About
One doctor, and the story behind the practice
When you join Almanac, you’re signing up with me, a person, not a corporation. Here’s who I am, why I left insurance-based medicine, and how I run the practice.
The name
Named for the book my family kept in the kitchen
My grandfather was a country doctor in eastern Colorado for forty years. He kept a worn almanac on his desk, the practical kind that tells you when the frost comes and when to plant. He knew every family in his county the same way, over years. He delivered babies and later watched them go off to college. He knew which of his patients would never call unless something was really wrong.
We kept one in the kitchen when I was growing up. You don’t read an almanac front to back. You go back to it over and over, because it already knows the patterns. That’s what I wanted to be for my patients: someone who already knows you when you come in, instead of a stranger opening your chart for the first time. That’s where the name comes from.
Why I left insurance-based medicine
For about eight years I was a family physician in a large Northern Colorado health system. On paper it was a good job. In practice I had a panel of more than two thousand three hundred patients. Appointments were booked every fifteen minutes, which really meant seven or eight minutes with each person. The computer needed more of my attention than the patient did. I charted until eleven most nights, what a lot of doctors call pajama time. I’d meet someone during the scariest week of their life and then not remember their name two months later. There were two thousand of them and one of me.
The week I finally decided was a pretty ordinary one. I spent forty real minutes with a patient who needed every one of them, which put me behind for the rest of the afternoon, and then I got pulled aside about my throughput numbers. Later that same week, a different patient thanked me for being the first doctor who actually listened to her. The system was penalizing me for the one thing my patients valued most, and I couldn’t keep doing both.
So I sat down and did the math. To give people real time, I’d need far fewer patients, and the only way to afford far fewer patients was to stop billing insurance completely. That’s basically what direct primary care is. I opened Almanac in 2021.
My credentials
I’m Dr. Elena Marsh, MD, board-certified in family medicine. I got my medical degree at the University of Colorado and did my family medicine residency there too. I’ve been practicing about fifteen years now, the first eight in the insurance-based system and the last few here at Almanac. I take care of everybody, newborns up through grandparents. That range is the part of family medicine I like most.
I’m the only physician at Almanac. When you’re a member, you see me, not whoever happens to be free that morning. Same doctor every time.
What I believe
The four things this practice is built on
A small panel
I cap membership around 600 people. That’s not a marketing number. It’s honestly the most patients I can carry and still know your history when you walk in. Once it’s full, there’s a waitlist. I’ll take the waitlist. The alternative is slowly turning back into the kind of practice I left.
Enough time to do it right
A lot of what goes wrong in primary care goes wrong because nobody had time to ask the second question. My visits run thirty to sixty minutes. That’s honestly about how long it takes to do this well.
Honest money
Every price is posted on the site. Labs are at my cost. There are no copays and no surprise bills, because I’m not running your care through a billing department.
The owner is the doctor
No corporate office sets my schedule, my prices, or how long I get to spend with you. I own the practice, and I’m the one who takes your blood pressure.
The team
It’s a small practice, but I’m not here alone.
Teresa, RN
Our nurse and care coordinator. She runs the labs and the in-office care. When you need a specialist or a hospital, Teresa is the one who makes sure the referral goes out, the records get sent, and the follow-up actually happens. She’s good at not letting things slip.
Marcus
Runs membership and the front desk. If you’re enrolling, have a question about your bill, or want to set up memberships for a team, Marcus is who you talk to. Email the practice and you’re probably reaching him first. He answers faster than I do.
Availability
A limited number of memberships are open
Because I cap the panel, I can’t take everyone. There’s room for new members right now, but that won’t last forever. If you’ve been thinking it over, my honest advice is to come meet me before the panel fills up.
In the community
Once a month I host a free coffee talk about what direct primary care actually is. Anyone can wander in. There’s no sales pitch, just questions and honest answers. Almanac also has its first employer partnership now, with a local business here in Fort Collins. Getting a whole team real access to a doctor is one of my favorite parts of doing this.
Come and meet me. Twenty minutes, no forms, and no pressure.
A free meet-and-greet, in person or over the phone. There’s nothing at all to prepare.