Driven by a desire to provide patient-centered healthcare, Dr. Vasanth Kainkaryam founded 4 Elements Direct Primary Care (4E DPC) in 2019. MetroHartford Alliance Content Manager Nan Price spoke with Vasanth about his experience as both a doctor and an entrepreneur and what makes his business model innovative.
NAN PRICE: What does the term “doctorpreneur” mean to you?
VASANTH KAINKARYAM: I think of the word itself. I’m a doctor first, businessman second. And in our healthcare system, the problem is it’s become business first, care second. In so many ways it’s not patient-centered. For me, “doctorpreneur” embodies a philosophy of why do we do what we’re doing and how do we sustain our practices and a business model that works for both the doctor and the patient?
NAN: Tell us about starting your business. Why did you decide to go out on your own?
VASANTH: I’m a triple board certified doctor. I do internal medicine, pediatrics, and obesity medicine. When I finished my training, I thought I’d do what everyone does—get employed by a large organization, which I did for a while. I moved up the ranks and became a regional medical director.
Then, seven years ago, an opportunity fell in my lap to open a direct primary care practice for a healthcare startup. That totally changed everything I thought about healthcare. We shifted the whole model to put the patient first. We had no copays for our patients. We visited them at home. If they were afraid to go see a specialist, we went with them. That experience opened my eyes to a new way healthcare can be delivered and I began ask: Why aren’t we doing it this way?
And then I got the opportunity to be a chief medical officer of a large health system. I remember thinking: I’m going to be this visionary and change healthcare top-down. I learned soon afterward that our system is so broken and rigid that you can’t fix it top down. You’ve got to rebuild it bottom up.
So, in 2019, I spent a lot of time staring at an Ikigai diagram, which is a Japanese philosophy focused on passion, mission, vocation, and profession. It brings together four concepts: What the world needs, what you love, what you’re good at, and what you can be paid for. It’s very powerful. After staring at that diagram for months, I decided to quit my job and build my own practice.
I went from a six-figure salary all the way to zero. I told my wife I was going to rebuild healthcare and practice medicine the way I want to and the way I want my patients to get care. I decided to open my practice in November 2019, right before the pandemic.
NAN: What makes your approach to healthcare innovative?
VASANTH: It’s a very different approach. Think of it as Amazon Prime or a gym membership where you get access to your doctor with an affordable monthly membership fee. It doesn’t depend on insurance. You may or may not have insurance. I dispense medications in my practice at near wholesale rates to help my patients save money. My labs are less expensive because I have my own lab agreements. So, your doctor is not just getting you care, but helping you navigate the health system that’s cost-effective and efficient.
This model is called direct primary care. It’s basically direct access to your doctor. The movement is more than 10 years old. Across the country, about 1,500 doctors have decided they’re done with the system. It doesn’t work for patients. It doesn’t work for the doctors. The burnout among physicians is more than 40%. So why are we doing it this way? Let’s do it differently.
NAN: Do you mostly work directly with individual patients?
VASANTH: I use the same model to work with businesses and employers in addition to individuals. Whether they provide insurance or not, businesses can provide their employees with direct access to a doctor without any copays. That’s very powerful. And, as a doctor, I’m helping stimulate the economy and supporting smaller businesses by being competitive by offering a unique low-cost high-value benefit and keeping their workforce healthy.
NAN: How are you building clientele?
VASANTH: Through a lot of networking and outreach. I’m in a Business Network International (BNI) networking group and I’m on the board of the South Windsor Chamber of Commerce. I also take opportunities like these to share my message, in addition to spreading awareness about the healthcare system on my podcast 4 Elements of Health Care.
NAN: You mentioned you went from a six-figure income to zero. From an entrepreneurial standpoint, what was it like to build yourself up and start from ground zero?
VASANTH: Part of it was figuring out whether I wanted to get a venture capitalist to back me up or fund my business myself. I decided to fund it myself because I wanted the control. As a doctor, I don’t want someone else telling me what to do. I want to do it myself. Part of that means working multiple jobs. So, I moonlight because I need to fund my business stream.
Thinking about income streamlines, I go backward. I ask myself: How much do I want to make? How many patients do I need to take care of? What do I need to charge them? I’m not incentivized by money for my primary care patients. I’m focused on providing good care and saving them money—not ordering tests and things to pad my wallet. That’s so different than the traditional system, where the more procedures you do, the more you make. This approach is the exact opposite.
I’ve been fortunate because even my first year I was in the black, which many new businesses can’t say. Right now, my goal is to be around 300 to 500 patients. I’m more than a third of the way there, which is really thanks to my patients who see the value.
They don’t teach business in medical school. It’s very different. And we’ve gone away from the model in the private practice world where you had your own business. Now many doctors are employed by larger practices. So, it takes a certain level of interest—and a desire to learn.
We’ve got a network of direct primary care doctors across the country who share knowledge and negotiation strategies with each other. It’s truly a grassroots revolution where the doctors are saying: We’re going to do this together and support each other. That’s been very helpful for me.