it you have time to do that once you sort of are into business so What started bringing in the patience for you did you do your own ground uh you know game marketing yeah I uh we hustle we hustle I was I was getting coffee and lunch with every therapist other physicians in the area every single week about twice a week I was meeting face Toof face with internal medicine doctors um family practice doctors concierge physicians in the area therapists like women's health specialists um Cody was bringing Donuts to like concierge OBGYN practices just so We got our name out there we also um sent out a bunch of postcards with our name on it saying we were open we were taking new patients so I did you know we did invest some money into marketing um we started running some Google ads not not a ton but just enough so you could find us in the area and basically it was Word of Mouth it was my foot game I was in I was in all of these events I mean it was exhausting and what uh what compelled uh them to to sit down with you was it the donuts was it your sparkling I think they were actually surprised they were like wow we don't usually have doctors reaching out that people said that so many times we don't usually have doctors like reaching out to us like this um and I was like oh okay um and so they were like happily like wow and Then they'd start referring patients to me because we'd already had this conversation and they felt like you know we could collaborate on patients I also um you know became acquaintances with a concierge Internal Medicine um guy in in Oldtown Alexandria he and I sat for coffee we you know kind of talked about our the way we do business and he started sending me over patience and vice versa so I wanted to connect with like-minded people and If all of those different things that you did what you think had the most impact in terms of marketing or bringing in honestly sitting down with people I mean for me in this area it's it's this area is a lot of like getting your name out and reputation this is the DC area um and so um I think it helped a lot because I i' suddenly get referrals like oh my therapist knew this other doctor who mentioned your name and They you know sent us over here so it it was a lot of work at the beginning I did enjoy it because it was was something different than just my old 9 to-5 job of seeing patients all day so I was like getting dressed up going out for coffee I mean you know it was kind of fun and you know you were doing it for like your essentially your your child your business that you were forming so You I felt really like excited about it um and so you know that was that that went a long way I went to practices to visit I gave a couple talks at a couple local practices yeah I love it I love it and uh you know it's funny in in this era of internet and and social media and you know I have docs saying do I need a dance on Tik Tock you know at the end of the day I always Felt has the biggest impact is what my partner calls you know you have to have a great ground game you have to and uh like you said you know you're not too big to actually sit down and H and have you know coffee with your providers and and and you know if you have that mindset I I think you're really of missing the boat as you said it was kind of a breath of fresh air for them sitting down and Getting to really know them and yeah they were like like literally the amount of times I heard we've literally never had a doctor reach out to us like this um and I was like oh yeah and i' I'd have like at the time you know some people were still wanting to do Zoom it was 2022 so or I think the early 2022 so I i' do Zoom kind of coffee with other providers a couple of practices wanted to do like Zoom Calls with me with with all the members of their practice just so they kind of knew um I was out there and I became friends with some of the um other providers I mean I got to know people in the area myself um and uh yeah it's funny I don't even have I I keep saying I need to get an Instagram page for the practice because I know people do I don't have any social media for this practice and Somehow I feel like it makes it a little more mysterious and cool but I also know that like social media is a thing now that I may have to get on board with but I um I've done all of this with no social media yeah it's one thing but you know I tell them and I come from an online background marketing background you shouldn't be spending all that money on on Google and and Faceook if you haven't done the ground game yeah so essential yeah it's it's and honestly I got that idea from Dr challe I mean she um she's done an amazing job of connecting herself to therapists and physicians in her area and she's you know well known in that area and that's how she did it and so I was like oh that's interesting um and I model I kind of knew that that was what I figured this is a similar area urban area people know each other here and that worked for me so I I've very much valued that piece of advice you gave me well we're coming to the the end of your interview this has been amazing lots of great uh information and nugget for someone either considering opening up their own practice or perhaps you're out of practice right now and and Maybe it's a little bit stagnant uh get some great ideas to to kind of accelerate the process so any yeah any last minute thoughts or advice you you'd give to that those uh perhaps uh early practice uh owners out there yeah I mean just keep at it and let it grow organically and and sort of you know don't rush things be patient um organic growth was really big for me rather than cancerous growth also for people who are stuck in jobs I don't like and they want to open a business just do it it's the best thing ever I love my job I literally love I do sometimes I'm like is this seriously my job like it's so awesome um and not like I said last time not many doctors will say that about what they're doing so I I feel lucky I I I've just I'm having a really good time if somebody wanted to to reach out to you and Perhaps uh pick your brain as as someone else did for you a few years ago oh my gosh I'd love it what would be the best place for them to to reach out yeah email me um Dr kappus at District dwell.com but um and it's I would I would love to share any pieces of knowledge or help people out so feel free to reach out all right well wonderful Dr kappus again her uh practice is called District Psychiatry and Wellness you can go out check out her website we'll leave that in the show notes thank you for your time today it's been Illuminating it's good it's good to talk to you again it was even better the second time around all right thank you again and thank you for listening as always you're GNA have ups and downs in your business It's always important to seek out mentors find out people who maybe doing what you want to be doing seek them out Uh get their advice and keep moving