Caring directly for the people

Name: Julie Gunther, M.D., spark MD, Boise, Idaho

Education

Undergraduate: Harvard University

Med school: University of Washington School of Medicine, Seattle

Residency: Ball Memorial Hospital, Muncie, Indiana

Gunther opened her direct primary care practice, spark MD(sparkmd.com), in downtown Boise in 2014. She is a board certified family physician who is passionate about her relationship with her patients. A Boise native, Gunther lives with her husband, two daughters and an extremely obedient three-legged Golden Retriever.

What do you like about being a direct primary care physician?

I didn’t realize how important nor how restorative autonomy is to being the doctor I wanted to be. I had a great moral conflict when my name was on the door of a clinic but I had no influence into a patient’s experience. I absolutely love having my own business.

I opened the spark MDby myself with a loan and a dream. My first patient in 2014was a previous patient of mine who fell and needed care before I was open. The space I was going to move into wasn’t renovated yet, so in the meantime, I moved into a space without air conditioning. My patients waited in their cars. Later, when I acquired more patients, my former nurse joined me.

Is there anything you don’t you like about being a direct primary care physician?

Direct primary care is a superior health care delivery model in my opinion, both for patients and providers. But just because I’ve changed to this model, it doesn’t mean the accountability with people is very different.

There are still patients who struggle to take care of themselves. Still people who don’t regard time or boundaries. Still people who want more from you than you can give. No matter what health care model you work in, you have to face the truth about whether you still want to take care of people. People are exceptionally imperfect.

There are a lot of physicians looking for alternative business models, but what they need to ask themselves is, “Do I still want to be in clinical medicine?”

One thing that’s different and may be uncomfortable for some is having the patient pay you. Also, growing a direct primary care business is slow. You have to believe in yourself and have a plan and, to be quite simple, to learn not to take things personally.

What surprised you about direct primary care?

One thing is how much work entrepreneurship is. I’m a workaholic, and I can take a beating. It doesn’t bother me; I just work harder and faster. But direct primary care can be a steep climb.

Another surprise is how the stress is different. This has been a nice surprise. I’m still stressed at work, but it’s not the stress that feels like it’s taking bone marrow from me. For me, owning my own clinic is empowering. It’s freeing. It’s work and stress, but it doesn’t feel like it’s killing me.

Another surprise about DPCis how much it lets patients see behind the scenes and learn what physicians really do. I have the opportunity to represent my profession to patients very differently. Another surprise was the direct primary care community, which is amazing in terms of mentorship. 

A few physicians who led the charge early on in this movement have set a remarkable standard of cooperative learning. When I found out about direct primary care, that put all of the pieces in place.

What advice would you give someone who wants to practice direct primary care?

Step one for anyone with interest in direct primary care is that you must fundamentally ask yourself if you still want to be a physician. That’s a really scary and hard question because physicians feel tired, trapped, burned out, scared… They don’t realize there is so much out in the world, so much they can do.

My recommendation is to take time off, think about what brings you joy. You can become something else if you no longer want to be a doctor. Entrepreneurship has so many forms.

Step two is to go to dpcfrontier.com, which has a map of all the declared direct primary care practices in the country. Find someone near you, call them, take them out to lunch and make arrangements to go see their clinic. From there, plug yourself into the direct primary care community. Google the phrase “direct primary care.” There are videos, talks and how-to books (one of which I’ve written) that’s all readily available.

Step three is to stop being afraid. I think the biggest risk is staying in medicine while hating it, and having it jeopardize your health, your marriage or your future. If you need to get out, get out and make your situation better.

Anything else?

I believe that one of the rewards that we owe ourselves is to find joy in our work. There are people who are so grateful for what a normal doctor tries to do.

Physicians are deserving of joy, and moments of joy are one of the greatest things about being human. I encourage my physician colleagues to be brave and believe in themselves. 

If they’ve grown away from the vision they had of being a doctor, they can get it back. They can get out there and be a great doctor, and people will pay for that.