Startup DPC Blog: Start and Grow Your DPC Practice
This week, we got a really nice testimonial from Alexandra A. about our Startup DPC book and Sales Funnel Course:
Thank you so much Dr. Thomas!
I read your Startup DPC book at the end of my first year of residency, and it has been such a help as I've started my journey.
Thank you for everything you have done for the burgeoning DPC community.
Thank you to everyone who has picked up a copy of the book or one of the courses - I appreciate all of you!
-Paul Thomas, MD
As a Direct Primary Care doctor, you started an amazing practice, and you’ve worked so hard up to this point to build out your work flows and to grow your panel, optimize revenue collection, and train your staff. You’ve done such a great job that, now, you’ve got a waiting list! Congratulations! People have heard great things about your clinic and they’re ready to signup!
Just one little problem - you’re fully booked and you can’t take on any more patients, and you really would like to go on a care-free vacation. Sounds like it’s time to hire another doctor!
Hiring a doctor for your direct primary care practice can be challenging as it involves several important steps. Here's a general guide to help you through the process:
Determine your needs: Assess your practice's requirements to identify the specific role and responsibilities you want the doctor to fulfill. Consider factors such as patient load, personality fit, and any additional skills or expertise you desire. The biggest thing you need to assess is this: does this person believe what I believe? Are they down for the mission of our clinic? Because you don’t just want a doctor, you want the doctor. You need to make sure their heart is in the right place, and honestly, the rest will follow.
Create a job description: Develop a comprehensive job description that outlines the qualifications, responsibilities, and expectations for the doctor position. Include details about the direct primary care model, your practice's mission, vision, and values, and any unique aspects of your approach.
Write a contract or have a lawyer help you write a contract. This is a job and also a legal obligation - having everything in writing and signed by both parties is crucial to getting what you want and showing the new doctor what to expect. We share our sample contract in our Startup DPC course, on how to hire a doctor!
Advertise the position: Utilize various channels to attract potential candidates. Post the job description on online job boards, medical association websites, social media platforms, and consider reaching out to local medical schools or residency programs. Networking within the medical community may also help you find suitable candidates. If you’ve built a strong social media ground game for your direct primary care practice, chances are there are other doctors on the outside looking in and wanting to join you! It may take one, well-written social media post to find the perfect practice partner. Additionally, your alumni reunion activities for your medical school may be a great place to find another doctor or your residency program - if you’re 3, 5, 7, or 10 years out, you may have a colleague who is looking for a change of pace or for that DPC work-life balance.
Review applications and conduct interviews: Carefully review the applications you receive, considering the candidates' qualifications, experience, and compatibility with your practice's values. Shortlist the most promising candidates and invite them for interviews. Conduct thorough interviews to assess their clinical skills, communication abilities, and alignment with your practice's philosophy. You will probably want to have your medical assistant interview the prospective person as well, and you’ll want to ask the same questions to each candidate to ensure a fair and balanced interview process.
Check references: Contact the references provided by the candidates to gain insight into their past performance, work ethic, and professionalism. It's important to verify the information provided in their application and ensure they have a good reputation. A great question to ask an old colleague - “how did you feel working with this person?” Another good question: “would you want this doctor caring for your spouse, kids, or parents?”
Observe clinical skills: Consider arranging a practical assessment to evaluate the candidates' clinical skills. This can involve having them perform a mock patient consultation or observe them during a real patient encounter. Assess their ability to provide comprehensive care and establish a good rapport with patients. At Plum Health, we invite our prospective doctors to spend a day or a half day in our clinic to work with us as we see patients. We get a way better understanding of their demeanor and presence in the exam room.
Assess cultural fit: Evaluate the candidate's compatibility with your practice's culture and values. Direct primary care often emphasizes strong doctor-patient relationships, personalized care, and a patient-centric approach. Look for candidates who align with these principles and demonstrate a genuine interest in the direct primary care model.
Offer and negotiate: Once you've identified the most suitable candidate, extend a formal job offer that includes details about compensation, benefits, working hours, and any specific terms or conditions (this is all in your contract ideally!). Be prepared to negotiate certain aspects, such as salary or benefits, if necessary.
Onboarding and orientation: Once the doctor has accepted the offer, facilitate a smooth onboarding process. Provide them with any necessary paperwork, introduce them to your existing staff, familiarize them with your practice's policies and procedures, and provide any training or orientation required.
Ongoing support and development: Support the doctor's professional growth and development by offering opportunities for continuing medical education, attending conferences, or participating in relevant workshops. Encourage open communication and provide a supportive environment that enables them to excel in their role. With our current doctors, we have helped them to get board certified in obesity medicine, shadow other physicians where they have skill deficits, invite speakers for lunch and learns, and send them to exciting conferences! If you challenge your team mates to bring out the best in them, they will bring their best to the office and to patient care.
Start your direct primary care practice in a desirable area! I know this might be a tough pill to swallow, but if you’re in rural community or a community that doesn’t have the resources that support family life (good schools, parks, museums, sports teams, and other enriching activities), you may have a harder time than typical finding great doctors. For us, in Metro Detroit, there are a lot of resources and therefore a lot of talented people in the area - we are blessed to be surrounded by great institutions that attract and retain great talent.
Remember, this guide provides a general framework, and you may need to adapt it based on your specific requirements. Consulting with legal and healthcare professionals in your state can also help ensure compliance with any applicable laws or regulations.
Thanks for reading, and happy hiring!!!
Again, if you want our sample contract and more nitty gritty on this topic, check out our “Hire a Doctor Startup DPC course”, here!
-Dr. Paul Thomas with Plum Health DPC in Detroit, Michigan
Payroll for your direct primary care practice can be scary - for most doctors who start a direct primary care practice, this is the first time paying themselves and it’s their first time paying employees.
But, don’t be scared any more! By the time you finish this blog post, you will have a good idea of how to pay your employees in a reasonably easy way.
There are several payroll options available for small business owners, including:
Manual Payroll: This involves calculating and processing payroll manually using spreadsheets or paper-based systems. While this option is low-cost, it can be time-consuming and prone to errors. I strongly recommend against doing this. Your time is WAY better spent taking care of patients or growing the business. Unless you have a background in accounting, do not do this.
Payroll Software: Payroll software can automate the payroll process, including calculating wages, taxes, and deductions. There are several software options available, ranging from simple and low-cost solutions to more advanced platforms with additional features such as time-tracking and benefits administration.
One example of a payroll software is Gusto. Gusto offers a cloud-based payroll platform that automates the payroll process. It includes features such as direct deposit, tax calculations, and benefit administration. Gusto also offers time-tracking and HR features, such as onboarding and document management. Small business owners can choose from several pricing plans based on the number of employees and the features they need. Payroll software like Gusto is a good option for small businesses that want to streamline their payroll process and have more control over the payroll function.
Online Payroll Services: Online payroll services provide a cloud-based platform for managing payroll. These services often offer features such as direct deposit, tax filing, and time-tracking. Online payroll services are typically easy to use and affordable, making them a popular choice for small businesses.
An example of an online payroll service is ADP. ADP offers a cloud-based payroll platform that provides payroll processing, tax filing, and compliance management. ADP also offers HR features such as time and attendance tracking, employee benefits, and talent management. Small business owners can choose from several pricing plans based on the number of employees and the features they need. Online payroll services like ADP are a good option for small businesses that want a simple and easy-to-use payroll solution, without having to invest in additional software or hardware.
Options 2 and 3 have some overlap because Gusto can be completed online (without downloading a software suite). Other companies that offer payroll software include QuickBooks, PayChex, Xero, and others.
Accountant or Bookkeeper: Small business owners can also outsource payroll to an accountant or bookkeeper. These professionals can handle all aspects of payroll processing, including calculating wages, taxes, and deductions. While this option can be more expensive than other options, it can provide peace of mind and ensure compliance with tax laws and regulations.
Professional Employer Organizations (PEOs): PEOs are third-party companies that manage HR and payroll functions for small businesses. They offer a range of services, including payroll processing, benefits administration, and compliance management. PEOs can be a good option for small businesses that need comprehensive HR services. If you want to completely outsource payroll and benefits, you’d use an option like this. i don’t know any DPC doctor who uses something like this, as larger businesses would use this option.
It's important for direct primary care doctors to consider their specific needs and budget when selecting a payroll option. They should also consult with a financial professional or tax expert to ensure compliance with tax laws and regulations.
When I started my DPC practice and hired my first employee, I had a really hard time with this. It was more of a mental barrier than anything. I ended up picking Gusto because they have a really nice user experience/design on their website.
I ran payroll for a year using this, but my account found that Gusto was NOT paying my taxes accurately, so we had to put some extra money in at the end of the year. After discovering this, we switched to “RunPayroll”, an online-based platform. I now submit payroll via RunPayroll and my accountant checks on it quarterly.
I pay $62 monthly for accounting, $250 quarterly to my accountant for them to review my books and make sure that all of my expenses are categorized perfectly, and about $1,800 annually for tax preparation for myself and for my business.
Usually you don’t need a payroll company if you’re the only employee in your direct primary care practice. Once you hire another doctor or a medical assistant, you’ll need to set up an account with a payroll company so that they can help you keep track of payroll taxes.
If you’re a solo doc and if you have an accounting software like Quickbooks, you can pay yourself through an owner’s draw. This is a simple way of paying yourself when you’re just starting out.
When you take an owner’s draw, you should set aside 40% of that owner’s draw for taxes. You will likely pay 25% to 35% of your Net Operating Income in taxes, so be mindful of these numbers. Your accountant should be able to calculate the amount of taxes that you need to pay each quarter.
With quarterly income taxes, you will mail up to three checks to your city, state, and the federal government from the money you make during that period. Here in Detroit, Michigan, we have city taxes paid each quarter (about $125) and state taxes paid each quarter (maybe $1,250). This is usually an estimate. If you over estimate, you could get money back during tax time or have a small tax bill. If you under estimate, you could owe a larger balance during tax time.
I hope this was helpful, and best of luck with your DPC practice!
- Dr. Paul Thomas with Plum Health DPC in Detroit, Michigan.
Direct primary care is a growing business practice in primary care. Many doctors start successful practices by recruiting about 400 or 500 patients and having them pay $60 or $80 monthly. With these examples, it’s easy to see how a doctor could earn $288,000 in annual revenue up to $480,000 in annual revenue. Now, if there are two or three doctors in a practice, it’s easy to see how one office can generate $1,000,000 in annual revenue.
As a side note, annual revenue does not mean take home pay. Doctors have to account for overhead expenses like rent, paying employees like medical assistants, and paying for labs, medications, and other services vital to the clinic’s function.
All that being said, what would it look like to take a DPC practice from $1,000,000 in annual revenue (a big achievement) to $10,000,000 in annual revenue? That’s what I want to explore in this blog post:
Growing a business from $1 million to $10 million in annual revenue can be a significant challenge, but it can be done with the right strategy, hard work, and execution. Here are some steps that can help:
Define your target market: Identify the specific segment of customers that you want to target and tailor your products or services to meet their needs. This will help you to more effectively reach and retain customers, and drive revenue growth. In the case of DPC, you need to have a very strong customer avatar - what does your typical customer look like?
Increase sales and marketing efforts: To grow revenue, you'll need to increase your sales and marketing efforts. This could involve expanding your sales team, improving your marketing materials and campaigns, and leveraging technology to reach new customers. Beyond blogging and SEO, your DPC practice might need to hire someone to recruit new patients for you.
Offer new or complementary products or services: Consider offering new products or services that complement your existing offerings and appeal to your target market. This can help you to tap into new revenue streams and increase overall sales. It could be a line of supplements, or a weight loss program, or BOTOX or other programs to increase revenue.
Enhance your customer experience: Providing excellent customer service and a positive customer experience can help you to retain existing customers and attract new ones. Consider implementing customer feedback programs and investing in training and development for your customer service team. Even a 1 hour lunch and learn about improving the customer experience could go a long way in growing your practice.
Leverage technology: Technology can help you to streamline processes, reduce costs, and improve efficiency. Consider investing in technology that can automate repetitive tasks, improve customer engagement, and drive growth. As doctors, this tends to be a blind spot for us.
Expand your geographic reach: Consider expanding your business into new geographic markets, either through physical expansion or through online channels. This can help you to tap into new revenue streams and increase overall sales. I think this is the easiest to understand for DPC doctors - you probably need to go to the other side of the city or to the next town over or even the next biggest metro area to grow your business.
Foster a culture of growth: Encourage your employees to take ownership of the growth of the business and to continuously look for new ways to improve processes, increase sales, and drive revenue growth. What if you incentivized your employees to bring on new patients?
These are some of the steps that can help you to grow your business from $1 million to $10 million in annual revenue. It's important to develop a comprehensive and well-executed plan and to stay focused on your goals.
Thanks for reading, and good luck starting and growing your direct primary care practice!
-Dr. Paul Thomas, MD with Startup DPC
Key Performance Indicators or KPIs are the important markers for your success or failure in direct primary care or any business for that matter.
If you have satisfied patients, that’s great - but can you measure patient satisfaction? If you are managing your diabetic patients with excellent care, that’s good, but can you measure the average a1c in your practice? What about total revenue and percentage of revenue collected?
When you start a DPC practice, you may not think about these KPIs at all, but as you grow and become more sophisticated in your DPC practice, these KPIs may become more and more important, especially if your aim is to scale your business or evaluate the effectiveness of a new hire, either a physician or medical assistant.
Just as you take vital signs from your patient to measure their health, so too can you take KPIs from your business to measure the health of your practice.
The most important Key Performance Indicators (KPIs) for Direct Primary Care (DPC) practices can include:
Patient satisfaction: Measured through surveys or interviews, this KPI assesses how satisfied patients are with the quality of care and services provided by the DPC practice.
Retention rate: This KPI measures the percentage of patients who remain with the DPC practice over a given period of time.
Revenue: This KPI measures the income generated by the DPC practice, which can include membership fees, additional services, and lab tests.
Utilization rate: This KPI measures the number of patients who use the DPC practice's services, such as office visits and telemedicine consultations.
Quality of care: This KPI measures the quality of care provided by the DPC practice, including clinical outcomes, patient safety, and adherence to best practices.
Staff satisfaction: It's important to measure the satisfaction of the staff with their job in order to keep them motivated and engaged.
Net Promoter Score (NPS): This KPI measures the likelihood of patients to recommend the DPC practice to others.
In February 2022, Dr. Paul Thomas was featured in an episode of The Soul of Enterprise with Ron Baker and Ed Kless. In the episode we discuss all things Direct Primary Care! and they plug my book, Startup DPC:
Dr. Paul WROTE THE BOOK on Direct Primary Care. It’s called Startup DPC. Ron recommends this book because you can learn a lot from Dr. Paul’s experience. Here’s the Amazon link.
Here’s the full interview.
Dr. Paul Thomas is a family medicine physician who started Plum Health DPC in 2016, right out of residency. He is a board-certified Family Medicine Physician.
Direct Primary Care (DPC) is a model of primary care that is growing in popularity as an alternative to the traditional fee-for-service model. In a DPC practice, patients pay a monthly or annual membership fee for access to comprehensive primary care services. This fee typically covers all office visits and DPC practices offer at-cost medications, lab work, and imaging services to lower the cost of care for patients.
One of the benefits of DPC is that it allows for more time for the physician to spend with each patient. This is because DPC practices typically have fewer patients than traditional practices, which allows for more personalized care. Additionally, DPC patients often have direct access to their physician through phone or email, which can lead to quicker resolution of health concerns.
Another benefit of DPC is that it can help to lower healthcare costs for patients. By eliminating the need for insurance and reducing the number of unnecessary tests and procedures, DPC can save patients money in the long run.
Dr. Paul Thomas has been offering DPC services for the last 6 years and has seen positive results in the health of his patients. He believes that the DPC model allows for better continuity of care and a stronger physician-patient relationship, which leads to better health outcomes.
A big thanks to Ed Kless and Ron Baker for highlighting the work of Dr. Thomas and Plum Health DPC on The Soul of Enterprise!
-Paul Thomas MD with Startup DPC
Starting a direct primary care (DPC) practice can be a rewarding and fulfilling career choice for doctors, but it is not without its challenges. In this blog post, we'll explore some of the common reasons why DPC practices may struggle to get off the ground or fail to grow.
Lack of understanding of the DPC model
One of the biggest obstacles for DPC practices is a lack of understanding of the model among both patients and other healthcare providers.
Many people are not familiar with the concept of DPC, which operates outside of the traditional insurance-based system and instead relies on direct payment from patients. This can make it difficult to attract patients and build a sustainable practice.
In many communities, your DPC practice might be the first of its kind, which means that you have to teach everyone about what direct primary care is and why it matters. This can be a heavy lift!
Limited marketing and outreach efforts
Marketing and outreach are essential for any business, but they are particularly important for DPC practices that operate outside of the traditional healthcare system.
Without a strong marketing strategy, it can be difficult to generate awareness of your practice and attract new patients.
Specifically, your name is NOT on the back of anyone’s insurance card, so you will not get guaranteed business and you certainly can’t guarantee referrals.
If you’re a younger doctor and not established in the community as a trusted physician, you’ll have to lean heavily on social media or leverage traditional media. I teach these skills in our sales funnel course, here.
Failure to differentiate from other DPC practices
As the DPC model becomes more popular, the number of DPC practices is increasing. This can make it difficult for new practices to stand out and attract patients.
To be successful, it's important to differentiate your practice from others by offering unique services or a unique approach to patient care.
Even though you’re a primary care physician, it can be good to have a specific skill that you’re better at than any other physician in your community. Are you great with OMT? Great with Botox? Do you have a stellar grasp of functional medicine? Are you fantastic at helping patients lose weight? Or can you help patients reverse their diabetes?
Poor financial management
Starting a new business is always a financial risk, and DPC practices are no exception. Many DPC practices struggle with financial management, often due to a lack of understanding of how to price their services or how to manage cash flow.
It's important to have a solid understanding of financial management and to seek out professional guidance when needed.
It is important to note that you should focus on your strengths and delegate your weaknesses. For a lot of doctors, they process their business transactions via Quickbooks and have their accountant review those transactions monthly or quarterly. Many doctors also rely on an accountant for payroll. This is okay! It’s good to delegate these tasks that slow you down to someone who can do them quickly and seamlessly.
Lack of support from other healthcare providers
Many DPC practices struggle to gain support from other healthcare providers, such as specialists or hospitals.
This can make it difficult for DPC doctors to provide comprehensive care for their patients and can limit the growth of the practice.
For example, if you’re in a small town and your local hospital won’t give a cash price for imaging services, it can be difficult to save money/provide value for your patients in the community.
In conclusion, starting and growing a DPC practice is a significant undertaking that requires careful planning, a solid understanding of the DPC model, and a willingness to overcome challenges. By understanding the common reasons why DPC practices fail, doctors can be better equipped to navigate the unique challenges of this model and build a successful and sustainable practice.
That’s why I strongly recommend our most popular course, our How to Write a Business Plan for your Direct Primary Care practice course - it helps you avoid many of the above pitfalls and it can help to ensure that you have the best chance possible at a successful Direct Primary Care practice!
Good luck, and take action today!
-Dr. Paul Thomas with Startup DPC
This year, we made many donations to local charities in our community, from $100 to $1,000, gifts can be impactful and go a long way, especially in a small town or a close-knit community. As physicians, we have an obligation to give back, to enrich the lives of others. Some of my favorite categories to give to include health and wellness, children and families, and recreational activities.
A shout out from a company that we donated to this year.
For your direct primary care practice, donating to a local charity can build good will for your practice in several ways. First, it demonstrates that your DPC practice is invested in the community and cares about the well-being of its residents. This can help to create a positive image for your practice and your physicians and improve your overall reputation.
Additionally, by supporting a local charity, your DPC practice may be able to build relationships with community members who may become customers or advocates for the business. Even if the folks at the charity don’t sign up for your practice, they will likely spread the good word about your practice to the people that they serve.
Finally, it can also show employees that your DPC practice is socially responsible and that you care about making a positive impact. This can help to boost employee morale and engagement. It’s a great way to boost engagement to work with your teammates, physicians, and staff to pick a local charity that you want to support. You could have everyone chip in and provide a match in addition to a baseline gift.
Good luck with your DPC practice, and happy giving!
-Paul Thomas, MD with Startup DPC
Direct primary care (DPC) is an alternative model of primary care that is gaining popularity across the United States. It emphasizes a personalized, patient-centered approach to care and eliminates the need for insurance. However, starting a DPC practice can be challenging. That's why we've developed multiple courses to help you along the way.
Our first most popular course, "Writing a Business Plan for a Direct Primary Care Practice," provides you with the tools and knowledge necessary to create a comprehensive and effective business plan. This includes understanding the DPC model, financial management, and how to attract patients to your practice.
Our second most popular course, "Attracting Patients to Your Direct Primary Care Practice," focuses on marketing strategies for DPC practices. It covers topics such as building a website, social media marketing, and community outreach.
Both of our courses are designed to help you navigate the challenges of starting a DPC practice and provide you with the knowledge and skills necessary to succeed.
Our courses are designed for doctors who are interested in starting a DPC practice, or for those who are looking to grow and improve an existing practice. They cover the most important aspects of starting a DPC practice, from writing a business plan to attracting patients.
We understand that starting a DPC practice can be a daunting task, but with the right knowledge and skills, it can be a successful and rewarding experience. Our courses are designed to give you the tools and support you need to achieve your goals.
If you're interested in starting a DPC practice or want to take your existing practice to the next level, our courses are a great place to start. Sign up today and take the first step towards success.
We are especially happy when we get feed back and reviews like this one:
There are several challenges that doctors may face when starting a direct primary care practice. These may include:
Financial risks: Starting a new business always carries some financial risk, and this can be particularly true for direct primary care practices. These practices are often small, and may not have the financial cushion that larger practices have.
Marketing and outreach: Direct primary care practices may have a harder time getting the word out about their services, as they are not affiliated with a larger hospital or health system. Doctors may need to be proactive about marketing their practice in order to attract patients.
Legal and regulatory issues: Direct primary care practices operate outside of the traditional insurance model, which can create some legal and regulatory challenges. Doctors may need to be familiar with state and federal laws governing the practice of medicine, as well as any additional regulations that apply to direct primary care practices.
Managing patients' expectations: Some patients may be unfamiliar with the direct primary care model, and may have expectations that are not consistent with how these practices operate. Doctors may need to spend time educating patients about the benefits of direct primary care and how it differs from traditional primary care.
Fortunately, all of these challenges are manageable and can be overcome with the right mindset and the right tools. Here are a few ways that doctors can address the challenges of starting a direct primary care practice:
Seek out resources and support: There are a number of organizations and groups that offer support to doctors starting direct primary care practices. These may include professional associations, business development organizations, and other resources. We’re glad that you’re using Startup DPC as one of those resources! When it comes to reaching out to patients, take a look at our course on attracting new members, here.
Carefully plan and budget: It is important to carefully plan and budget when starting a new business, and this is especially true for direct primary care practices. Doctors should have a clear idea of their financial needs and how they will cover them. I would work with another direct primary care doctor or another local business person in your community - have them review your business plan! We created a business plan course as a part of our Startup DPC resources, because doctors don’t often have experience writing a business plan or creating a clinic budget. This is one of our top resources on our site and our business plan course includes a sample budget!
Educate patients: It is important to educate patients about the direct primary care model and how it differs from traditional primary care. This may involve explaining the benefits of the model, such as longer appointment times and more personalized care. If you try to do this on a one-on-one scale, this will be difficult. But, if you leverage tools like YouTube or a great website, your patients can watch videos and read blog posts on your site to educate themselves. Make the type of service that you provide in your practice clear on your website. For an example of what this might look like, check out our clinic’s FAQ or Frequently Asked Questions page. We have media interviews, YouTube videos, and written content to explain our services clearly.
Stay up to date on legal and regulatory issues: It is important for doctors to stay up to date on state and federal laws and regulations that apply to the practice of medicine, as well as any additional regulations that apply to direct primary care practices. This may involve seeking out legal or regulatory guidance from professional associations or other resources.
Thanks for reading, and best of luck with your DPC practice!
-Paul Thomas, MD with Plum Health DPC
P.S. Our direct primary care practice, Plum Health DPC, recently celebrated SIX YEARS in businesses - I love teaching other doctors how we’ve been so successful at our DPC practice in Detroit. I sincerely wish you the same or greater success - we need excellent doctors like you to create value for patients and create a better health care system.
