Direct Imaging Founder’s Story – Part 1

Direct Imaging Center is a remarkable place. It changed the town of Yakima, WA from a small town with limited affordable healthcare options to one that local and big-city patients flock to for care. How did this come to be? The story is crazy and interesting, as its founder Dave Atteberry will attest.

Creating Community-Centered Healthcare in Yakima

Dave isn’t like other professionals in his industry. He goes by his first name. If you talked to him on the phone or ran into him at the local store, you’d never know he was a doctor, least of all a neurosurgeon. Dave’s not from a wealthy family of multi-generational doctors. He comes from the humble roots of Mexico’s migrant farmworkers, following his parents from Texas and Arizona to California, and later Yakima, Washington.

He was the first generation of his family to go to college. Dave’s parents pressed him to attend because they wanted a better life for him. His long, 14-mile bus rides from the Fresno suburb of Clovis to a district farmland school drove the point home. He discovered that a neurosurgeon owned a large mansion he passed daily on those bus rides. It helped him make up his young, dreamer’s mind; that would be the job for him. So, after graduation, he went off to the University of Southern California, headed on a neurosurgery path – without any backup plan.

Learning About Medical Services

Dave ensured success on his educational path by studying biomedical engineering at USC, a degree which he’d discovered held a better chance for admission to medical school, with an entrance rate of 85%. The college lifestyle was foreign to him, given his migrant background. But he adapted well and had a lot of fun. Because he’d spent most of his life out West, after graduation, he applied at programs in the Northeast and Midwest, looking for a change of scenery. He was accepted at multiple schools, choosing the University of Pittsburgh because of the reputation of its neurosurgery program and the area’s low cost of living.

He matured tremendously during his time at the University of Pittsburgh Medical Center. He went there a kid and came out a young, adult professional. During his tenure at the top medical school, Dave met many people who have continued to help him in his medical career. The University of Pittsburgh Medical Center, where he trained, was one of the best hospitals in the country, and it put him on a leadership path.

The Path to Becoming a Local Neurologist

When it was time to choose his residency, Dave stuck with his neurosurgery career goals, again applying at multiple facilities across the US. He likened acceptance to winning the lottery, with only 1-2 spots available in each city. Ultimately, his tenure at Pittsburgh paid off, and they ended up keeping him at the University of Pittsburgh Medical Center through his residency and fellowship. Dave described the experience as living in a time warp. You go in, do nothing but study the entire time, and suddenly leave years later in need of a job.

Luckily, as with his residency, the University of Pittsburgh Medical Center hired Dave to work in the place where he had been trained. He worked there for two years, but began longing to return to the West. His choices for employment were an academic position, a private practice, or a hospital job. He’d tired of the academic route after schooling and had no desire to be a professor. After his tenure at the hospital, he wanted to work somewhere smaller, where he could have more control and leave his own stamp on the world.

Moving to Yakima, WA and Establishing a Diagnostic Imaging Center

At this point in his life, Dave’s parents were retired and living in Oregon. He found this new Northwest locale intriguing, so he interviewed for a job in Washington state. The healthcare center’s pitch was “come practice in paradise – Washington’s wine country.” It was a good pitch, if not appropriate. Yakima, Washington reminded Dave a lot of socioeconomically depressed Fresno and its surrounding cities, where he grew up. They had only a single large community hospital and one urban hospital. He was hired by the former to lead the neurosurgery program, where he worked for about a year. Yet, he still felt like an employee, yearning to have more control over his daily life and make his own decisions, so he decided he would stretch his wings as an entrepreneur.

In 2010, Dave began Frontier Neurosurgery, where he has worked – in its many incarnations – to this day. Dave operated Frontier Neurosurgery solo for six months, later to be joined by Dr. Hoan Tran, a Vietnamese neurosurgeon who’d attended med school in the Caribbean, earning a spot in a residency program in New Mexico from which he graduated. The pair practiced side-by-side for five years, growing the business. They saw thousands of patients and performed hundreds of surgeries. Their little practice grew so fast, they got the grandiose idea of Direct Imaging – a diagnostic imaging center to serve Yakima Valley and surrounding areas.

The Birth of Direct Imaging Radiology in Yakima

Dave and Dr. Tran came up with the idea to open the imaging center across from their neurosurgery practice. But not long after, in 2015, Dr. Tran left unexpectedly, leaving Dave with a rather large bill for the new facilities and all the imaging equipment it housed. The gaping hole his friend left was hard to fill, professionally and financially. It was hard to get people excited about moving out to Yakima, except for those with a calling to cater to the underserved. Luckily, they had a good marketing team – one that made their imaging center “look like John Hopkins,” according to a marketing leader at a seminar Dave attended. This facilitated the sale of Dave’s practice to the local hospital, Sunnyside/Astria.

Trouble for the Availability of Affordable Imaging Solutions in Yakima

The relationship with Sunnyside/Astria was short and troubled. In 2017 the company went bankrupt. With the limited healthcare options remaining at the urban facility in town, residents had to drive an hour and twenty minutes to get care or work in nearby facilities. But this turned out to be a blessing in disguise for Dave and the community. During the bankruptcy process, he was able to unpack the practice to meet community needs. Direct Imaging was once again separated from the hospital and put back in his name. Dave went out on his own again, worrying over the damage the merger had done to his credit when Sunnyside/Astria had owned the company. He was also nervous about taking back Frontier Neurosurgery.

Direct Imaging of Yakima is Back in Business

Dave assumed the credit obligations of Frontier Neurosurgery and the imaging center – now all under Direct Imaging – setting out on his own again in June of 2019. Following the bankruptcy, he formed a parallel company identical to its predecessor in every way – except for a new tax ID. Direct Imaging was reborn from the ashes of the Sunnyside/Astria bankruptcy and the credit damage that resulted. But this came with yet another blessing in disguise. When he sold the business to Sunnyside/Astria, he’d only paid off 5-6% of the debt on the imaging equipment. Following the settlement, the equipment was 75% paid off, reducing his debt by millions.

Expanding Access to Medical Services in Yakima Valley

While he was at it, Dave thought, “Why not open a new ambulatory surgery center – and an outpatient spinal surgery at the facility and take on even more debt?” He also knew a 30-year veteran of gastroenterology, Dr. Pulliam, who’d been laid off by the hospital during bankruptcy. With a 9-month waiting list at area providers for scopes, EDGs, and colonoscopies, he knew he could help the community and create a profitable business segment.

Direct Imaging would then include:

  • The Yakima imaging center
  • A neurosurgery center
  • Gastroenterology services

Hiring Board Certified Radiologists and Staff

Dave now needed a team. Many of his previous coworkers had scattered, but he was able to re-employ most of his prior medical office staff. He also hired radiology readers who each specialized in a single body part, ensuring incredibly detailed reads that fundamentally changed the quality of care in Yakima. Between the quality of imaging reading and the low cost – about 50% of what surrounding facilities charge – insurers were on board, making authorizations easier for patients seeking care.

COVID Treatment Drives Dave to Open Ambulatory Services in Yakima

Dave managed all this through the pandemic, testing patients for the disease at his clinic and even surviving COVID himself – beating the odds though healthcare practitioners urged him to get his affairs in order. The experience drove him to open an ambulatory facility or “mini-hospital,” where patients could get not just “better than substandard care,” but good care. A place that functioned not for profit – but for the community. A facility where anyone could get good treatment, not just the wealthy and insured. Dave is now pursuing opening an ambulatory center as well.

Faith in the Future of Medical Services in Yakima

Despite the pandemic, Dave’s business thrived even with waning patient volumes from quarantine. Dave became more faithful through the experience. He feels like God laid out this plan for his future – an almost unbelievable story he wouldn’t have dreamed possible when he started his medical career. A journey from student to resident to practicing surgeon, later to administrator and owner/operator of his own medical practice. Out of the despair of a community hospital closure came this – Direct Imaging’s expansive line of community healthcare services.

Though Dave was offered 6 billion by investors interested in purchasing the practice, he declined. He acknowledges he is sitting on a jewel, but under his direction, it’s doing great things for people in the Yakima area, lifting the community, which he finds a pleasure to call home.

Dave’s Latest Addition: VA Assessments and Pain Procedures for Veterans

Dave’s most recent medical services addition is in partnership with a subcontractor, to who he sub-leases a part of the building to service the long backlog of VA patients. The need for this service is so tremendous in the area, people are even bussed in from Seattle, Tacoma, Spokane, and beyond for disability evaluations – which have a three-year backlog. With the services of his Yakima imaging center, veterans can get their assessments and imaging done quickly and cheaply, getting the classifications they need to qualify for disability benefits, pain control, and PTSD treatments.

The Future of Diagnostic Imaging and Medical Services in Yakima

Today, Dave continues to work at the local hospital three days a week for a salary and runs Direct Imaging and its subsidiaries in his spare time. He continues to take over neighboring facilities in the plaza where he operates, filling the vacated space with services that meet area healthcare needs. He runs his business on word-of-mouth referrals, striving to expand his Yakima Valley medical services to meet the needs of area residents. “If one day I lose it all, but it does something good for the community, it will still be worth it.”

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