As direct primary care continues to gain traction throughout the nation, we’re excited to see specialists also following suit and offering direct specialty care. It’s American Heart Month, so we’re highlighting the specialty of cardiology. Dr. Nicole Harkin, MD, FACC is a cardiologist who is also board certified in Internal Medicine, Nuclear Cardiology, Echocardiography and Clinical Lipidology. Dr. Harkin founded Whole Heart Cardiology in San Francisco, CA in the midst of the pandemic offering telehealth services only.
Prior to relocating to San Francisco, CA in the summer of 2020 with her family, Nicole Harkin, MD, FACC resided in New York City and worked in a traditional private practice at a part-time capacity since she was raising two children and just had her third child with her husband. After the move, Dr. Harkin deeply reflected on how she wanted to practice medicine and felt inspired by the doctors she came across on Facebook groups, who discussed the advantages of direct primary care and also noticed some specialists talking about direct care.
In 2022, Nicole Harkin, MD, FACC opened her physical clinic serving local patients in the Bay Area and continuing to offer telehealth to her patients in New York. Dr. Harkin is passionate about prevention and helping patients identify the root cause of their heart health issues as well as bring to light any cardiac risk factors. At Whole Heart Cardiology, patients receive personalized cardiac health plans to treat and prevent heart disease.
In medical school, Nicole was originally interested in infectious diseases and did work in Africa for malaria and HIV, but soon realized that chronic diseases are a much bigger problem and cardiovascular disease is the number one cause of death globally. This led her to complete a cardiology fellowship at New York University in addition to her Internal Medicine residency at Columbia University.
While Dr. Harkin treated patients with chronic heart disease, she also attracted many patients who had heart disease in the family and were interested in prevention. She wanted to provide as much guidance as possible to her patients focusing on cardiovascular disease prevention via lifestyle medicine.
Dr. Nicole Harkin admits that, “cardiologists are lucky if they get 10 minutes with a patient,” in the traditional fee-for-service health care system, which is insufficient to make any meaningful lifestyle changes. Making the leap to direct care, however, can be scary and like any major metropolitan area, the major health systems dominate. In the Bay area, these systems include Kaiser Permanente and UCSF. People are accustomed to seeking specialists through these health systems and their insurance. Therefore, some concerns that Dr. Harkin had included patient acceptance of the direct pay model and it working for her financially. Notwithstanding that she was in a new city and had to build an entirely new referral network.
However, Dr. Harkin did not let this fear stop her and she followed her own inner guidance in how she wanted to serve her patients and balance her personal life with work. Ultimately, she realized that patients want quality and high touch care that is only available with direct care. She was surprised to learn that a good number of her patients have Kaiser, but found her and want the care that she offers because “they want to be able to call their doctor.” Therefore, these patients still get their labs done through their insurance or Kaiser healthcare provider with Dr. Harkin facilitating.
Whole Heart Cardiology is preparing a membership plan for patients who need regular, continuous care, but has been operating on a per visit cash pay basis. Dr. Harkin realized that many patients already had membership with primary care doctors and so she did not want to stipulate a membership in order to receive care. There are patients who see Dr. Harkin to simply get a second opinion as well.
Dr. Harkin has a thorough intake process with all of her patients, getting a comprehensive family history, lifestyle questions, which include information on nutrition, movement, stress, sleep and behavioral changes as well as her patients’ goals. She focuses on evidence-based testing including advanced lipid testing and will do echoes and stress tests as well as coronary artery calcium scores as needed.
Learn more about Dr. Nicole Harkin and her direct care journey via the My DPC Story podcast hosted by Dr. Maryal Concepcion.