Episode 105: What is the One Question You Wish You Knew Before Starting a DPC Practice?

Direct primary care (DPC) is a movement that is growing quickly in the United States. Patients and physicians are looking to bypass the traditional box store medical practice and deal directly with one another. The DPC relationship is personal, small, and simple without middle men (or hospital systems). Instead of relying on copays and insurance for receiving care, patients sign up for a monthly membership with a doctor and usually get 24/7 access to a doctor. Often, the doctors provide extra value for membership by providing medications at wholesale prices, discounted laboratories and imaging studies, and unlimited visits. All of this is for an affordable price that is much, much less than the cost of an insurance plan.

But the shift to this sort of practice can be scary for a doctor. If you're newly out of training and carrying hundreds of thousands of dollars in medical school loans - can you make it? Will you find patients? What do you need to know? In order to answer some of these questions I asked nine DPC practices from around the country what is the one question you wish you knew before you started a DPC practice?

(The quotes below are actually paraphrases from our conversations both on and off air.)

Marketing

Dr. Rebekah Bernard of Gulf Coast DPC in Fort Meyers, FL says that you should watch out on what you spend for marketing.

"The advertising sales people are great at selling their products and getting you to buy to grow your practice. But I found that they weren't that helpful and the best way to grow was on my own through social media. There really isn't a need to spend a lot on advertising since the best kind is free."

 

Trial Memberships

Dr. Deepti Mundkur of My Happy Doctor in San Diego, CA was surprised that a number of potential patients looked to receive free trial memberships for her medical services.

"I was surprised by people calling to see if they could get a free month trial period for my medical services.  I wasn't really prepared for it and it caught me off guard. I understand how direct primary care may seem similar to a subscription service like Netflix and YouTube.

"With the medical liability and importance of good care I had to gently say that I didn't provide free medical service as an office policy. Then I explained what I offered and its value but added they could try to find that sort of service for free elsewhere in San Diego. I doubt any of them did."

 

 

 

Empathy and Trying to Run a Business

Dr. Matt Falkiewicz of Nova DPC in Grand Rapids, MI says the most difficult question he and his partner have faced is being empathetic to those hurting financially while still running a business and staying profitable.

"We were not ready for the problems that come from people who can't pay for care and services. There were a number of times when they didn't pay the lab fees or monthly membership that we ended up having to pay for those costs. It is still a discussion we have to have to decide whether we cover some costs or delay payment.

"We went into medicine to care for people and help them. But we also have to be mindful that it is a business and we can't always do things for free. So we are more careful by charging ahead of time for labs and the month of membership. But we still talk to each other whenever the question of need comes up to decide what to do for patients in specific circumstances."

There is No Cookbook for DPC

Dr. Nitin Gupta is the owner of Rivertowns Pediatrics in Westchester, NY and practices pediatrics in the metropolitan New York City area. He said the most important question he wished he knew before launching his practice was that there is no cookbook.

"I followed the all the 'rules of DPC' before starting out. I posted all my prices. I touted direct primary care as the model. But I really struggled getting off the ground. I kept having conversations with potential patients and spent a lot of time explaining to them what direct primary care was. Eventually they'd say something like, 'Oh, it's like concierge medicine.'

"I realized that I was spending too much time confusing people with the term direct primary care. So I started calling myself concierge and it changed everything. Now I was having conversations about what I could do for patients, not a payment model. I also learned that by removing the transparent pricing off my website that I had a lot more people reaching out to me and signing up. This is probably not the right thing in every area but it is in my market. You need to understand your market and adjust even if the model is the same as other DPCs."

Learn from Others

Dr. Belen Amat is the owner of DPC of West Michigan in Grand Rapids, MI (and happens to be my doctor). She says that flexibility and a willingness to learn from others would be what she wished she knew before starting.

"There are so many things that I didn't know and it turns out that most people had the answers. Whether it is to not waste money on marketing or which licenses to get, I wish I knew to find out more from those willing to help early on. Facebook groups are now a great place to find out information on what you should know.

"There is no reason to pay for a lot of that information but you have to accept what you don't know and be flexible. I tend to be stubborn and have to learn on my own the hard way but you don't need to do it that way any more. There are so many more practices out there now and doctors who are happy to help you get started. There are plenty of patients so there is no one too worried about competition."

What to Buy

My next guest, Dr. Katie Edson, is the owner of Edson Family Practice in Christiansburg, VA and says she wishes she knew what to buy for medical supplies before starting her practice.

"When you're in training or working for a traditional practice the medical supplies are just there. You don't have to think about them or even know what they're called. You also have no idea what quantities or anything that you might need are.

"I realized when I started that I needed medical supplies so I purchased a lot of things for every possible medical procedure that I could imagine doing. Later, I realized that I had too much and a lot of things that I didn't need."

I Wish I knew About DPC Earlier

Dr. Christine Hoffman of Vanguard Direct Family Medicine in Murfreesboro, TN had a very simple answer to the question of what she wishes she would have known before starting a DPC practice.

"I had practiced medicine for 20 years and just wish that I had known about DPC sooner. It has made medicine fun again and I've gone from a doctor ready to quit to one who loves practicing medicine again."

 

 

 

 

Buy Exactly What You Need

Dr. Julie MacNeil is a pediatrician and the owner of Anchorage Home Call Pediatrics in Anchorage, AK. She wishes she knew that you can order exactly what you need.

"I thought when I started that you had to buy everything in large quantities for medical supplies. I also thought that it would be difficult getting supplies living in Alaska so that the shipping rates would force me to buy in large amounts. It wasn't until later that I discovered I could buy just very tiny numbers of things like 5 syringes and needles. This has helped prevent a loss of inventory as products and medications expire.

"Even in Alaska, there are lots of options that don't cost a fortune if you take the time to look. So now I buy exactly what I need for each procedure and don't usually have to wait very long either."

Believe in Yourself and DPC

Finally, Dr. Eric Kropp of Active Choice Health Care probably has the answer to the question at the forefront of anyone thinking about starting a DPC practice.

"The question I wished I knew before starting a DPC practice was that it would work. I only wished I had confidence to have started earlier because I can now practice medicine and care for my patients the way I want.

"I was in a traditional practice for only 5 years when a senior partner suddenly passed away in his sleep. My reaction wasn't of empathy or concern but of anger and frustration as I knew I'd have to care for those patients on top of my current ones. I realized that if that's the reaction I had then I had better do something better for myself and my patients. I heard about direct primary care and thought it sounded right. Now that I am doing it I am no longer missing my kids and family and am back to being a doctor treating others with the empathy they deserve."