Population Health

Dr. Rebecca Byard opened her family medicine practice in October 2021, just before the Omicron variant sent COVID-19 cases skyrocketing. She’s the only physician in her Pittsburgh office, and recruiting patients has required patience. After five months, she had 14.

Yet Dr. Byard is already feeling more fulfilled than ever, energized to be forming the kinds of bonds with patients that made her pursue medicine in the first place. Launching a direct primary care business, Dr. Byard says, “is kind of like medical school. Once you get immersed, you’re going to realize pretty quickly if it’s the right environment for you.” 

That might sound like a generic observation, until you realize just how much Dr. Byard’s commitment was tested during med school. 

She enrolled at Marshall University School of Medicine after experiencing a “quarter-life crisis,” realizing she wasn’t growing or feeling gratified after working for eight years at a biotechnology company. 

It wasn’t a convenient time to reroute her career. Dr. Byard was recently divorced, and her son was entering preschool. After spending most of her life in Pittsburgh, she would be attending school four and a half hours away in Huntington, West Virginia. Even with her ex-husband making the move with her, balancing studies and child-rearing demanded constant sacrifice.

“There was a lot of time that I should have been studying that I couldn’t because I was a mom,” Dr. Byard says. Forced to be on call for 36 hours straight during her surgery rotation, she couldn’t afford a babysitter, so for eight weeks her child went to stay with family in Pittsburgh. 

Dr. Byard graduated with substantial debt, and by the time she began her residency, a second child was on the way. Overcoming all of these challenges strengthened her convictions about medicine. “It makes it a lot easier when you’re doing something aligned with your goals,” she says. “And I felt that way the whole time.”

The road to launching a DPC practice came with its own twists and turns, but after years of searching, Dr. Byard for once has no doubts: “This is the right place for me.” 

Longing for fulfillment

Dr. Byard was always drawn to science, but while earning her undergraduate degree in biochemistry from Pittsburgh’s Chatham University, pursuing medicine never occurred to her. After graduating she worked as a waitress and bartender, then stumbled into the business world: The president of a large biotechnology firm was looking for a “glorified secretary,” she says, who knew enough about science to keep an eye on his competitors. 

“I worked my tail off,” Dr. Byard says, but there didn’t seem to be much opportunity for her to grow within that field. Divorce inspired “a lot of soul searching,” which led her to medical school. Afterward she returned to the Pittsburgh area, doing her residency at a hospital in the small city known as Little Washington. 

Dr. Byard gravitated toward family medicine, but her priorities were divided once she took on moonlighting jobs to cover growing expenses for her kids and pay off debt. During her residency, and then for three years as an attending physician, Dr. Byard served as the Washington County Jail’s sick call doctor, squeezing in an hour of work starting at 6 a.m. before reporting to the hospital.

There she would see 20 to 30 patients a day, which often left just 15 minutes for each patient. “It was ridiculous,” she says. “That’s barely enough time to say hello.”

After work she would rush off to moonlight at an addiction treatment center for another two to four hours. 

“That took a toll on everyone in my life,” she says, “not just me.” 

Exhausted, Dr. Byard left for what some in the family medicine world think of as “the dark side”: urgent care. Four and a half years later, Dr. Byard had caught up on bills, reestablished a bit of balance in her life, and become a top performer in her group. “But there was no next opportunity,” she says.

Plus, “I missed my patients.” 

Putting family medicine first

Dr. Byard craved mentorship. She found a group of women who run Direct Care Physicians of Pittsburgh. Although Dr. Byard owns her Mt. Lebanon office — just as the other doctors own theirs — the group offers an invaluable support system. 

They share a slick website. They use the same vaccine supplier and human resources personnel. They collaborate on marketing campaigns and brainstorm business ideas.

Without having to tackle the challenges of launching a business on her own, Dr. Byard has prioritized patients. She loves the intimacy of DPC, which allows her to respond to patients’ emails or text messages and let appointments run as long as necessary. It’s a stark contrast to the days when the conventional health insurance model forced her to hustle patients in and out every 15 minutes. 

She has some advice for physicians thinking of pursuing DPC: 

• Take a long view. “You’re going to go through a growth phase,” Dr. Byard says, especially if you’re transitioning from a different branch of medicine, like she was with urgent care. “Keep the faith.” 

• Get the right EHR. At her biotech company, Dr. Byard helped design their customer relationship management software, which made her feel comfortable working with EHRs. Still, she was struck by how intuitive Elation Health is. “I sat down to bill a patient, write their notes, and fax their requests for release of records to their prior doctors, all without needing to go back and look through training documents.” 

• There’s no shame in learning. Much has changed in family medicine since Dr. Byard left to work in urgent care, and at first she was anxious about playing catch up. But she found a continuing education subscription that’s been great for helping her stay up to speed on the latest guidelines and techniques. 

Dr. Byard sees the power of DPC. One patient recently exhibited possible side effects from an antibiotic. Instead of forcing the patient to wait for hours at an urgent care facility or shell out a copay at a hospital, Dr. Byard gave her at-home testing supplies.

“We had an answer within about 36 hours and got her on the right medication,” Dr. Byard says. 

Her life at home is better, too. In fact, for the first time since she entered medical school, Dr. Byard has taken her kids to the school bus stop 2-3 times a week. 

“I’ve been really grateful for that opportunity,” she says. She can already see the positive impact it’s had on her kids’ moods and energy levels, and her own. Having the time to spend an extra moment — with a patient, with her children — makes a world of difference.