Skip the Waiting Room: How House-Call Pediatrics Is Changing Child Care with Dr. Christy Rivers

[0:00] Imagine trying to get a pediatrician appointment for your newborn child only to be told that the doctor will see him in a year. What if there was something like DoorDash but for healthcare? Oh, I think in the old days they called that a house call. Today we’re going to talk to Dr. Christy Rivers about how she’s bringing back the classic model of healthcare with a modern twist. All right, this episode is perfect for parents who are busy, overwhelmed, or just looking for something different when it comes to healthcare for their kids. This is the PTCH.

[0:31] What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? But chiropractors and physical therapists don’t like each other. Oh, think again. I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger. I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH Podcast. Remember, there’s no I in PTCH. Oh, we did it. We’re back. Welcome to the PTCH Podcast. I’m Dr. Jason Young. I’m Dr. Kathy Lynch.

[1:01] Jason: All right. And we have our special guest with us here today, Dr. Christy Rivers.

Kathy: We have a real doctor with us.

Jason: A real doctor. Yeah. So but you are a DO. Is that because you couldn’t get into chiropractic school or PT school or like —

Christy: I did not apply to either of those schools. I’ll be 100% honest.

Jason: Okay. All right. Well, let me tell you all a little bit about Dr. Christy Rivers. She’s a board-certified pediatrician and the founder of New Way Pediatrics, which is

[1:32] an innovative in-home pediatric practice that’s based in Corvallis, Oregon. That’s where we are. Yep.

Kathy: Okay. She’s reimagining what it means to deliver family-centered care, bringing the doctor’s office to your doorstep. After years in a traditional clinic setting, Dr. Rivers launched her own direct care model that offers parents a monthly membership, same-day visits, and access to her through a dedicated app. So, thank you so much for being here.

Christy: Thank you for having me.

Jason: It’s going to be fun.

[2:02] Kathy: Super exciting. Before we jump into this though, we kind of need to brag on the show a little bit.

Jason: Yeah. We hit a couple milestones recently. Number one, we had a video that went over 10,000 views.

Kathy: That’s unbelievable.

Jason: It is unbelievable. You know, I remember when we were partying when we had 10 views. Nine of those were me.

Kathy: Lots of burner accounts, ladies and gentlemen. No, but apparently they’ve discovered the PTCH Podcast in India.

Jason: So, hello to our friends in India.

[2:32] And we had one that not only went over 10,000, it went to 18,000.

Kathy: Well, last time I checked. So far. So far — by the time — I mean, we could be at a million.

Jason: A million by the time this comes out.

Kathy: That’s right.

Jason: Yeah. So,

Kathy: that’s what we’re hoping for.

Jason: And as always, you can get your swag, your PTCH Podcast swag. I think that they do ship to India.

Kathy: I don’t know. Maybe it’s super expensive. It’s going to cost you like a bazillion rupees to get —

[3:02] this shirt right here in India. Yeah.

Jason: So, yeah. Thank you to everybody who’s been supporting us and hopefully we’re providing good content for you that matters in your life. And that being said, we should get to it.

Kathy: Let’s do it.

Jason: Yes. So excited to have you here, Dr. Christy Rivers. Can I just call you Christy on the show? But to the rest of you, she’s Dr. Rivers.

Christy: That’s right.

Kathy: So, you want to start with your patented question? The one that you love to ask.

[3:32] Jason: The one?

Kathy: Yeah. The one that you ask everybody.

Jason: Okay. What motivated you to leave traditional practice?

Kathy: Oh, you ask everybody. Everybody. All right.

Jason: Yeah, she likes to come right in with a why. Like, what are you doing?

Kathy: What’s your why?

Christy: I think my why — I mean, I know I left primary care. I was at the Corvallis Clinic for 11 years and had a great run there. But it was starting to be too busy and I couldn’t do care the way I

[4:04] wanted to do care. I think the best way to do care when you are a pediatrician is to watch kids grow up. That’s fun, and to be there. Like, I remember a parent who came in for a meet-and-greet when she was pregnant and kind of admitted that she wasn’t excited to be a mom, but here she is. And then last time I saw them, both of their kids are there and this family is hilarious and they always seem to get ear infections right before they go on vacation. So then they come in and I get to help them. And that’s what I love

[4:35] about pediatrics — is watching kids grow from that and watching parents go from being unsure to being confident later. And I was missing that because I would have patients that would be seeing other doctors at the same time that I’m seeing their patients. The model has sort of changed. So it’s just trying to get people in the door. And I don’t think that’s the best kind of care. I think the best kind of care is knowing your patients really well, to celebrate the good things as well. It’s not always when they’re sick, but also like I take

[5:05] care of teenagers who do competitions and sports and stuff, and getting to celebrate with them when they get a college scholarship or whatever — like, that’s part of it. And you miss that if you don’t get to see your own patients.

Jason: Sweet. So we just heard it here — if she’s seeing your kids, you’re guaranteed to get them a sports scholarship.

Kathy: That’s exactly what she said.

Jason: I’m pretty sure that’s what it was. Yeah, we can roll that back. 90% sure.

Christy: If only I could guarantee that for my own high school senior right now.

Kathy: Yeah.

[5:36] Jason: Oh man. Yeah. I know after the show my sons are going to be like, “Dad, let’s get me in to see her.” Yeah, please. Well, I think that’s the frustration that a lot of providers seem to have with healthcare. Healthcare is inundated. It’s overrun. And I don’t think that there’s anybody who gets into healthcare because they just want to see a bazillion patients for very little

[6:07] amount of time. So yeah. So why did you become a doctor in the first place? Because I wanted to help people. Oh, really? The same reason everybody — they say don’t say that at your med school interviews, but it’s like, but that’s true. And I wanted to do pediatrics, because in medical school, that is like — when you’re studying pediatrics I always wanted to read more, and when I was studying other

[6:37] things it was work. Proctology was work. Yep, yep. So unless it was like pediatric constipation, and then it became interesting. So I thought, well, for your whole life you’re going to have to be continuing to learn stuff, so be a pediatrician. And sorry, go ahead. I was just going to say, I’ve always heard the tagline that kids are not just small adults. That is true. Which makes it interesting to be a pediatrician, I assume. I don’t know why anyone would want to be

[7:08] any other kind of doctor. Yeah. Because kids are not small adults. So you get — I also love talking to my patients. That’s something that I enjoy, because they’re hilarious, and if you don’t talk to them you miss out on that. And so, I mean, I ask kids like, “What do you like to eat? What do you like to drink?” And I hear normal things mostly, but sometimes they’ll throw out pickle juice or something. It’s like, “Okay, nobody said that to me before.” Right. I would miss that. “Why are you here for your appointment today?” “Sewing lessons.”

[7:39] Okay. Okay. I think you’re going to walk away disappointed. But I appreciate that. At least I know how, you know, whip out the suture kit, or right, that. So now in direct primary care I could maybe do that more, which is sort of the fun thing. I have time to do that sort of thing. And if I knew that — I don’t know that I’d whip out a suture kit for a four-year-old. That seems dangerous. But Oh, you mean in terms of you could show

[8:09] a kid like, this is how — I have time to do this. Oh, that’s cool. Yeah. So like make your own little doctors. The future. We got to grow the practice somehow. The — the world of pediatrics and healthcare, because we’re short of doctors. So yeah, it seems like we’re short of doctors of like every kind. Oh yeah, we’re short of every kind. Yeah. I mean, we got enough physical therapists, but there’s too many. No, I don’t know. People wait to get into physical therapy. Yeah. I mean, just — but seriously, every kind of doctor there’s a wait for. Yes. So, can you give us an idea of

[8:42] like, in a clinic setting, if somebody’s out there working in a hospital, like what is a day like? What’s so frustrating about that? What is it like? And what do you want it to be like? Because I’m sure you’re not alone. Yeah. So working in a clinic — I have worked in a hospital, but working in a clinic, which is what I did before — I would see between 20 and 22 patients a day. And that means 20-minute appointments

[9:13] mostly. So sometimes that’s plenty of time to look in an ear. That’s plenty of time. But for a mom who just had a baby and is worried that she’s not doing a good job, or for a child who is bouncing all over the room and it’s really hard to manage the child and also talk about the child, that is not enough time to do things. Because it gets stressful for everybody, right? It’s stressful for everybody. Yeah. And that really means you don’t have time to prep charts the way

[9:43] — or you’re one of those doctors that’s there till 8:00 every night or whatever, and all of that burns people out. Mhm. So now that I have time, I have gone through the charts of all of my patients — like before I go see them I spend a lot more time to know — and they were, so far all of the patients in my practice are patients that have followed me, and it’s surprising to me how many things I have forgotten about the patients, because it happened a few years ago but it’s still part of who they are. And so now I have

[10:15] time to know that before I walk into their room. So, 20 patients a day — I think I did it pretty well. You try to get your notes done as soon as you can. So I would always be sitting and typing while looking. I’m pretty good at typing, but I can look at them and type at the same time, which kids think is a superpower, by the way. But I could do that. And then try to close the note as soon as possible. A bad day — I always have the saying like, if it’s a bad day for me, then it

[10:46] was probably a bad day for a patient. So trying to have grace about that. But if it’s a bad day for me, that means that I’m making people run really late, because I have to call specialists and I don’t have time for that. And so then everybody else gets even less time because you’re compressing it — and then you stay late to finish those notes, and then you go home, and then you do it again the next day. And so that’s what it was like before. And what I think it’s nicer to have it be like — well, one other thing about that is, if it takes six months or

[11:17] a year to get in to see your doctor, and so you save up a list of all the things that you want to talk to your doctor about when you finally get there, and you show up and you have 20 minutes — and so the doctor’s like, which thing do you want to talk about, your headache or your back or your stomach? And it’s like, I want to talk about all of those things, because I waited six months. And your 20-minute appointment started an hour and a half ago, right? Yeah. I was pretty good at running more on time than that. But yes, and you know, okay,

[11:48] well, if I have to schedule with you to talk now about the stomach, that’s going to be another six months. Yeah. So I just don’t buy that as good healthcare, because I think probably the headache and the stomachache, they very well might be related. And if you take the time to hear all of it — which every doctor wants to do, it’s not that the doctor doesn’t want to do that — but we didn’t have the opportunity. So now all of my visits I plan are just going to be at least an hour. That doesn’t mean they all take an hour,

[12:18] but I plan for that to be the case because that also gives time to look at the race cars they want to show me and read a book and watch them today. It was like dive onto their couch over and over. Sure, I’ll watch you do that. That’s kind of fun. That’s important. So that — that’s right. Those dives, stick the landing. Yes. Yes. So, that’s what I think a better way of doing things is — that is much more sustainable and much more joy-filling — is to be able to go see a kid dive on a couch. Like, that’s actually

[12:49] fun. And I learn how does the mom manage this child running all over the place. And it’s not like I’m sitting there judging, right? Most of the time I’m sitting there thinking, man, they are nailing it. Like, they’re doing such a good job. Like, yeah. You kind of like take some notes. Yeah. Yeah. Right. Do it again. If I were going to do it again because my kids are 17 and 19. I could learn from my patient parents. Yeah. So what’s it look like to be one of your patients now? I come to your house. They love it

[13:22] because it’s like a famous person shows up, which — I love that. I feel famous. They — you’re dating yourself. I did watch that show. These kids have not. Yes. And then usually they want to show me some toy or something like that or a project they’re working on, their backyard, whatever. So, get to do that. I’ve read stories to kids because they want to do that. Oh, that’s so cool. Yeah. And then we do the exam. One thing that’s a little different — that’s a little awkward — that

[13:52] I’m getting used to is all the things that I used to do in office now I’m doing in front of them in their house. So, as I’m getting my Wi-Fi hooked up to my hotspot and you know opening like — they’re just watching all that — and before you do all that stuff in your office. But people understand and I have told all the families like, I am — I am really good at being a pediatrician. I am not really good at technology. I am not — like, I have not run a business before. So when you see things that I could do

[14:22] better, just tell me, because I want to be excellent at everything. And so we work well together for that. So what do you see this becoming — like, when you imagine peak New Way Pediatrics, what do you see that it could eventually grow into? So this is not brand new — like, it is brand new for me and it is new in Corvallis. Nobody else is doing this, and actually in the state of Oregon when I started I couldn’t find any other pediatricians that were doing it. Not

[14:54] the case anymore, but because it’s growing so fast, because so many people want a better way of doing healthcare. Yeah. But nationwide this has been going on and the movement is building. So I’m wearing my DPC shirt, which is direct primary care, because in two days it’s direct primary care day — because that’s also the start of open enrollment and so people have a choice what they want to do and they could choose direct primary care. But in answer to Corvallis, I envision having a full practice, which I

[15:24] don’t know exactly how many patients that looks like yet. In general, direct primary care doctors have between 150 and 600 patients, just depending on so many circumstances. At the Corvallis clinic, they told me I had a little more than 2,000. So, just to keep it in perspective — a lot — like, but that’s why you can’t get same-day access and things like that. And then I would love to have partnerships with people who do family medicine or internal medicine. I’d love parents to be able to be involved in

[15:55] this model as well. I’d love to do partnerships with mental health professionals. So, we could just have this really strong network of people who care about great access to care. Kind of an invisible clinic. Yeah. And I don’t know — can’t walk into the building, but the clinic comes to see you all there. And it might be that there is a building, because there are some people that love home visits, but there’s also some people that maybe feel awkward with you coming to their home. Yeah. My wife would be like,

[16:25] “Kids, you better clean this place up.” Like, and that’s not my goal. That’s not — people don’t need to do that. Wash the walls. Wash the walls. Right. The doctor is coming. Yes. You have to dust the top of the fan. Yeah. I mean, you can always just say like, “Our house is always usually clean, but just ‘cause she’s sick.” And I could be like, “Of course, of course I couldn’t clean.” I think one of the best strategies though that I see is when people go and they like clean their house, it gets all like perfect and everything. Then we show up, they’re like, “Uh, I’m sorry.

[16:56] This place is such a dump. Oh, it usually looks better than this. I’m so mad.” And then I feel like, gosh, I’m glad you’re not seeing my house. This is your house in a mess. Yeah, that’s what that whole tactic is about. We had a great conversation a couple weeks ago and I thought one of the coolest things you were telling me is you got a phone call from a mom like, do I need to go to urgent care, and you were like — that’s me. That’s right. Yeah. I was a mom who

[17:27] thought their child — her child — maybe had a broken arm and wanted to know if I thought they should go to urgent care and I said no, I will stop at your house in like half an hour. We’ll look at it. Yeah. And then I sent her to get X-rays and it wasn’t broken. That same mom has had another child who has had a broken arm since then. There is no concern about abuse in this family, I promise. They just have busy kids. But that one I didn’t even go see because

[17:57] she sent me a picture and so I ordered an X-ray and then it was broken, so I sent to the specialist — to a hand doctor. So nice. Didn’t have to go sit at urgent care for 3 hours. Yeah. That’s awesome. Yeah. I want my primary care to — Sure. Hello. Thank you. Well, and there’s some things that probably just work better at home. Like, I think about blood pressure — you know, the most accurate blood pressure that people take is the blood pressure they’re taking at home because they’re not stressed out being in a doctor’s office or something like that. Uh, that whole thing about you know,

[18:30] Kids banging themselves up — it reminds me of when my kids were really young and we were on like the WIC, Women, Infants, and Children, where they give you like the medical care and like more cheese than any human being could ever eat. But we could always tell when it was time for one of our WIC checkups where you had to take the kid in and get the exam, because like our daughter would go and like run into a doorknob and give herself a black eye or something like that and she’s like, “Ah, geez.” Or it’s

[19:00] like that’s when she’d put her hand on a stove and it’s like, “Well, well, oh, yep. Tomorrow’s the appointment.” Yeah. So it’s like, “Geez, that’s so tough.”

Kathy: Well, when those things happen, I always tell people my worst parenting moment, because everybody has them. So that was my son. I put him in his car seat and I was driving down the freeway and had to slam on the brakes, and then I hear screaming and I looked in the back and he wasn’t in his seat.

So I didn’t buckle him in and I was on the freeway and couldn’t get to him, and

[19:31] so he’s okay.

Jason: Yes.

Kathy: But I — I just think also sharing those stories makes everybody feel a little more human, like —

Jason: My wife doesn’t have any of those stories and the house is very clean. So —

Kathy: I’m sure — if only we could understand what — yeah, right.

Jason: You can’t relate.

Kathy: No, it’s not. It’s not. If we could all be me in your family — — make too many mistakes.

Jason: So, how do parents react when they find out that something like this is available? Are they pretty excited about it, or do they get kind of

[20:02] like, what’s going on?

Kathy: I think it’s both. So I think everybody thinks it’s exciting. Here’s how it works: you get an app. So when you sign up, in order to put you into my electronic medical record, you register and the app is part of it. So then people can send me questions and everything comes to me. There’s not a secretary middleman in between.

And then I respond, and so they sign up, and then we do the best kind of care possible. So sometimes that’s in the

[20:33] app. Sometimes I’ll then call because it’s easier than texting. Sometimes it’ll turn into an appointment. Nobody doesn’t think that’s a good idea — like, that seems good for everybody. The thing that throws people is that I don’t take insurance. And that is something that — I get that — but insurance is not

always the answer that everybody thinks it’s going to be. And —

Jason: Is another way to say that that health insurance is kind of a scam?

[21:03] Kathy: Don’t put words in my mouth. I think it’s useful if you’re in a bad car accident and need the ICU for a while — that is, thank goodness for health insurance. But

health insurance is kind of bizarre because it doesn’t function like any other insurance, right?

Jason: No.

Kathy: We all have auto insurance, but I’m not looking to get anything out of my auto insurance. In an average year, if I can go the whole year and I don’t have to file any claims,

Jason: that’s a good year, right? Yay. Right.

[21:33] But if I get in a car crash, yes, I need to have insurance. But not with health insurance. People show up and like, “I have rights, you know, give me an adjustment. I’m entitled to this many adjustments every year because I have health insurance.” Which is kind of weird because there’s no other insurance that’s like that. So sometimes people get a little freaked out about the idea of a cash-pay thing, but — I’m not saying don’t go get

[22:04] health insurance — but if people spent on actual health care what they spent on health insurance,

Kathy: they would probably save a whole bunch of money.

Jason: This is true.

Kathy: Yeah.

Jason: Most people would.

Kathy: Yeah. Because most people are healthy. Yes, right.

Jason: Yep. Yep.

Kathy: And so it’s the health insurance — it’s more useful when you’re really sick, but it’s like, if you know, you had to pay out of pocket for, you know, vaccines for your kids and you

[22:34] know, maybe a prescription here or there and a few visits, as opposed to having to pay $20,000 in the year and then an extra $5,000 on top of that which is your deductible

before you get any.

Jason: And you often don’t know how much you’re going to pay. There are people who still have good insurance.

Kathy: Yeah.

Jason: Most people have high-deductible plans, and so you have the privilege of paying — for me it was like $900 a month for me and for my family — and then I’d get a bill from whoever saying I went to

[23:06] physical therapy and this is $194.

And so I get to pay that on top of my insurance, and that’s the negotiated rate. But I have now called a physical therapist’s office to find out what the cash rate is and it’s like $175, and it’s like, oh, so it was either the same or more with the insurance that I paid for.

Kathy: So I do encourage families to have insurance because that does cover vaccines, that does cover

[23:36] X-rays, ambulance rides, things like that. I have had — MRI — when you go to a specialist, those sorts of things. But it doesn’t even have to be insurance. There’s more and more alternatives to insurance now, like health shares and things like that, that are kind of like insurance used to be, where people pay into a pot and then when you really need it for those high-cost things, then you can get the money back. But

day-to-day, you’re saying you’re a

[24:06] cash-pay patient. And so for instance, I ordered a urinalysis lab for somebody today and the rate I can get it for as a cash-pay doctor is $3 — I think it was $3.27. Might have been 72 cents. But anyway, urinalysis and culture, less than $4. So I don’t know what their insurance would charge for that, but when I have used labs for insurance, I’ve never seen a bill less than at least like $25. And so a lot of times you do pay more

[24:36] because of those negotiated fees that insurances have. So

I get it that it’s a big change to not use insurance,

but I also know time is valuable and access is important, and I think — yeah, I have a direct primary care doctor too now and it’s fantastic because I can send her messages and ask about

whatever, and she responds to me and I don’t have to wait. So it’s good. But she’s not in Corvallis because there are

[25:06] Jason: None here. So, that’s my dream. Kathy: All right. Jason: Yeah. If you know any family medicine people who want to see adults — Kathy: I want to keep the kids, at least for now. Jason: Or internal medicine. Kathy: Yeah. Jason: If anyone’s listening and they want to — Corvallis is a beautiful place to live. Kathy: It really is. Jason: Come to Corvallis. And I hear the flights from India are very, very affordable. A one-way flight from, you know, New Delhi or something like that. Certainly. Kathy: Yeah, absolutely. Jason: Yeah.

[25:36] Kathy: The climate’s a little different. Jason: It’s roughly the same. Kathy: You might appreciate the other — Jason: True. It’s maybe 20° cooler. So, yeah, that’s good. Kathy: Mhm. Jason: Well, that’s really great information. So how does yours work then? You say that it’s cash-based. Every time you show up to somebody’s house, are people like — here’s a check or no?

[26:06] Jason: Like how do you handle that? Kathy: So, here’s the process. You call me, you say I want to be your patient. And I say — Jason: You’re too old. Kathy: Yeah. I say to you — and I say your family’s too perfect for me. Jason: You have a great beard, sir. Kathy: Yes. But that’s for Jason. For anybody else, if they call and they have children, then I say, “Let’s have a meet and greet,” which isn’t necessarily a — like if I already know you, I’m still going to have this conversation because I want to make sure they understand what the model is.

[26:37] And that is done just by telephone or a Google Meet or something online. And then I send them an enrollment link and they sign up if they want to, and with that they start getting automatic payments. So they put in their either credit card or bank account number and my EMR bills them once a month. So if they — if I show up at their house, I have a family, I’m going to go see them for the third time

[27:07] tomorrow in the last week. Because they have a sick child and hopefully he’s better tomorrow, but I’m going to go see him tomorrow for the third time. There’s no extra cost for that and there’s been texts in between. Same price as for the family that I haven’t seen at all this month. Jason: So I was thinking this — like sometimes when I tell my kids this — sometimes when you win you lose and sometimes when you lose you win. So you’re losing because you have to pay in those months where, just like for the gym or Netflix, you have to pay whether you use it or

[27:37] not, but you’re winning because you don’t need a health appointment. But when you’re losing on the health front, you’re winning because your doctor doesn’t charge you more every single time you need to talk to them. Kathy: Okay. Jason: Yeah. So they can just send me a message too to say, “Hey, is this something I need to see you for?” And Kathy: I love to be able to say, “These are all the things to watch for. Let me know if this happens.” So, yeah. Jason: And I don’t know if this is true, but I remember hearing that there are some cultures where you pay your doctor the

[28:08] months that you’re well. Because that’s their job — is to help you to stay well. Kathy: Yeah. I don’t know where that is, but, or if the climate is nice there. Jason: Maybe India. Kathy: Yeah, it could be India. We’ve come full circle. Jason: Must be it. That must be it. Kathy: Well, that is so cool. Jason: Okay, so you’re using the app. Kathy: Using the app. Some — another thing some people are saying — right now while I’m trying to grow the practice, I will do one-time visits. So

[28:39] like this morning I did a tongue-tie procedure and they’re not my patient, but I can help them with that. So I went and did that for them at their house. And so I can do one-time things. My members are my priority. And yeah, but if someone’s interested and they don’t — right now, like I’ve also had a family say, “Well, for this year, we’ve kind of used up our HSA money, but we’re planning on starting with you next year.” And so we’re factoring that

[29:11] in differently. And so — HSA is health savings account. Jason: Yes. Right. So people can pay into that. You can use it for health expenses. It’s like tax-free. Kathy: Yeah. Jason: It’s a good way to go. Kathy: That’s a good way to sell it. Jason: So yeah. And I think some people have those and they don’t even realize that they have them, right? Or like an FSA. And it’s kind of funny because they’re all of a sudden surprised. Wait, I’ve got $5,000. Jason: $5,000. Kathy: Squirreling it away. Jason: Yeah. Wow. You didn’t even know. You just found it.

[29:42] Kathy: Yeah, exactly. And they’re like — good savings plan, so you don’t need to spend it. Jason: Can I buy my own X-ray machine? You know, so are these the conversations in your house? How much ibuprofen can I buy? So, well, let me ask you a question with a little bit of context, because we sat down and we talked a while ago and one of your questions for me was, okay, you’re a chiropractor. What do you think about vaccines?

[30:12] And I think I might have surprised you with my answer. Kathy: No, you didn’t surprise me. Jason: I didn’t? If I knew the answer, I wouldn’t have asked. Kathy: Yeah. So, is that — especially in our hippie-dippy community? No. Like, is that a difficult thing to have to kind of navigate these days — going through that vaccination conversation with parents? And I’ll just make a disclaimer. I like vaccines. I’ve been vaccinated myself and — you know, my kids have been vaccinated — that’s none

[30:42] of your business — but, you know, vaccines save lives and the evidence is really, really good for it. Kathy: Yes. Jason: So, is that a difficult thing to work through with some parents? Kathy: I would say that is sort of bread-and-butter pediatrics. So it is in the news now way more than it has been ever before, and we have leaders now that are calling it into question, but it’s not new that we had those kinds of conversations. So it is tricky as a pediatrician that people trust us on all these crazy

[31:14] things that we are willing — like they want antibiotics, they want hormone blockers, they want all these things, and then vaccines, which are incredibly well-studied, right? They don’t — they look for their own evidence. So that’s frustrating because it’s like, you want me to be evidence-based for everything except this. Mhm. But I believe that parents are trying to do what’s best for their kids and I’m trying to do what’s best for their kids, and we’re just going to have a conversation that hopefully is very

[31:44] respectful, and ultimately I can work with anybody. So if they don’t want vaccines, then I tell people we’ll have to agree to disagree. So I’m going to think that this is the best choice. Every time we have a well visit, I’m just going to tell you what they’re due for and if there’s anything going on in the community — which, you know, more and more there’s measles. I read an article about diphtheria is on the rise, because

[32:16] Kathy: I remember having diphtheria. Oh, wait. No, I don’t. Because a vaccine.

Jason: Probably not. Probably you don’t. Yeah. I’ve never seen a case of diphtheria. So, you know, we’re getting to a world where — yeah, knock on wood — where the doctors haven’t — I mean, I’ve read about it, but we’re — I don’t know that you want to have your child have these sorts of things. But anyway, we can have these conversations. If it is in the community, sometimes people change their minds, like measles feels really far

[32:46] away, but when there’s an outbreak, then they want to get the vaccine. So that’s what I feel like my job as an educator is — to just let people know, and then if they say no thank you, then I will say okay and we’ll talk about other things, because there’s a lot more to the doctor-parent-child relationship than just vaccines. So yeah, I will take care of people who don’t vaccinate or do different vaccine schedules, but that’s not what I would recommend, because I try to follow the guidelines.

[33:16] Jason: Yeah. That sounds familiar. It’s like, “Do you ever recommend that people exercise or something like that?”

Kathy: Once in a while I do. Once in a while.

Jason: And then they’re like — “Also sleep.” They’re like, “Yeah, I don’t agree with that.” And it’s like, “Okay, well, what did you expect?” So, my goodness.

Kathy: I know. Every once in a while I’ll have somebody who will come to see me and they’re like, “Yeah, so I’ve got this problem and I don’t want any adjustments.” Which, fine. I don’t have to do an adjustment. I also don’t want

[33:46] to exercise. Okay. And I don’t like to be touched. Like, I will pray for you.

Jason: Yes. Bow your head. Let’s — let’s — let’s do this.

Kathy: And I believe in the power of prayer. I don’t know that I’d go — go to your office for that. Like, there’s other places.

Jason: I can’t bill your insurance company for a good prayer. Right. So yeah, it’s kind of funny. But I think one thing that is — because I had somebody like that the other day and she came in and she told me — she started

[34:17] by telling me all the things that she did not want me to do. And the thing that was interesting was by the end of the conversation she’s like, I would like all of those things.

Jason: Yeah. And the reason is — I think people have ideas about what health care is going to be, and I think people approach it really fearfully sometimes, because they’re afraid of a needle or

[34:48] they’re afraid of bad news or they’re afraid of whatever it is. But if you can listen to people, you can have a good relationship with people, if you can laugh with people sometimes, then you have that trust and then they’re going to be okay with anything. And I think that’s probably something that the home-based model really lends itself to — like, if I’m on my turf and you’re coming to my turf and I can feel comfortable here, I’m probably going to

[35:20] end up being a lot more comfortable with your recommendations too. Is that something that you find?

Kathy: Yeah, so far all of the families that I have in my practice right now — they all vaccinate. There are a couple who are not doing the COVID vaccine, which I still recommend. But I do think that doing them at home is so much better. I was just saying before that it’s great to go into the home, and also I didn’t do vaccines when I was at

[35:52] the Corvallis clinic — the medical assistants did — but now I mean, I’m a doctor. I have the ability to give vaccines.

Jason: You can do that. They gave you a needle.

Kathy: They let me. They let me. And so I go and they’re playing and running around. So all that anxious energy — if they know I’m there for shots, they can let out their steam by running around while I’m talking to the parents and getting things ready. And then we give the shot and then they can run around and have all their comfort objects right there.

[36:23] And so it’s really not nearly the big deal that it is in the doctor’s office. Last week I gave vaccines to a child who — the mom said, “Do you remember last year when I came in the office, we couldn’t do it, because his reaction was hiding under the table and screaming, and this year we were able to do it.” And that’s a huge win.

Jason: Yeah, because the kid was playing PlayStation and you just —

Kathy: He did. Yes. And I mean — they do that in the office too, but it’s not like it’s necessarily — they don’t like shots any better at home than they do. They really try hard to tell me

[36:55] how much they don’t like shots.

Jason: I don’t like shots anywhere.

Kathy: No, that’s what I tell them. I don’t like them either, but they save lives, so I don’t like other things worse.

Jason: So when I hear you — when I hear the idea that you’re accessible by app all the time — like, how are you going to balance —

Kathy: So —

Jason: How are you going to balance your work life?

Kathy: Yes. So I would say that the app is available to the families all of the time. Yeah. And I tell — that’s part of that meet-and-greet conversation is

[37:27] I check the app between 8 and 5, like business hours. Yeah. Families do have the phone number to the clinic, and I — it’s on my cell. Like, I have two — I learned how to do that technology of two different SIMs on my phone, and if you’re my patient, your phone number is in my phone, so it will actually ring through my do not disturb. So if you need me, then you call me 24/7. And so far, nobody has done that. Like,

[37:58] because the whole goal is you send me a message in the afternoon during business hours and say, “What do you need me to call for?” Somebody’s listening. They’re like, “I’m going to be the first. I’m going to do —” Well, and if you’re abusing it, then we might not be the best fit, right? But the goal is that that’s not the case, and that you get such great quality care during the day that you know you don’t need me at night. But if you do need me at night, I will be there for you. And then when I go on vacation,

[38:29] there is another doctor who is my backup person, so people can — and we share. So that’s cool. So there is — and it’s not 24/7. Like, they get very good access, but you know, my phone is off right now, in case you wondered. So if they’re calling me, I have no idea. And it’s the same when I go see a patient — I’m not checking my phone. I don’t — I insist on not having an Apple Watch. Like, I don’t want to be that connected. And I go to the forest for walks and stuff sometimes. So if you need me, you

[39:00] send it to me, but I have a little time to get back to you. You can still be a person. Yes. What? And a happier one. And you still probably get to talk to me sooner than you did before, because you’re on my phone. Yeah. Right. And you’re getting better care. Yeah. There’s no doubt about that. I do want to be clear that I think the doctors are still giving great care. It’s just the whole system is broken up. They definitely are. It’s the system. Yes. Yeah. It’s not —

[39:30] Which I know you were saying that too, but I just — Yep. Yep. Yeah. Healthcare is not the problem. Healthcare delivery is the problem. And I think — I think I have this right, but one of my favorite trivia questions out there is: if you stop paying doctors — like you quit paying every single healthcare provider — how much would that save in the American healthcare system? Like, how much would that decrease the overall

[40:00] cost of healthcare? Right? The answer will shock you. I think it’s 8%. I believe that — which is insane. That’s not the last — because you think about neurosurgeons getting paid like $800,000 a year, and they deserve every dime, right? And I think your average physician is making about $250,000 a year. So it’s not like most doctors are being underpaid. It’s just there is so much crap piled on top of that

[40:30] that getting paid $250,000 or whatever it is in order to do a job you love is one thing. Getting paid $250,000 and doing mostly what you don’t love — it’s still good pay, but it comes at a cost that definitely is your soul. Yeah. Well, it sucks your soul. I’ve had times in practice where I’ve just been managing too many patients, going over stress, doing notes late at night, all

[41:01] that kind of stuff. And the thought that goes through my mind is that I am trading my health for other people’s health. And yikes — it just doesn’t feel good. It’s not sustainable. That’s a word that you’ve thrown out there a few times. So yeah, you know what is sustainable though? Games. Game time. Time to play. I think we should play a game. And when we talked about this, you requested the hardest game that we could possibly — I just was so afraid — possibly come up with. No, you’re going

[41:31] to do great on this. So in this game, you are going to choose one or the other. You can’t choose both, right? Okay. Sometimes you’re going to choose something that’s better, and other times you’re going to be choosing the lesser of two evils. And so you just have to make a decision and you have to make it quick. I don’t know what I’m choosing for. You don’t know what you’re choosing between. No, we’re just going to jump into this. We’ll just kind of alternate on this. Can you see that? Is that large enough for you there, Dr. Kathy? Got it. Okay. Ready? Here we go.

[42:01] Disposable diapers or cloth diapers? Cloth. Gummy vitamins or chewable tablets? Chewable tablets. Diaper blowout or projectile vomit? Uh, which one do we keep? Okay, we’re going to keep the blowout. Oh, wow. Breast milk or formula? Breast milk. Screen time or sugar? Oh, man. Screen time can be educational. Okay. Oh, Band-Aid or kiss from mom?

[42:31] Kiss from mom. Yeah, sorry, Band-Aid. You could still be a sponsor though, Band-Aid, if you’re listening. Johnson and Johnson — they’re very important. Talking to you, Johnson and Johnson. Usually both, but you said I had to choose. Yeah, you do. Chickenpox party or vaccine? Vaccine every day. All right. Vaccine party. How about that? Could you put him in like a Nerf — like, the doctor who figures that out?

[43:01] Yes. Genius. And also going to be the recipient of a very large lawsuit. Okay. All right. Back on track. Here we go. Snot sucker or humidifier? Snot sucker. Okay. Snot on your sleeve or glitter in the carpet? What? Oh man. Snot on the sleeve. All right. Toddler nap or parental nap? Oh, parental nap. Stethoscope or thermometer? Got to get rid of one of them. Which one do you

[43:31] keep? Kathy: Stethoscope. Jason: All right. Kathy: Bluey or Sesame Street? Jason: Sesame Street. Kathy: Oh my God. Let’s go. Gen X. Jason: That’s what I watch. Kathy: Yes. Jason: Yes. Kathy: All right. Bubble bath or baby wipes? Jason: Baby wipes. Kathy: Pacifier or thumb sucking? Jason: Pacifier. Kathy: Doctor’s office or house call? Jason: Ooh, house call. Kathy: Toddler tantrum or teenage attitude? Jason: Toddler tantrum. Kathy: You can laugh at them. Jason: Yeah. Kathy: You can. Teenagers. No. Jason: And you can’t kill the teenagers.

[44:01] Lego injury or scooter injury? Jason: Lego. But they hurt just the same. Kathy: Oh my gosh. Fruit snacks or fruit leather? Jason: Fruit leather. Kathy: Okay. Lullaby or bedtime story? Jason: Bedtime story. Kathy: Okay. Coughing kid in your car or crayon on your wall? Jason: Coughing— Kathy: Coughing kid in your car or crayon on the wall. Jason: Crayon on the wall. Kathy: Yeah. Okay. I think she got 100%. Yeah, I love those kinds of games. Kathy: You went 20 for 20. Jason: All right. I had to answer. Kathy: I told you that you were going to do

[44:31] well. I told you you were going to do well. Jason: That makes me want to go through and explain all of it, though. Kathy: Okay. Well, pick one or two that you feel strongly about that you want to explain. This is why I picked it. Jason: Well, I’ll tell you that the reason I chose cloth diaper is because that’s what we did. Kathy: Okay. Jason: And so, I don’t want anyone who uses disposable diapers to think anything bad about that, because you just do what you do. I was at a time — I was in residency when I had babies, and it was

[45:01] like there were just a couple areas where I had any control over anything, and so I was like, well, this is going to be one of the control areas, and I got to be in control. And my husband was the stay-at-home parent, so he did all the — so, you know, I — Kathy: You’re like, guess what, buddy, Jason: we’re doing — you’re doing the cloth diapers. Jason: And then I also think screen time, you know, it gets a bad rap as it should, but I mean, you have screens in front of you. Screens also are a

[45:31] great — people can’t see, but there are a hundred bajillion screens over there. Kathy: Scott has a problem. This is actually a screen problem. Yes. Jason: This whole podcast is an intervention. It is. Yeah. Scott, we love you, but we’re no longer willing to enable. Kathy: Yes. Jason: You said you should have some sugar. Kathy: Yes. Totally get some sugar. Right. Yeah. So,

[46:01] and we all know why you chose Sesame Street. Sesame Street’s dope. We love it. Jason: Yeah. Kathy: Big Bird. Jason: Well, good stuff. So, Kathy, takeaways. Kathy: You know, I think this is awesome. I wish my doctor did house calls, to be honest. Jason: Someday. Yeah. Kathy: Yeah. Jason: Yeah. And for me, it gets me fired up about seeing something that’s just different, because it — sometimes healthcare seems hopeless whenever you’re looking at the big thing, because we’re only finding models that

[46:32] add to that pile of things and not models that are delivering better care all the time. And so, bravo to you for doing something that’s so brave, so different, and it seems like it’s really making you happy, though. Guest: I am pretty happy. Jason: Good. And I’m sure it’s doing that for your patients, too. So, Guest: hope so. Jason: All right. So, somebody wants to find out more about you or get in touch with you, how do they do that? Guest: They can go to New Way Pediatrics — newwaypediatrics.com. They can find me and

[47:03] click “contact me” and send me a message, and I will respond to them. My phone number’s on there, too. They can also call, either way. Jason: Great. And we’ll make sure to put that in the show notes and everything like that. So, whether you’re on Spotify or YouTube or whatever you’re on, if you go to the caption or the description of the episode, we’re going to put the links to Dr. River’s website there. And immensely grateful for you coming and doing this with us. This was so fun. Kathy: Yeah. And

[47:35] reminder to all of you to like and subscribe, because boy do I love saying those words — like and subscribe. So you want to be an early adopter, right? One day when Joe Rogan is asking if he can come on our show. And we don’t do smelling salts or smoke weed on the show, so sadly, Joe. But you want to say that you were an early adopter — like, you were one of the cool kids. So yes. And oh gosh, there’s one

[48:06] thing that I forgot. Yep, there’s no I in PTCH.