Delivering change: One physician's mission to close gaps in maternity care

When Esther Khatibi, M.D., opened New Life Direct Primary Care in Corpus Christi, Texas, in 2020, she planned to care for patients across the lifespan. As a family physician with additional training in obstetrics, she also wanted to care for women during pregnancy and childbirth. But Khatibi soon discovered that many of her pregnant patients could not afford her $150 monthly maternity membership — and many lacked access to insurance or financial assistance.

"I couldn't desert these patients," Khatibi says. But she realized that subsidizing maternity care herself was not sustainable. So, in 2022, she established My DOC — My Direct Obstetrics Care — a nonprofit providing maternity care to underserved patients.

My DOC opened its doors in September 2023 and now offers completely free obstetric, delivery and postpartum care for patients who are uninsured, underinsured or facing circumstances that put their pregnancies at greater risk.

Starting a nonprofit

Starting a nonprofit proved considerably more difficult than Khatibi anticipated. Her first step was to obtain legal help to establish the organization. Then came recruiting a board, developing bylaws, arranging referrals, raising money and pursuing grants.

Khatibi quickly learned that running a nonprofit demands skills and relationships beyond clinical medicine. "It's so much about networking, and I was not prepared for that," she says, noting that she had to trade her usual scrubs for a professional wardrobe for the first time. She also realized that she could not do everything herself. Donor outreach, financial documentation, grant applications and administrative work required people with the right expertise. "The sooner you start asking for help, the better," she says.

Khatibi recruited volunteer physicians and other community members to help. Although her first fundraiser brought in only about $3,500, local grants eventually helped purchase an ultrasound machine. She continues to pursue additional funding but says the application process is demanding. "You almost have to have somebody who's in a paid position," she says, describing the need for grant-writing and accounting support. "And for the one doc trying to run two businesses, it can be very difficult."

That difficulty is one reason Khatibi wants to develop a model other physicians can use. She hopes to share the legal, administrative and fundraising groundwork so that doctors who want to provide charitable care do not have to recreate it themselves.

Keeping obstetrics in family medicine

Practicing obstetrics as a family physician is not easy, says Khatibi. "To make the direct care model work, you need strong relationships and physician support in your community." The practical limits of practicing as a solo physician became clear when one of her patient's membranes ruptured at approximately 24 weeks of pregnancy. "I needed to round on her every day until she delivered, and it's just me and a clinic, and I have my own kids," she says.

Khatibi says she faced some initial opposition to the direct care model. "I think there was a miscommunication in that some people think that direct primary care is concierge, that your patients are paying you tons of money to get that cellphone number and to have access to you." The fact that most of her patients were financially struggling wasn't immediately apparent to her covering physicians.

Over time, Khatibi was able to gain the confidence of her community. "Now they understand that just because your patients all know you and like you because you're in their lives and present, doesn't mean that they're paying you a ton of money." Further, she frames conversations this way: "I explain, 'These are not my patients — they are our patients.'" Through this messaging, Khatibi has been able to gain support, recruit physician volunteers and raise funds to promote the mission of providing maternal care to needy patients in her community.

Direct obstetrics care with patients at the center

Providing obstetric care through a direct care model serves multiple purposes, says Khatibi. Some patients lack insurance or do not qualify for financial assistance. Others have coverage but struggle to obtain timely care. These gaps are particularly apparent in the South Texas communities she serves.

But Khatibi emphasizes that access alone is not enough. Patients also need time with their physicians.

"Access to care is important, but quality care is just as important," she says. She describes the limitations of brief prenatal visits: listening to fetal heart tones, asking a handful of questions, and then turning the remaining work over to a nurse. Those tasks matter, but they may not reveal everything affecting the patient's health.

In her experience, it often takes at least 10 minutes before a patient begins to open up. That is when she may learn about domestic abuse, sexual assault or other difficult circumstances that influence care. "The longer you're in the room, the more likely you will get to the complicated part of medicine."

For Khatibi, helping patients means building relationships that allow those conversations to happen. "Sometimes, yes, it's the chatting," she says, "but it's the chatting that leads to the deeper stuff a lot of times."

She believes that expanding direct obstetric care can give physicians more time to understand their patients' needs and provide better care.

Building a path others can follow

Khatibi hopes to help other family physicians continue practicing obstetrics within a direct care model.

She envisions branches of My DOC that physicians could join while maintaining their own direct primary care practices, drawing on the nonprofit's resources rather than starting an organization from scratch. "You want to deliver OB patients, you want to help people who need help, let us help you," she says.

For now, she has stepped back from personally performing deliveries to focus on fundraising, recruiting and running My DOC, while volunteer physicians provide delivery care. Her long-term goal includes paid positions for family physicians who want to continue practicing obstetrics.

Khatibi saw a gap in medical care in her community and built a way to fill it. Now she is working to make it easier for other doctors to do the same. That is exactly how physicians can take back medicine.

Rebekah Bernard, M.D., is a family physician in Fort Myers, Florida, and the author of four books on health care topics.

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Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 Cold open. Bernard asks what physicians can do when pregnant patients need care they can't afford.

0:10 Meet Esther Khatibi, M.D. A Corpus Christi, Texas, family physician who delivers babies and founded both New Life Direct Primary Care and the nonprofit My DOC.

1:26 A practice that delivers babies. Khatibi opened her direct primary care practice in 2020, just before COVID-19 hit, seeing children, adults and pregnant patients.

1:48 Why she started My DOC. She saw a huge need among pregnant women without insurance and launched a free clinic in 2022 for patients who are uninsured, underinsured or at higher risk.

3:22 A job for family physicians who deliver babies. Most options are academic jobs or high-call group practices, and she wants My DOC to offer another path.

4:05 Working with the hospital. A hospital-based obstetrics group helps family physicians with call in Corpus Christi, largely because of the local residency program.

4:32 Pushback and the concierge myth. She faced pressure to be on call around the clock without backup, partly because colleagues assumed direct primary care patients pay a fortune.

5:29 Patients who couldn't pay. Before the nonprofit, pregnant patients paid $150 a month, and many couldn't afford it.

6:00 The patient who changed her thinking. A patient whose water broke at about 24 weeks stayed in the hospital until delivery, and Khatibi had to round on her daily as a solo physician.

6:46 Get buy-in first. You can run direct primary care on your own, but adding obstetrics means you need backup and strong relationships with hospital colleagues.

7:38 Stepping back from deliveries. Volunteer physicians now handle deliveries so she can focus on grant writing, board meetings, hiring and fundraising.

8:21 The long-term goal. Paid positions and My DOC branches that physicians can join while running their own direct primary care practices.

8:56 Starting a nonprofit. A lawyer, a board of at least three people, bylaws and 501(c)(3) status so donations are tax deductible.

10:27 Finding patients. Outreach to a local pregnancy center, a federally qualified health center, a Catholic hospital and the emergency room before opening in September 2023.

11:04 Funding it herself. Her practice covered the nonprofit's costs for about a year, until she realized it would sink her business.

11:40 A different kind of business skill. Business training helped with her practice, but the nonprofit was all about networking, starting with a new wardrobe.

12:18 "Why don't you give to it?" People assume physicians have money. She learned to stop doing everything herself and ask for help, and a first fundraiser raised about $3,500.

13:46 Why grants are hard to win. Funders are wary of new nonprofits, one grant fell through because My DOC shares space with her for-profit practice, and large grants require a paid grant writer.

15:23 Paving the path. She wants to give physicians the groundwork for charitable care without a corporation telling them what they can and can't do.

17:08 Quality, down to the speculum. Why she insists on the right tools, like a plastic speculum and a working light, so physicians don't miss things.

17:56 Access isn't enough. Federal maternal health efforts focus on access, but many patients on Medicaid get two minutes with their physician.

18:46 What 10 minutes in the room reveals. That's often when patients open up about domestic abuse, sexual assault and other hard circumstances that affect their care.

19:33 Bernard on poor-quality care. Bernard argues that access to poor-quality care can be worse than no access at all.

20:20 "These are our patients". Khatibi on critics who call My DOC her foundation, and why she works about 30 unpaid hours a week for it.

21:17 The trust problem with free. Bernard recalls a hospice medical director who told her to accept fair pay for the sake of credibility.

22:15 From $25 a month to free. My DOC charged $25 a month until it became a charitable clinic, and going free changed how people responded.

23:03 The photographer story. At a county medical society event, a photographer offered free photos as soon as she said the care was free.

24:03 Trial and error. She expected free care to bring no-shows and scare off funders, and found the nonprofit world saw it differently.

25:30 Knowing who needs help. A patient with diabetes who pays his membership when he can, and why she doesn't drop him.

26:15 Closing. Khatibi on why physicians are rarely seen as the empathetic ones, and Bernard signs off.