Dr. Kyle Rickner with Primary Health Partners! https://primary-healthpartners.com/
Emotionally Unavailable
Episode 49: Global
Well, good questions are very traumatic for me, I've learned, but look at us being vulnerable. This is so great. We're kind of friends here aren't we? Hey guys, today's guest is Dr. Kyle Rickner. He is one of the founders of primary health partners, so you will hear us talk about that. He was a medical director for the hospice that I worked for for a while. So anyways, hope that you enjoy this conversation with us. Hey Melissa. Hi. Can you hear me? Okay. Are you fine? I hear you just fine. Yep. Are you? I haven't seen your face in so long. I'm good. I'm good. Back from AK I'll refresh. Oh, I don't know if I would go that far. Well, good questions are very traumatic for me, I've learned. So, you know, dramatic or traumatic? Both, both, because I don't do messing up my routine very well. And so, and then especially when there's a lot of moving parts and a lot of people involved, I'm not great at it. I get overstimulated and overwhelmed in about a nanosecond. And, you know, I tend to, tend to blow things up a bit. I am. Yeah, I experienced a little bit of that. So, I had some challenges. And so, I'm better to vacay with few people. Me too. Very few. Yeah. It makes it hard if you have like more than one kid too, because when I say very few people, I mean, you know, the children, they complicate things no matter how old they are, because I want to, I want to take care of them and them have fun. But, really, I require a lot of self-care. Yes, that's true. Well, so, one of the reasons I wanted to have you on today, I never really got an opportunity to say this. Well, I probably did. But, you know, I'm real difficult with being vulnerable with people. So, that's why, you know, started this journey of emotional availability. But, I chose you because you have always just presented with so much compassion for people. And, I always just felt so safe in a room with you. And, every time you would explain something to us, for the audience, Dr. Rechner was our medical director for the hospice I worked for. And, yeah, you would always give like the best explanations to stuff. You never made anybody feel stupid. And, the one thing that really sticks out, like sticks out with me, this is such a silly thing. But, you were explaining like your body's natural cortisol release process to a nurse who was having issues with a patient who was having a lot of pain at night. I learned so much from you teaching us stuff like that in those meetings, but also just the way you teach is very kind. So, thank you. I've always been very kind with you. Well, thank you. That means a lot more. So, I'm getting a little misty. Oh, good. Look at us being vulnerable. This is so great already. So, do you think, and I mean, I'm sure I know the answer to this, but do you feel like that's always informed your practice? Oh, yeah, I think, let's see, I think the way I would talk about it is people might say that, oh, Dr. Ritter is very likable. And so, maybe more people came to see me because of that. But, I think the likability is more that I'm willing to identify with them, listen to them. Probably one of my biggest weaknesses is I can be a little bit too self- vulnerable with patience. I've gotten better about that over time, but it's, you know, so I'm, I'm willing, and I guess I'm able to connect with them on a deeper level. And at the end of the day, I think it just comes down to, you know, do you really care? I mean, you care. And so, yeah. So, that, I guess, came naturally for me. Well, can I ask you what your challenge was with feeling like you were being over vulnerable with your patience? I think that the challenge was, and it's a blessing and a curse, probably had you familiar with the term transference. So, people would actually start to view me more as a friend than a physician. And so, those lines would get blurred, in fact, a long time nurse of mine actually would get upset with some of my patients because a few of them just without thinking always called me by my first name. I wasn't too corrective around that. And, you know, so that that probably could be, it could be unhealthy. Right. You just had to have some better boundaries. Yeah. So, you battle that tension of connecting and identifying, but having those professional boundaries. So, there's a tension there. I've lived my whole career in. You know what? I can imagine because people like me, this is why I want to do more trauma-informed stuff with physicians. Because people like me, who have a little more leaning towards the anxious attachment style, the second anyone in a position of authority comes at us in a very compassionate way and even discloses information about themselves. Just, you know, you do, I'm really far along in this journey. So, I don't really do this anymore, but you do kind of go, oh, we have a different special thing going because that's my whole thing in life is needing to feel special and chosen. So, the second my brain could click in with someone and be like, oh my god, I'm special. And not like I thought they were like physically attracted to me or anything like that. But I was like, we're kind of friends here, aren't we? That's fine. But I mean, I can see that happening with you because I mean even, I would do that 100%. I'd be like, so I have the ability to like, you know, call you whenever, right? Because like, we're buddies. Well, and actually, I have run into stuff like that in my lifetime. But like I said, I've worked too long in that journey. So, I can definitely see where that would be. I'm just laughing with the dumb stuff I've done. But I do wonder, I know that you've been married forever. How many years? 35. 35. And you had very good examples of this as well, right? Yes. Yeah. So, I mean, you have to be at least a little emotionally available to make relationships work this long, right? Well, yeah, you would think so. I don't think that's going to, especially for men, we tend to gravitate towards a lot of our coping mechanism or our defense mechanisms can be a default of withdrawal and anger, even things that are that sort of emotionally disconnect. And so, we, you know, I still have to be mindful of those things because you, you know, you're most, you are most yourself when you're with that person that you're closest to. And so, you know, which gives me permission to not worry about her liking me sometimes. So, that's really, you know, being emotionally available can be seated in a little bit of a sickness where you're like, I'm really going to be available because I really want people to like me. And if I connect with people, they're going to like me more. And so, all of us want to be liked. And I want to be thought of well, but you can't let that get in the way of helping them and maintaining those professional boundaries where you can be effective for them. So, I think there's a there's a tension there. But in a long term marriage like ours, it's making sure I don't default to unhealthy stuff. And, you know, and us being willing to talk about it, and we are, and we still do. Yeah. Yeah, I think the communication part is so important, but where I really struggled for a lot of years, my poor husband, you know, was the type of communication because there was way too much I didn't understand about myself to really be able to communicate with him. For instance, I am very reactive, and I have a really extensive history of trauma from childhood. And I, before understanding my triggers, didn't understand that actually me talking about anything in a, even a slightly dysregulated state will get me very dysregulated very quickly. So, I had to learn to communicate with myself first and be like, what are you mad about now, my God? And then, you know, go have that combo with him. And also, so to me, I would say emotional availability is more of an understanding than an act. And I think it's been understanding what my triggers actually are, and what they're actually triggering. Because I could say, I'm really triggered by that, but I have zero idea what it was that did it, or why it did it. So, you know, and I think too, being emotionally available means being able to look at yourself and go, why do I care so much if that person likes me, even a patient? You know what I mean? But, you know, there's just those some that you perform a little differently for here and there, because of esteem or whatever. And I have really struggled with that in my lifetime. So, that's what I really have had to come to terms with is like, maybe not everybody's going like you. And that's okay, because right now you don't even like yourself. So, let's work on that. Maybe we'll care a little bit about what people think, but we really got to work on our self-love here. So, that's what I'm doing. But you are very popular. So, you know, you're doing something right. And what I wanted to talk, what I want people to know about is to about primary health partners, because I remember when you first told me about starting this, that I mean, it was so exciting. I will never forget. You'd be like, yeah, you remember that whole philosophy of like the little black bag? We're saying the little black phone. You know, like, you have access to us, but it's like the old way we practice medicine, blah, blah, blah. And I was like, oh, wow, this sounds amazing. So, do you want to talk a little bit about that? Yeah. We've been around for a little over eight and a half years now. We open in January of 16. And primary health partners is a direct primary care practice. We call ourselves a practice. We have several clinics, but we're one practice in several locations. And the entire premise is that it's relationship based healthcare. So, we're on a mission to restore the doctor-patient relationship, to bring time back into the equation of that interaction and not make things so transactional, but make them relational. So, in order to achieve that, we had to remove the third-party payer situation. We operate in this model where there's a monthly membership fee, like a gym membership. And then you've got access to your personal physician, unlimited appointments. If you have an emergency after hours, you can get them, you have a way to contact them. That's the analogy you brought up in black phone instead of a black bag to take care of patients. And so, we do that. And that's achieved through those doctors having a limited panel. So, not trying to take care of the world anymore, but taking care of the right number of people so that you're accessible and available. And you know what I found is that this is something that not only patients we're starving for, but doctors we're starving for. And even our staff love it because you're coming into a medical environment now where it's not the more is better philosophy. Right? No turning burn. No turning up with every single diagnosis code you possibly can. No, we don't have to play those games. Yeah, no rescheduling doctors appointments for labs for that because we didn't plan on that today. So, we have to code it this way. It's a very, very broken system. So, we're not going to try to operate play in or fix that system. We're just going to create this new one that makes the old one obsolete. So, yeah, that's been our mission. We do that. And the other side of it is it's actually very effective at helping people save money too. And so, healthcare is just kind of, we say we bring common sense to the chaos of medicine. There's so much cost and complexity in healthcare. And so, we try to, we try to be cost containment and be simple. And so, it's refreshing for those of us on this side of it that we, that we provide it, but the recipients on the other side are super loving it. Right now, about 56% of our patient population are just like individuals that join, just like individual join the gym. And then the other 44% are, this is an employee employer place benefit. So, yeah, it comes to their workplace benefit. So, which helps those companies save money. So, we, we love what we do. And it's really bringing, we're getting out of a sick model motif operating status quo into more of a health model. Yeah. So, we can be more proactive. We have the time. We, it's funny, we find doctors, primary care doctors are trained to do a lot of things. And we just have to have the time. And unfortunately, the status quo system churn and burn, as you said, is about not having time. So, you can do less. So, you have to refer more. And which helps their downstream efforts at revenue. So, we're just trying to turn all that on its head, because nobody I know is super satisfied with health care as we know it. So, although we're, we like to be that little niche that people are, they absolutely are happy with and satisfied with. Yeah. I don't know how yet, but for a while, I have been like, I want to do something like that with mental health care, like something that makes it so much more affordable. For now, I, the most affordable thing, I'm working out like a chat option, you know what I mean? Because I can, because I have like 95 for an hour, 50 for 30 minutes, but I want to offer like 50, like 30 minutes of like chat session, just in tools or whatever, a grounding technique, something like that, for like 25 or 30, you know, I mean, that's, that's where I'm at in the creative process right now, just because I'm doing so many things. So, it's like, you know, when you're the only one doing it, it's hard to make it all work. But down the road, I really want to find a model that will provide all the stuff that I'm doing. But, you know, I'm not the center of the thing. And, because that's one me. And, you know, when you have a dream to change the world, you know, you got, you got to leverage technology where you can. So, right. I love it. Yeah, that goes. But I mean, yeah, I was, when you started telling me about primary helping, I was like, you know, there's got to be a way to do that. And I see other people doing, you know, versions of that. I just, you know, technology's not really my friend. So, I met right now. So, I'm just waiting. But I do think it's important, because again, this is about people and about meeting people where they are. And I feel like you're really good at that, because even if it's obvious that your opinion is different than the person sitting in front of you, you, you know, at least you are able to sit there and hold space for them to say what they're thinking or feeling or whatever. I mean, you were my primary care doctor for a couple of years, you know, and little sweet Charlie's. And I'll just let the audience know that if you are chaos and calamity, like myself, and your card is constantly getting fraud on it. And then you have this automatic withdrawal for primary health partners, because I've been a member there for a long time, at least seven years. And, you know, you're not really paying your bill anymore, then they'll be so sweet to you when you send your money to deal with it. Because this just happened for the third time. And I was like, Brian, I had this huge to do list that I was like crying really hard about. I just was so overwhelmed. I'm like, okay, listen, one of the things I really need help with, will you please go to primary health and fix my account? Because I don't know what I've done now, and I knew that I needed to, at one point, they contacted me like, hey, girl, and I was like, oh, my gosh, my stupid card got, I had to trade for the card again or whatever, you know. But now I'm broke. So wait till Friday, and I'll go ahead and put that on my profile. Well, I got busy and didn't. And when I don't do something at the time that I was going to, then it's like on my back and just growing in intensity. So when I was like, please, will you just go take care of my primary health account? And so he did, and he's like, you're all good. And honey, I just went ahead and this is the second or third time he's had to do this too. Honey, I just went ahead and we're using my card now. Okay, like that. Well, good. Thank you, Brian, because, you know, I'll just be doing stuff like that sometimes, where I think I'm going to do something on time, and I don't, and they're always so kind about they're like, that's okay. Things happen. That is okay. That's great. Well, good. Yeah, we don't, we don't try to be harsh and mean on people stuff happens. We know that, you know. Yeah, well, and fraud happens. They're getting so good. Yeah, I just heard this thing yesterday, stressed me out and I was like, Oh, Captain, don't you listen to that anymore about a data breach? And I was like, I'm sure I'm going to be, you know, affected by that. But okay, that's fine. So then are you seeing patients at all yourself now? Are you just doing all this big, big stuff? Well, now three years ago, I cut my panel back to where I have a small panel. I probably spend about 20% of my time on clinical stuff. It's, you really can't, it's hard to recruit doctors, manage doctors and do all that if you're actually not playing a doctor. So, you'll lose the room really quick. So, and I don't, I still like my patient relationships. I, you know, I still want to do that. I don't want to lose that. You know, so yeah, I still see patients with about 20% of my time. That's cool. Is it kind of like whenever a teacher gets promoted to assistant principal and everyone's like, Girl, I'm not listening to you. Like, like, you're not in the classroom anymore. What do you know? It could be, you know, I don't know. Doctors are kind of, they would go unsaid or unspoken. But you know, the doctors that kind of quit being a doctor and just do whatever administrative work, that there is a little bit of a loss of respect. Yeah. So, I mean, from, and plus I don't want to give it up. I don't. Yeah. Yeah. Yeah. Yeah. I totally see that because like, I'm wanting private practice therapy to be the smallest portion of what I do. But I definitely want to do it. And I, I'm not getting like clients very fast. So I signed up, you know, on one of the big apps to work a little bit. And I was telling my son, I was like, man, I don't really want to do it. The pay is crap. And I feel like a sellout. And he was like, Hey, you need to be saying that you're a therapist. And that's what it's going to give you. And I was like, thank you 21 year old. I appreciate you. I was like, you're right. And I get free CE use with them, which I need. So boom, you're right. We're going to do it. So actually, the last step of that got done today. So they should be funneling clients my way. Awesome. Awesome. Yeah. Well, so how do you feel like you like, does, does work stuff ever like affect you? How do you keep a good work home balance in terms of your emotions? So I think there's a dynamic. So I founded primary health partners with Dr. Lockwood. So the two of us found together. So, and when we felt like we had a mission to grow this and bring it to as many people as possible, as a lot of people would understand, when you're when you start and own a business, you don't clock in and clock out, right? It's where all the time. So, that is a challenge to to not let it be not let the business be present all the time in your personal interactions. And so if I'm being honest, that was a there was a big struggle for a long time. You know, now we've got we've got enough wonderful people that that help with things. So it doesn't all end with me anymore. And so we've got great people that I trust. And so it's it's not as bad now. That that is a challenge to to be able to create that space. It was a lot easier, honestly, when I wasn't the owner of of something and didn't find something when I was just an employed physician. You know, get into your thing and and then and then you can kind of shut your so there is a there's a healthiness to that. And so that's part of the other thing we're trying to do here, primary health partners, is there's a lot of doctors that want to do direct primary care, but they actually don't want to start and own their own business to do it. Yeah, that's the majority don't. And so we're able to bring doctors in, employ them, kind of put them in an employment model, but but give them the freedom of direct primary care. And so I think that's a big reason why we've grown so much. Yeah. Well, I looked one day, this was probably over a year ago and you're in a lot of different states now too, right? Well, we have what are called I don't have practices that I own and operate in different states, but we have contractual relationships with a lot. Okay. So those are those are known as affiliates. And so some of the companies that we take care of, they have employees in other states. And so we contract with providers that are closer to those people to take care of those people. So those are those are what you see as affiliates on our on our website. And I think it's a beautiful thing because where else can you say I work for company X and we're going to have primary care available to all these employees in these five different states. And this is a workplace benefit and it goes across state lines. I mean, it's a it's a beautiful thing. Nobody else can do that name the large health system. They can't do that. They can't do that. So that's a beautiful thing. And so that part of things has grown quite a bit. There's been a big need for companies that have employees scattered and all over and how do they access care. Yeah. The historical way of doing that is to leverage these PPO national networks. But those are just satisfying to say the least. So we want a doctor patient relationship. So so that's that's what that is. So that's how we're operating in other states right now. Okay. Okay. That is wow. Yeah, that is a great idea because I can think of a couple companies that probably could really use that. Wow. I tried to talk to Brian about it because they my husband because they have to offer something. And I think it's real crappy and no one ever uses it or signs up. And I was like, you know, that you could just pay for primary health for them. And didn't that be that? But he doesn't like to make those types of decisions. He defers that stuff to his business partners. So he's like, yeah, that's one of those things. That's not my strength. So I'm not good. I'm not good. But his strength is, you know, fixing my account whenever I mess it up. So, you know, just we can't be good at everything. You know, it takes all rights around here. And it takes a village for me specifically. Okay, I got all these people that I'm like, please just help me keep keep it together because I got a lot going on. And as much as I, well, actually, the truth of the matter is I was quite chaotic in my early 20s. And then it's a shock. And then I was like, okay, we must be perfect at everything. So then I got really structured and organized and whatever. I mean, you know, as perfect as I was going to be. And then I had kind of a mental health crisis. And you don't have time for stupid stuff like perfectionism when you're in a mental health crisis. And so I was like, okay, just whatever. And I had to get really used to being late to everything, losing everything because my brain was just not functioning. I mean, I was in a very dark place. So memory retention, nothing was going well for me. And so I'd be like, Oh, yeah, I lost it. My bad about that. I don't know what I would say. I mean, because I didn't have any energy to be upset with myself or care if they were upset. So it kind of like got me in this place where I was like, you know, what's crazy is nothing bad happened at all. Like nobody died or anything. And I lost a lot of stuff and forgot a lot of stuff. And we're all just still managing our lives. Okay. So in losing some of my perfectionism, I've embraced a little bit more of my chaos and calamity. And I, you know, I try not to lose important stuff. But sometimes I don't, you know, put a new card on my primary health profile when I'm supposed to make my husband take care. I wish, I wish that you could have been there when he was explaining to me how much nobody cared, you know, like nobody cared. It's fine. And are you happy now? Because it's all good. You can go call Dr. Fair right now if you need to. I'm like, I don't need to. The point is, if I did, I couldn't. Right. Right. And just for the audience, you guys use a couple of different really useful communication apps too. Right. So we actually have one that is a patient portal app. So this allows you to see things in your chart. This allows the provider to send you results. This allows you to message the staff. You need a med refill or whatever. So that's more the day to day business type stuff, non-emergent type stuff. But then we do have a second app that we make available that, you know, if it's 7.38 o'clock at night, whatever starts happening and you're like, Oh crap, what do I do? Am I supposed to go to the emergency room? Well, no, the first answer is you're going to get in touch with Dr. Ferrell. And so we wanted people to be able to have that access to where, you know, they're making decisions. There's a lot of unnecessary emergency room and urgent care visits that happen in people's lives. And they don't really produce good medical outcomes. And they actually produce really poor financial outcomes. We try to help prevent those for our members. Well, I don't know if I've ever shared this with you, but whenever I was in my twenties, well, really, probably until I was like 25, I did not really have steady health insurance. I was awarded the state. And so once I graduated, I lost a lot of benefits and just didn't really have anyone to help support me. Well, again, I have chronic ear infections. Like, anybody who's ever looked in my ears is freaked out by them because they have holes all in them. And I mean, they're not as bad now, you know, because I quit smoking forever ago. But at the time, it was really bad. And they perforate every time and nasty stuff comes out of them every time. I was having to go to the ER for stuff like that, because I was so poor. At the time, it costed, well, urgent care wasn't a thing in my early twenties, just, you know, understand that. So to go to the doctor without insurance would cost like $150, $175. That's what they all charged. No matter what, I didn't even have a $25 copay if I did have insurance. I mean, I was a poor 20 year old, you know, and I have such trauma. I'm so serious from how much medical debt and how much ruined my credit for years, because am I going to be able to pay that $2,500 emergency room bill that I had to get for antibiotics for my ear infection? No. The only reason they ever got paid, Dr. Rayner, I'm going to be really honest with you is because then the hospital said, you know, wait, we'll garnish your check, honey. That's what we'll do. And then they did. They all did. Like at one time, I got one after another after another, it took probably three years to get every one of those paid off. But that was really good for your mental health, wasn't it? Yeah, exactly. Like, oh good. I already didn't have any money. Like now here it is. It's, you know, and I also had no understanding of how garnishment worked. I didn't know I could go to court and set an amount, you know, I learned that after the third one. Okay, honey, if you're getting garnished and you get it, don't be afraid to open the mail. First of all, that was my first problem. They probably did inform me and I was like, I can't deal with that trash. But you can go and you can say, hey, that's fine, but we need to set a reasonable amount. This is my paycheck. You may take $25, whatever, you know, that's not what they took for me. But, you know, you can do that. But it, man, now when my kids are hurt, I swear to you, the very first thought I have is, oh my God, this is going to cost me so much money. I'm so serious. And I can't help it because now, well, right now, mama is broke because I'm following a passion and it's not paying me yet. But it's going to, so it's fine. But my son has to have hardware removed from his shoulder. He had a break from jujitsu in September. Oh my God. The very first thought I had was, oh, I'm never going to recover from this. I mean, like, I'm so sad that my baby's like, you know, broken and stuff. But also, like, this is going to cost me so much money. And I remember one time, like, doing a phone call with you about Charlie, like, okay, she's not right. I'm a little worried she's got appendicitis, but I'd really like you to tell me you don't think that's what it is because I really don't want to take her to the ER. Turned out I was an nasty UTI, but that's fine. But I was like, emergency room bill. I mean, I just get so cringed out by it because it's ridiculous. You get a bill from the receptionist, you know, that's what we try to save people from. It's just you going to the emergency room for your infections is ridiculous. Not saying you were ridiculous. It's just ridiculous. I had to created that. You know, so what you really needed in your early 20s, if it was around, then, was a direct primary care membership. And that would have saved you, man, how much hassle, how much expense, unbelievable. So much because, you know, they charged interest and legal fees too. Oh, sure. I got all of that. And it was so cute and fun. I was really excited about that time in my life. But you know what? Once I got it all done and, you know, paid my student loans, like I was supposed to credit restored. What are you going to do? You know, that's great. Good job. I like avoid medical stuff at all costs until it's, you know, an issue because I'm like, Oh, no, no, no, no, no, no. If that's going to require anything outside of primary health, that's going to have to wait because that's expensive. And like, Jake is now, he's about to have the hardware removed from his shoulder. He got a skateboard from his friend. And the first day he walked out of my house with it, I was like, I don't want to be this person, but I'm not very happy with him right now. And then two hours later comes home, I hear him telling someone else that he fell and was like so scared. He had broken such and such. And I was like, I knew it. I knew that skateboard was a bad idea. So this morning, I was like, what if you didn't use the skateboard until everything is like completely healed, so that we can have one thing taken care of before we have to move on to the next, because you're also going to start jujitsu really hard again. And he's wrestling for the high school. So I'm like, I guess medical bills are just going to be a part of our future. And I'm sure you know all about that. Oh, yeah. Well, okay, I want to keep us to a short time because I have an appointment and you are busy, but I do appreciate you being here with me today. And I will make sure on the intro and the closing notes to give the primary health website. And is there any other information that you want to say? That'd be great. Okay, that'll be in the show notes. That'd be great. Is it okay if I tag you on Facebook with the post? Okay. Yeah, that'd be great. All right, we'll have a great rest of your day. All right, Melissa, you too. You buy your first name. All right. Take care, Melissa. Thank you. Bye-bye. Hey, what do you say? Listen, first and foremost, please make sure that you have provided this podcast with a five star rating on whichever platform that you are listening. If you want to support the show, please rate, like, and share. Also, like, comment, and share on any social media posts that you see for me on Instagram or Facebook or TikTok. Please follow the podcast Facebook, emotionally unavailable podcast. You can shop my foot online, store, or schedule a one-on-one with me, emotionally unavailablepodcast.org. I'm offering what I'm calling non-traditional counseling, astrology readings, and tarot readings, and self-publishing services. And thank you so much for listening to the emotionally unavailable podcast. All right, I hope you liked the episode of Dr. Reganir. In the show notes, I will put the website to primary health partners, and hope you guys enjoyed it. And until next time, let's all just keep swimming. ♪ Emotionally unavailable ♪ I-N-D-E-P-E, and cut.