Happy St. Patrick’s Day

St Patrick’s Day has always been a fun holiday (maybe because green is my favorite color!).  I’ve always enjoyed celebrating, and I love the idea of luck—this magical force that is on your side.

This past year, I visited Ireland on a walking retreat, and that experience clarified two things for me:

First, I rediscovered that I LOVE medicine, and I needed to keep practicing as much as I needed air, water, and shelter.

Second, I learned what it feels like when I can trust that my comfort and needs matter, and will be taken care of.

The Irish love a good story, so indulge me as I share this one with you here—

One day, we set off on the Dingle Way, and our plan was to walk to the next village over, about eight miles.  It was one of those days where the rain was sideways, pelting our faces, laced with slivers of sleet, our hair whipping as we walked along the shore.  My “waterproof” hiking shoes were SOAKED within five minutes, and what started as a fun adventure quickly became a slog with wrinkled feet and miserable bone-chilling cold seeping into my core.  I looked over at my hiking partner, and her face was full of pain from an aching hip, blisters on her toes, and a day made for dementors’ delight.  We finally rounded a corner, and there, in front of us was the sweetest “true mirage” I have ever seen—The Stonehouse Restaurant. 

The Stonehouse Restaurant, Ventry Ireland

It wasn’t even a question. We trudged up the hill, opened the front door, flooding the beautiful stone floors with a torrent of water.  The restaurant-owner, David, immediately came over, welcomed us, directed us to the warmest tables right next to the wood burning stove, and mopped up our puddles while the waitress brought us all steaming hot fragrant bowls of vegetable soup and platters of fish and chips with Irish coffees all around.  Not once did either complain, as we descended upon their peaceful oasis with our cold hands, dripping packs and hungry mouths. Our comfort was their primary concern.  They made the Irish Coffees extra strong and regaled us with Irish tales as we all bailed on hiking for the rest of the day and waited hours for our ride to take us to the next stop, staying long after closing time for the restaurant.  By the end of the long afternoon, The Stonehouse felt like a second home, and we wondered how we had ever been strangers. 

That experience has stayed with me, because it was my first experience with Irish luck—this magical force that is always on your side.

And just like the Irish, at Ultra Primary Care, your comfort is the heart of the experience, and you always have someone on your side.

Our office is bright and inviting, and we often meet in our “parlor” for initial consultations, complete with a fireplace and comfy chairs.  We don’t have a waiting room, because we don’t want your schedule to be held hostage by ours, and we take the anxiety out of medicine by giving you the assurance that comes from knowing someone is in your corner, bringing a piece of that Irish luck to Roanoke, Virginia. 

If this sounds like something you need in your life, schedule a Meet and Greet phone call to feel the Ultra Primary Care (and Irish!) difference. We’d love to have you.

What I realized (about what insurance really covers)

Insurance doesn’t pay as much as I thought. I recently looked at my personal insurance rider, and I am responsible for all medical costs up to $2000 except for routine medical care! That means, in scenario #1, I would be responsible for $1325!

Here’s an example of how hidden insurance costs can add up—

The Old Way:  Let’s look at what happens when you see your primary care doctor in the traditional, fee-for-service system.

1. You wake up with a cough, and call to get an appointment in a few days. You have the appointment, and it costs a co-pay of $25.  Your doctor does an x-ray that day and sends it out to radiology.  Your doctor bills insurance $125 for the whole visit.

2. Some time later, you get an EOB (explanation of benefits), which shows that you owe an extra $20 for that visit.  The new $20 charge is for the “co-insurance”.  In this case, that’s 20% of $100.

3. Then, you get a bill from the radiologist for $40.  They charged $200 for the x-ray and the interpretation, and you had to pay 20% of that bill. 

4. You aren’t better.  You call your doctor back.  You get an appointment in seven days. While waiting for that appointment you get much worse.  You go to Urgent Care and pay the $75 co-pay. 

5. They send you to the emergency room, where you have a CT, receive IV antibiotics, and are sent home after eight hours. The emergency room co-pay is $200, and then you have 20% of the $1000 bill from the ER. You return to work after two weeks.

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The New Way:  Let’s look at the same scenario from a Direct Primary Care standpoint.

1. You pay your monthly direct primary care membership fee (you can use your flexible spending dollars to pay that fee).

2. You wake up that morning with a cough, and you call me. I see you that afternoon, virtually. You pay NOTHING.  I order an x-ray and radiology reads it. You use insurance, and it still costs you $40 (20% of $200).

3. You aren’t better. You call me.  I need to assess you further, and offer an in-person visit the same day.  I call in an antibiotic and tell you to use over the counter cough medication.  You use your insurance to pay for the medications, which are generic, for $10.

4. I check in with you by phone the next day, and you feel like you are getting better, but the cough is keeping you up.  I call in a different cough suppressant, and you get some sleep (the biggest factor in getting better).  It costs another $10.

5. We do another phone check-in and you tell me you are getting better.  I tell you to call me for more shortness of breath, a new fever, or feeling weaker.

6. You have the peace of mind knowing that if any of those things happen, you will be able to get the medical care you need.  You return to work in a week.

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Now granted, there were a lot of assumptions in the scenario above. Needing to go to the ER is a worst case scenario, and doesn’t happen often. And, even if you are able to access care early, sometimes an ER visit is unavoidable. But, in general, earlier access to care and treatment translates to an earlier recovery.

The beauty of direct primary care is that it allows me to keep my panel small and manageable because of the monthly fee. That fee essentially preserves your access, and it means that you can get the care you need when you need it.  The peace of mind that comes from knowing I have your back can make all the difference.

Insurance Charges:

Co-Pay: office visit $25

Co-Insurance office visit: $20

Co-Pay Urgent Care: $75

Co-Pay Emergency Room: $200

Co-insurance ER: $200

Medication: $20

Total (if deductible is met): $540

Total (if deductible is not met): $1325

Direct Primary Care Charges:

Monthly fee: $100

X-ray fee: $40

Medication: $20

Total: $160

Dr. Christy Arthur’s Journey to Direct Primary Care

As a child, I suffered from recurrent bouts of strep throat, and I got to know my pediatrician, Dr. Gower, very well. Even though I was just a child, his patience and presence allowed me to feel heard. From the age of nine, I have wanted to do for others what he had done for me—treating me compassionately so I got better faster.

When I started practicing family medicine at Carilion, I enjoyed forming relationships with patients. Spending time talking about what was going on in their LIFE (not just in their disease) fulfilled me and inspired me. And over the years, my panel grew. In 2021, when I departed traditional fee-for-service medicine, I was listed as the primary care physician for over three thousand patients. My schedule was packed, and I was consistently frustrated that not only were the demands to physically see patients in the office increasing, the administrative side tasks (like fighting with insurance to get a CT scan approved) were becoming more numerous. In addition, I had taken on many administrative responsibilities, and it was challenging for me to delegate or ask for help. The result was that I was feeling stressed and rushed, I was not showing up as the physician I wanted to be, and it was taking its toll on me and my family.

Then, the CoVID-19 pandemic happened, and we all learned that the next day isn’t promised and it became more urgent to make each day count. I journaled, hiked, took up mountain biking, re-dedicated myself to meditation and practicing yoga, and all of that allowed me to slow down and listen.

And, two things became very clear. The first was that when I thought about medicine, one part I liked the most was the coaching. It required deep listening, asking the right questions, meeting the patient where they were and helping them figure out how to move forward. Several of my friends are life coaches, and they encouraged me to become certified. After completing a program through the Healthcare Coaching Institute, I am an Associate Certified Coach through the International Coach Federation, and I have opened my private coaching business, called More Than Doctor. And while I enjoy helping young physicians to see things differently, coaching them through the stresses of the medical system helped me to see things differently too.

And that led to the second thing that became clear. Continuing to practice medicine in my previous hospital-owned practice was not allowing me the environment I needed to pursue my purpose. I shifted to working in a flex capacity, filling in for doctors throughout the New River and Roanoke Valleys. And, I fell in love with medicine again. The flex pool doesn’t have all the administrative burden of carrying a large panel. I had the opportunity to practice in smaller offices and I liked the collegiality a small practice affords. At the same time, I missed “knowing” my patients, getting to see them more than once, and continuing the story into the next visit.

I had learned of direct primary care years ago when I went to a conference in April of 2016, but I just wasn’t ready. It has taken six long years for that seed of inspiration to take root and grow, and now I am finally ready for this next step. All the pieces are falling into place, I have the support of my husband and family, and THIS is what I have been seeking.

The direct primary care model makes possible what I was missing the most—more time with patients, so I can use coaching skills; flexibility to do things differently, so I can structure my schedule with time for coaching and medicine; and time for self-care, so I can be the type of wife, mother, physician and coach that I was meant to be.

My vision is to impart inclusive, sustainable, revolutionary human care with great compassion and mutual respect through use an inclusive direct payment system that allows our patients to receive mental and physical care in a timely, respectful and compassionate manner, so they can achieve ultra health and we can all heal. I want each patient to feel welcomed, respected, and well (not just free of disease, or “better” from an acute problem). I envision using coaching to help patients overcome mental issues that are contributing to physical issues, and I will continue to coach individuals who aren’t members of Ultra Primary Care as well.

It’s been a worthwhile journey to have brought me to this specific point in time, on the precipice of opening my own practice, delivering medicine in a way honors you, the patient. I can’t wait to share this dream with you—I believe everyone deserves to live their purpose. Thank you for helping me live mine.