Award-winning doc addresses health equity in DPC

That wasn’t the case for Wendy Molaska, MD, FAAFP, who opened her DPC in 2021 in Fitchburg, Wisconsin, after leaving an employed position in hospice care. That hasn’t stopped her from rapidly exceeding her own expectations.

“I initially thought I would close my patient panel at about 400,” Molaska said. “The hard part was turning away patients who needed care. So, my panel grew beyond what I had hoped. I'm now at 600, waiting for a new doc to start in October, and we have a wait list of more than 100 people.”

Molaska had seen much of what family medicine has to offer before opening her own practice, including full-scope practice at a federally qualified health center in rural Colorado, a rural clinic in Wisconsin, emergency medicine and academic medicine.

Along the way she overcame open-heart surgery related to Marfan syndrome in her 30s and, more recently, breast cancer.

“When I was diagnosed with breast cancer I thought, ‘What am I doing? This isn't what I'd wanted to do, spending my pajama time charting and not being there with my kiddos,’” she said. “I decided to rethink what I was doing. I had heard about DPC, but there was no way I was starting a business right then.”

In 2019, she took a job in inpatient hospice care instead.

“I loved it,” she said. “I loved the team I worked with, the social workers, the chaplains, the nurses, the CNAs, everybody. It was an amazing group of people to work with.”

It didn’t last. When COVID hit, Molaska was scheduled to work six days a week, though her contract called for four. Personal protective equipment was lacking. Her youngest child’s daycare closed. Her oldest child’s school closed.

It was time for another change.

She started her DPC practice in spring 2021 in a one-room suite with an exam table in one corner and her desk in another.

“It was just me,” she said. “I was the receptionist, phlebotomist, medical assistant, janitor and everything in between. It really appealed to me because this is why I went into family medicine: the continuity of care, taking care of the whole family, affordability, accessibility and trying to keep people out of urgent care. I couldn't be happier.”

Patients from a previous practice found Molaska’s DPC, and the growing new practice moved to a larger location. Nurses from her hospice team joined, along with an office assistant.

“They are all bilingual, so we serve a huge Latinx patient population,” said Molaska, who is a civil surgeon, offers immigration exams that bring new patients through the door, and also has arrangements with Dane County Immigration Services and a multicultural center that refers refugees and other immigrants. “A lot of people are unfamiliar with the U.S. health care system. It's too complicated and hard to navigate, and we can help.”

Word of mouth has helped the practice grow, too. A family of Cuban immigrants made a two-hour trip to see Molaska. Others have followed.

“They liked the experience,” she said. “Now we keep getting all the Cuban immigrants from Appleton down here.”

Molaska also works with small businesses that are enrolling their employees in the DPC.

“A lot of these are businesses that don't typically offer health insurance to their patients,” she said, “but in this way they're at least offering primary care, which is 80% to 90% of what most people need. One of the things I'm most proud about my DPC clinic is the fact that we are addressing health equity concerns. A lot of people have the misconception that DPC is only for the healthy and the wealthy.”

Molaska said roughly 8% of people in her community don’t have health insurance. Among her patients, it’s 40%.

“We have patients transferring from an FQHC to us because it's actually less expensive to get care at a DPC,” said Molaska, whose patients pay $70 a month.

She has negotiated lab rates with vendors to make them more affordable for patients and has identified cancer screening services that are free or offered at reduced cost.

Patients also appreciate that Molaska is willing to share her own experiences as a patient.

“I have been on the other side of the stethoscope quite a bit,” she said, “and that helps me with providing empathy because I know what it's like to have your butt hanging out of a hospital gown.”

Molaska, a past president of the Wisconsin Medical Society, has been working to make it easier for others to practice DPC in her state. She advocated for a bill that would have exempted DPC practices from insurance regulations that passed both chambers of the state legislature this year before being vetoed by Gov. Tony Evers.

“We'll go back to the drawing board with that next session,” said Molaska, who was named DPC Physician of the Year earlier this year at the DPC Summit.

Molaska served on Evers’ Health Care Workforce Taskforce last year and has served on the Wisconsin Council on Immunization Practices Advisory Council for more than a decade. She said it is important for primary care physicians to be involved in advocacy and policy development.

“You might not agree with all the policy work that the AAFP, the AMA or your medical society have in place, but you probably agree with the majority of it,” she said. “And the bigger point is that we agree with not having legislators in our exam rooms.”

Molaska has participated in Reach Out and Read for more than two decades and has served as co-chair of her state literacy program’s advisory council since 2013. She started Reach Out and Read in two of the communities she has practiced in and continues to provide books during well-child visits.

“I was first exposed to Reach Out and Read during my residency in North Minneapolis and just fell in love with the program,” she said, “and part of that is just because I love reading myself.”