DAKOTAH ASHER

Dakotah Asher, PA-C, RT (R) Journey from FFS grind to DPC's patient-centered design

Dakota's practice now thrives, with quality care where empathy lives.

From Burnout to Breakthrough: One Physician Assistant's Journey in Revolutionizing Primary Care 

In the heart of Tennessee, a quiet revolution in healthcare is taking place. At its center stands Dakota, a passionate physician assistant (PA) who has transformed her frustration with the traditional healthcare system into a thriving direct primary care (DPC) practice. Her story is not just one of personal triumph, but a beacon of hope for both healthcare providers and patients alike, showcasing a model that prioritizes quality care over quantity of patients seen. 

The Path to Primary Care 

Dakota's journey into healthcare wasn't straightforward. Like many high school graduates, she felt pressured to choose a career path quickly. "We're kind of forced to think that we all have to go to college immediately after we graduate," Dakota reflects. "There are really no other options, and if you don't go to college, you're looked at as not doing anything with your life." 

A suggestion from her father after a hospital visit led Dakota to consider radiology. She enrolled in a health science bachelor's program with a concentration in radiology, but during her clinical rotations, she discovered her true calling. 

"I realized that I love patient care," Dakota explains. "I was able to connect with patients on a deep level." 

However, the brief interactions typical in radiology left her wanting more. She craved the opportunity to build lasting relationships with patients and see the impact of her care over time. This realization led her to explore other avenues in healthcare. 

The Physician Assistant Path: A Perfect Fit 

After taking a few years to travel and mature, Dakota found herself drawn back to healthcare at the age of 25. Her research led her to the physician assistant profession, a career that offered the perfect blend of patient care and medical decision-making, without the lengthy and costly path of medical school. 

"I discovered the physician assistant career field just by researching," Dakota says. "You know, we provide care just like a physician does, but the schooling was a lot less time and a lot less money financially to go to a PA program." 

In 2015, Dakota embarked on her PA education at South College of Knoxville, the same institution where she had earned her radiology degree. It was during this time that she found her true calling in primary care. 

"I specifically went into PA school wanting to focus on primary care because in that field, in this area of medicine, you're just really able to make deep connections with patients, really impact their lives," Dakota explains. "You know, you get to follow them through many decades of life. You really get to know who they are. They become almost like family." 

The Reality of Traditional Primary Care 

Armed with her PA degree and a passion for primary care, Dakota entered the workforce full of optimism. However, the reality of working in a traditional, insurance-driven primary care setting quickly dampened her enthusiasm. 

"I quickly realized that you cannot provide great care under insurance guidelines and restrictions," Dakota recalls. The financial realities of insurance reimbursements, particularly for PAs who receive only 80% of what physicians do for the same visit, created a system that prioritized quantity over quality. 

"In order to earn your keep, as you would say, I had to see a very high volume of patients in very short time periods, you know, about 15 minutes per patient," Dakota explains. "And a lot of the patients I was dealing with needed much more time than that to really be heard and listened to and to formulate a proper treatment plan." 

The constraints of this system left both Dakota and her patients frustrated. "If I wasn't able to take care of something in a 15-minute appointment, to have to tell them, 'Oh, well, you have to come back and see me,' but maybe my next appointment isn't for another two months, you know, availability wise. Or maybe they couldn't afford another copay, or they had issues with transportation, and they weren't able to come back." 

This cycle of rushed appointments and inadequate care took its toll. After two years in this setting, Dakota knew there had to be a better way to practice medicine. 

Discovering Direct Primary Care 

Dakota's search for a better way to provide healthcare led her to the concept of direct primary care (DPC). This model, which operates outside the traditional insurance system, immediately resonated with her vision of what primary care should be. 

"I started researching if there was a way to provide primary care without insurance. And that's where I found the direct primary care model, and it was exactly what I had been looking for," Dakota enthuses. "It was speaking my language. It was providers who were like-minded like myself in a community that wanted to provide better healthcare, but just needed more time to spend with patients." 

The DPC model offered everything Dakota had been yearning for: the ability to spend quality time with patients, the freedom to tailor care to individual needs, and the opportunity to build the deep, lasting relationships she had always envisioned in her career. 

Taking the Leap: Starting a DPC Practice 

Armed with this new knowledge and driven by her passion for better patient care, Dakota made the bold decision to leave her traditional practice and start her own DPC clinic. It was a daunting prospect, especially for a young provider only two years into her career. 

"It happened a little bit sooner than I had kind of anticipated, you know, being a young provider only two years into my career and starting my own business was a huge undertaking," Dakota admits. "But I was up for the challenge, and I knew that it was gonna work because I had just seen the population of patients that were getting 15-minute appointments in their primary care setting, and nothing – and they were just as sick as they were when they started coming there." 

Dakota's transition was supported by her husband, who helped with the financial aspects of starting the practice. She also brought with her a core group of loyal patients who believed in her vision. 

"I actually had about 85 patients that followed me once I left my previous practice," Dakota recalls. "So I started out with 85, which was pretty good, you know, to not even have the doors open yet and have that many people signed up." 

Building a Patient-Centered Practice 

From the very beginning, Dakota's focus was on creating an environment that put patients first. Every aspect of her practice was designed with patient comfort and care in mind. 

"It even boils down to the colors that we have on our walls are very calm and soothing. We play music in our office," Dakota explains. "I have six people that work for me, and they all are customer service-oriented because I really view primary care as customer service." 

This emphasis on patient experience extends to every interaction in the practice. "From the moment they walk into the door, they're met with a smiling face, all the way back to the nurses, to our providers, and then to the exit point of checkout. I mean, they really feel almost like royalty. And that's what we want." 

The DPC Difference: Time, Access, and Comprehensive Care 

At the heart of Dakota's DPC model is the luxury of time. Instead of the rushed 15-minute appointments typical in traditional practices, Dakota and her team spend anywhere from one to two hours with each patient. 

"We have about an hour to two-hour appointments with patients, really getting to listen to them," Dakota explains. This extended time allows for deeper discussions about health concerns, more thorough examinations, and the development of comprehensive treatment plans. 

But the benefits of DPC extend beyond just longer appointments. Dakota's practice offers a range of services that make it a one-stop shop for most of her patients' healthcare needs. 

"We are able to draw labs in house, we send them to a third-party lab. So Quest Diagnostics is the lab that we use," Dakota says. "But we draw labs and then, you know, they come and pick them up, or we're able to read them and treat based on whatever needs to be done." 

In addition to primary care and lab work, Dakota's practice offers weight loss management, hormone replacement for men and women, and is even planning to add aesthetic services like Botox. This comprehensive approach allows patients to receive a wide range of care under one roof, from a provider they know and trust. 

Growing Through Word of Mouth 

One of the most remarkable aspects of Dakota's success is that it has been achieved almost entirely through word-of-mouth referrals. In just four years, her patient panel has grown from 85 to an impressive 1,400 patients – all without any formal marketing or advertising. 

"We don't do any advertisement or any marketing. All of our patients just come from somebody who knows somebody who knows somebody who comes to see us and then they get referred to come and see us," Dakota explains. 

This organic growth speaks volumes about the quality of care Dakota and her team provide. Patients are so satisfied with their experience that they eagerly spread the word to friends and family. 

"We get phone calls all day long about, 'Oh, my friend comes to see you, and she feels the best she ever has.' So I wanna schedule an appointment," Dakota shares. The power of positive patient experiences has even led to referrals from other healthcare providers in the area. 

"We even have some physicians in our area that are in a primary care practice that even send patients to us to come see us for primary care because they just know the quality of care that we are able to provide is different than what they are able to." 

Navigating the Business Side of DPC 

While the patient care aspect of DPC aligned perfectly with Dakota's vision, running her own practice came with its own set of challenges. In the early days, Dakota found herself wearing multiple hats. 

"It wasn't till about I was in business for about a year that I was able to financially hire a nurse or hire somebody else to do the front desk. So I was doing it all. I was the nurse, I was triaging patients, I was drawing blood work, I was a provider, I was scheduling appointments," Dakota recalls. 

This period of intense multitasking required not just medical skills, but also business acumen and sheer determination. "If I didn't have passion and drive and know that this is something that I really wanted to do, it would have been really difficult for me to do that," Dakota admits. 

As the practice grew, Dakota was able to build a team to support her vision. She now has six employees, including nurses and front desk staff, all aligned with her patient-first philosophy. Recently, she even hired another PA to help manage the growing patient load. 

"I was kind of maxed out with the patients that I was able to see, you know, at about 1300. I was like, okay, you know, I need some help," Dakota explains. "We had patients that were calling that were having to be put on a waitlist because I just didn't have the capacity to care for them the way that we needed or that I thought that they deserved." 

The Technology Behind the Care 

To manage her growing practice efficiently, Dakota turned to technology designed specifically for DPC practices. She uses Atlas MD, an electronic medical record (EMR) system tailored for direct primary care. 

"The EMR that we use, the electronic medical record, is Atlas MD, and they are specific to direct primary care practices," Dakota explains. "So all of our billing, all of our communication, all of our patient information is there, so that is where we do all of our everything." 

This integrated system simplifies many aspects of practice management. "We don't have any other separate systems, which is really nice because it's very easy to use, and you don't have a bunch of different programs that you're trying to switch back and forth between," Dakota says. 

This technology choice aligns with Dakota's philosophy of keeping things simple and focused on patient care. "Our process is so simple that there's not a lot of ways that it can be complicated, you know. So keeping it simple is the best way to do it. And you don't have to have this complex program to really do what you need to do and provide good care. We think simple is best." 

Overcoming Skepticism and Legal Challenges 

While Dakota's practice has thrived, she acknowledges that there can be initial skepticism from some patients about a healthcare model that doesn't accept insurance. 

"One of the only apprehensions that I have ever seen is somebody saying like, 'Can you just...?' being shocked that you can provide healthcare without accepting insurance," Dakota shares. "So that's the main thing, like, 'Are you sure this is something you can do?'" 

This skepticism often stems from the deeply ingrained belief in the U.S. that health insurance is necessary to receive care. However, Dakota finds that most patients are actively seeking alternatives to traditional healthcare models. 

"More times than not, patients are seeking out a different way to receive healthcare because they don't get good care where their insurance is accepted, strictly because of the time constraints and just how insurance is set up for reimbursement with specifically primary care practices," Dakota explains. 

The legal landscape for DPC practices varies by state, and Dakota is fortunate to practice in Tennessee, which she describes as a "direct primary care friendly state." This means there is legislation in place that protects DPC practices from potential legal challenges from insurance companies. 

"We actually have legislation in place that protects us from insurance companies from coming in and trying to shut us down, saying that we're posing as a health insurance plan or whatever the case is," Dakota explains. This legal protection provides a stable foundation for DPC practices to operate and grow. 

Navigating Medicare and Medicaid 

One area that requires careful navigation in the DPC model is dealing with Medicare and Medicaid patients. Dakota's practice has found a way to serve these populations while staying within legal boundaries. 

"There's actually legislation that states that they are allowed to contract with a direct primary care clinic and still keep their benefits," Dakota explains. As a Medicare opt-out provider, Dakota doesn't file claims or receive reimbursement from Medicare, but she can still see Medicare patients who choose to pay out of pocket for her services. 

For Medicare patients, there's an additional step to ensure compliance. "We have to have them sign a form every two years that states they understand that we are not filing anything with their Medicare benefits, and they are also not allowed to ask Medicare to reimburse them for any services that they pay for out of pocket at our office," Dakota explains. 

This arrangement allows Dakota to serve a diverse patient population, including those on government health programs, while maintaining the integrity of her DPC model. 

The Impact on Patient Health and Satisfaction 

The true measure of success for any healthcare model is its impact on patient health and satisfaction. By this metric, Dakota's DPC practice is a resounding success. The ability to spend more time with patients, provide comprehensive care, and build lasting relationships has led to significant improvements in patient outcomes. 

"Our patients are extremely well taken care of," Dakota states proudly. "The relationships that we're able to make... our patients definitely feel the sincerity and really have the best care that we have to offer." 

This level of care and attention has resulted in patients feeling better than they have in years. The word-of-mouth referrals that drive the practice's growth are a testament to the positive experiences patients are having. 

Moreover, the DPC model allows for a level of accessibility that is rare in traditional practices. Patients have direct access to their provider, often able to reach out via phone or email with questions or concerns. This increased access can lead to earlier interventions and better management of chronic conditions. 

Advice for Aspiring DPC Providers 

For healthcare providers considering the switch to a DPC model, Dakota's journey offers valuable insights. When asked about the do's and don'ts of starting a DPC practice, Dakota focuses on the importance of passion and genuine care for patients. 

"Honestly, there's no 'don't' shockingly," Dakota says. "Some do's: it's really, you have to be compassionate about healthcare. That's first and foremost. If you don't really... and that's kind of one of my biggest pet peeves in healthcare, is people who choose healthcare as their career but don't like people. You know, that's never a good combination, and patients can tell if you're just going to work for a paycheck and you don't really care about their wellbeing." 

Dakota emphasizes that the challenges of starting and running a DPC practice require a deep commitment to the model and to patient care. "If I wasn't passionate about what I do, the hard work that I put in in the beginning to be a solo provider... it would have been really difficult for me to do that." 

She also notes that while marketing can be helpful, providing excellent care is the best way to grow a DPC practice. "We didn't do a lot of marketing. I think that just because of my experience with patients and just the quality of care I was able to provide them... that really helped a lot." 

The Future of DPC and Primary Care 

Dakota's success story is not just a personal triumph; it's a beacon of hope for the future of primary care. Her journey and achievements resonate with many providers who feel constrained by the limitations of traditional, insurance-driven practices. The Direct Primary Care (DPC) model, which Dakota champions, offers a refreshing and viable alternative that benefits both providers and patients. 



Dakota frequently receives emails from providers nationwide, all eager to learn how to transition into direct primary care. "Providers from all over the country reach out to me, asking how to start in direct primary care," she shares. "They're experiencing burnout in insurance-driven practices and feel they're not providing the quality of care their patients truly need." 

This growing interest in DPC highlights its potential to significantly shape the future of primary care. By prioritizing the patient-provider relationship and enabling more personalized and attentive care, the DPC model addresses many of the critical issues plaguing today's healthcare system. Providers can spend more time with their patients, fostering deeper connections and understanding, which leads to better overall care and patient satisfaction. 

Dakota's journey is a testament to the positive changes that DPC can bring. It’s not just about reducing burnout for providers, but also about transforming the patient experience. By focusing on quality over quantity, Dakota and her fellow DPC advocates are paving the way for a more compassionate and effective healthcare system. 

Conclusion: A Model for Patient-Centered Care 

Dakota's journey from a PA in a traditional setting to a successful DPC practice owner illustrates the potential of this innovative healthcare model. By removing the constraints of insurance-driven care, DPC allows providers to focus on what matters most: providing high-quality, personalized care to their patients. 

As healthcare continues to evolve, the DPC model offers a promising path forward. It empowers providers to practice medicine in a way that aligns with their values and gives patients the time, attention, and care they deserve. Dakota's story serves as an inspiration and a roadmap for those looking to revolutionize primary care, one patient at a time. 

Whether you're a healthcare provider considering a change or a patient seeking a more personalized healthcare experience, the Direct Primary Care model is worth exploring. It's not just a different way of doing business – it's a different way of caring for people, and that makes all the difference. 

Find her on google: Direct Primary Care Clinic Knoxville, TN 37938 or visit the website: www.integritymedicalknox.com