We would like to introduce you to Dr. Vasanth Kainkaryam, a DPC doctor who owns a practice in South Windsor, Connecticut called 4 Elements Direct Primary Care with an additional location in Rocky Hill, Connecticut. Dr. Vasanth has a very interesting DPC story and has been running his practice on HintOS since he started his practice in 2019.
Hint Health: How did you get started with your own practice? What was the defining moment that led you to begin your DPC journey?
Dr. Kainkaryam: I was introduced to what I later learned was "Direct Primary Care" about 8 years ago when I actually was starting an employer-based Direct Primary Care practice. All I knew at that time was that I loved everything I did, and my patients got great care. I took those lessons I learned and continued my journey up the corporate chain, and made it to the top. I then had an epiphany - the health care system couldn't be changed, it just had to be rebuilt, a little at a time. And it had to be built by those of us who were in it. I found myself in corporate medicine questioning a lot of things, until one day, I realized I had learned everything I needed to learn to feel confident to quit my executive job and build my own vision of health care.
Hint Health: Tell us a little more about the executive job in medicine that you had. In what ways did it show you how you didn't want to work as a doctor?
Dr. Kainkaryam: I was the Chief Medical Officer of a health center, and I was responsible for all of the medical operations and all of the clinical divisions. I thought I could help influence top down and we did a lot, but soon found the amount of regulations from federal, state as well as some of the quality accreditations actually limited some of the innovation due to so many rules.
However, the lessons on how I didn't want to work as a doctor come from all of my experiences. In many ways, the clinical structure in medicine is built from a financial one. It often starts with how much will insurance pay for x, y, and z? And then how much do you need to pay for staff [followed by how] you structure the duration of appointments, [and the] number of issues to address in each appointment based on the money. In DPC, you are freed from that model, and [patients] are paying for the relationship, not the transaction.
Hint Health: What did you see as unchangeable from the top of the corporate ladder? What limitations did you see that you had as a leader within the corporate system?
Dr. Kainkaryam: Generally, when a health care model is built on a financial model that undervalues the clinical services, there's only so much you can change. The more regulations you have, the less scope for innovation. The larger it is, the less nimble to make decisions quickly and change.
Now [in my DPC practice], if I want to change something, it's literally sometimes minutes between an idea and implementation. We go through rapid PDSA (plan-do-study-act) cycles with innovation and we can quickly make changes. I want something changed on my website, it takes me 5 minutes to do it max.
Hint Health: How long have you had your DPC practice?
Dr. Kainkaryam: I opened my practice in November 2019, a day after I left my previous job.
Hint Health: How did you come across DPC? Did you model after anyone?
Dr. Kainkaryam: When I worked under the umbrella of a joint initiative between a large health system in Connecticut 8 years ago and a healthcare startup company, I didn't know at that time that I was building an employer-based direct primary care practice. I was building a practice from scratch as the sole doctor initially where I didn't know how to build a practice, how to hire a team from scratch, how to review all compliance, but we had great support and a great team.
I loved everything I did - the patients I served, the way I practiced including texting patients 8 years ago! I did read some articles and books before starting my practice, but in some way, I had already built a practice from scratch. I had learned about regulations and compliance. I had a network of specialists. It was time for me to do my own thing.
Hint Health: In what ways has DPC improved how you practice medicine?
Dr. Kainkaryam: DPC has allowed me to mold myself as a physician to the needs of my patients. I've visited patients at home, at physical therapy, done walks with them. I've been able to break traditional barriers and have had multiple relationships with my patients - professional and personal. I've been able to help understand their needs and flex my own style of practice to suit them. It's amazing how much you can do as a doctor when you have control over how you do it. It has in a big way helped me educate my patients about the healthcare system, its flaws as well as its benefits so that they can become informed consumers.
Hint Health: What would you say is your defining purpose as a physician?
Dr. Kainkaryam: When I decided to open my practice, I stared at the Japanese concept of Ikigai for months - it is a symbolic representation where four things come together: what you are good at, what you love, what the world needs, and what you can be paid for. My practice is my Ikigai - it allows me to execute on my 4 Elements (4E) Philosophy: Engage, Educate, Empower and Encourage. And through this modality, I am able to do so many things -- be a doctor, an educator, a leader in the local community, [and] an advocate for small businesses. I think being a physician isn't just about being in an office, it's about being in the community as well. I find that everything I want to do and love to do, I am able to do in my own practice and the best part is, I don't have to get permission from anyone!
Hint Health: What aspect of medicine are you most passionate about?
Dr. Kainkaryam: I love incorporating multiple modalities in the care of individuals and really addressing social determinants not from just taking a survey but actually talking to my patients about them. I think we do a lot of lip service to social determinants but we don't actually do a good job in incorporating them in our practice -- be it in the choice [of] medications, recommendations for exercise, concrete offerings in the practice, etc. I also believe that there isn't always one path, and that people have a choice in how they want to care for themselves, and my role is to be their doctor and their guide in using the healthcare system so they can make informed decisions.
Hint Health: How do you think DPC can transform healthcare in this country?
Dr. Kainkaryam: DPC is a grassroots revolution. It represents patients and physicians taking back control and expressing their choices. And yes, we may not be able to change the experience of the entire health care system, but we can show people how it CAN be done, and inspire another set of doctors to do it. The best part of DPC is that EVERYONE wins! Patients are happy. Doctors love their work. Employers can offer their employees a great care model with expedited care. And even insurance companies benefit because of less claims going through their system due to DPC doctors.
The hardest part is that every doctor who does DPC takes a big risk to do so: they give up benefits, a salary, etc. but in return, they get freedom, choice, and the ability to BE their own brand. And while it may take a few difficult years to build, what you get in return is priceless.
Hint Health: You call yourself the Immigration Doctor. How did you come to offer immigration medical exams? Has this always been a part of your practice from the beginning?
Dr. Kainkaryam: I also own "CT Immigration Doctor" which is a service we provide. I have always offered immigration medical services right from the beginning. As an immigrant myself, I have been able to help thousands of people through their process in providing education, screening for communicable disease, and serving as a liaison at times with the USCIS (United States Citizenship and Immigration Services) and the CDC in times where there are questions on [an immigrant’s] admissibility from a medical standpoint. [These new migrants to the US] get to experience my style of medicine and many have become my DPC patients.
In addition, I speak about 8 languages, and have extensively traveled, so whether someone comes from Ghana and we talk about the Twi language, or from Peru and I share adventures my mom had looking for the Nazca lines, or from France and I talk about the time I lived in Switzerland and would do weekend getaways in Paris, or from India and I have full conversations in various Indian languages, I have found it exciting and fascinating to meet people from all over the world. And it gives me ideas on where to travel next. ;-)
Other services [we have] include a full scale aesthetics offering, massage, weight optimization with coaching and training, acupuncture for stress, and integrating such as clinical hypnosis in our model. And we recently launched our own skin care line under our brand "4 Elements Life."
Hint Health: We appreciate that you are a loyal HintOS customer and would love to know what problems you were having prior to using HintOS. How has HintOS solved these problems?
Dr. Kainkaryam: I think HintOS is a wonderful platform, and I've loved using it right from the beginning of my practice. It has great integrations, it's so automated, and has taken away a lot of work from me where I don't really think much about collecting payments, etc. Oftentimes, my patients are the ones reaching out to me letting me know they are going to pay a specific charge, etc. The platform is so easy to use and makes my life much easier.