You Have a Business When You Have Your First Customer

What Does it Take to Start a Business?

This week, a friend asked about next steps for starting a new direct primary care business.

For smart people who’ve never started their own business, people like young doctors, young lawyers, or young dentists, graduating from medical school or professional school and entering the work force, it can feel like the only option for you is to get hired by a big firm or to join an existing practice.

But, you have to know that you can start your own business - and that’s the point of this blog post!

So how do you know when you have a business? When someone tells you that they want to pay you, yes you directly for your services, you have a business. For example, if a neighbor lady asks your son or daughter to mow their lawn, your child has a business. If that same neighbor wants to hire you as their doctor, you now have a business.

In short, you have a business when you have your first customer.

You Have a Business When You Have Your First Customer

Now that we know what makes a business, how do you capitalize on that business? Meaning, how do you legally accept payments from someone as a business, and not as an individual?

1.) Register for a PLLC - your PLLC can be anything, ours is "PLUM HEALTH PLLC" but we're doing business as (dba) Plum Health DPC. You could be Fred’s PLLC and dba "Smart Street Health", or Karl’s Dad's PLLC and dba Cool Dad DPC etc... The PLLC tells the state government that you have a business. Here in Michigan, we register PLLC’s, but it may be different in your state.

2.) Get an EIN from your accountant - once you register your PLLC, get the EIN from your accountant. This is a unique number that is essentially a social security number for your business. You need it to open any major accounts, including a bank account. From the IRS:

An employer identification number (EIN) is a nine-digit number assigned by the IRS. It's used to identify the tax accounts of employers and certain others who have no employees. The IRS uses the number to identify taxpayers who are required to file various business tax returns.

3.) Set up a bank account! I started mine with $90 that I had in my pocket:

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A post shared by Paul Thomas MD (@plumhealthdpc)

4.) Deliver services - this could be refilling a medication, performing a physical exam, performing a Beck’s Depression Inventory, or giving a joint injection. Never underestimate how much value you can provide for patients with your brain and your stethoscope. As your company grows and as you refine your services, you’ll be offering more services and broader services. But for now, focus on getting started rather than having everything that you could possibly need to start.

As an example, I didn’t have an office when I first started - I started by making house calls for the first 2 months of my business. I also didn’t have an EKG machine when I started, but I bought one within 3 months of starting. I didn’t have a spirometer when I started, but I bought one within 5 months of running the business. As you get more revenue, you can use that extra revenue to make your services more robust.

5.) Track payments. This could be as simple as a spreadsheet with a Microsoft product or a Google Doc spread sheet, or it could be a more sophisticated product like QuickBooks or FreshBooks. I started during my first two months using Microsoft Excel to track revenue and expenses, but it was tedious! I quickly switched over to QuickBooks and I’ve never looked back. Often times, these companies will offer a free 30-day trial or a discounted fee for the first 3 months - it makes taking the leap easier. If you hate the service or the product interface, you can always switch companies!

NOW GET OUT THERE AND GET MORE CUSTOMERS.

Have a great weekend,

- Paul

P.S. If you enjoyed learning this material and if you want to take the next step, please check out the Startup DPC book - there’s a step-by-step guide on how to start your direct primary care practice in the book

Additionally, check out the Business Plan Course where I take a deep dive and show you how to write a business plan that will help you grow your direct primary care practice, starting with a written foundation.

Startup DPC Reviewed on GoodReads.com

Startup DPC Reviewed on GoodReads.com

This week, we took a look at our reviews for Startup DPC on GoodReads.com. Most of our reviews for Startup DPC are on Amazon.com, where we have 103 reviews for Startup DPC with an aggregate of five stars overall. On GoodReads.com, we have 15 ratings and 2 reviews for the Startup DPC book with an aggregate of 4.67 stars. These aren’t the most important metrics of all time, but they do give us an insight into our readers, and these positive reviews and great feed back show us that the material in the Startup DPC book is valuable for our readers - doctors who want to start and grow their own direct primary care practices.

This is a screen shot from GoodReads.com, a site that has 15 reviews for Startup DPC, our book about how to start and grow a direct primary care practice.

We got a glowing review from one of our readers, Ronald:

Dr. Paul Thomas writes: “You should start a direct primary care practice because you can become the doctor you’re meant to be.” There is a Japanese concept called Ikigai, or “your reason for being.” There’s no doubt what Dr. Paul’s reason for being is: to transform healthcare in the United States, transform the lives of his patients, better his community, and his profession. His passion bleeds through this book, and makes it an incredibly compelling read. It also is a nuts-to-bolts guide on how you can start your own Direct Primary Care practice, from marketing, branding, pricing, and a host of other issues that need to be addressed. When you read that we lose one doctor every day to physician suicide, the equivalent of an entire medical school graduating class, you realize that good people are working in a bad system. I absolutely love his question: “Who in this room would want a five minute haircut? No one raised their hand except for a bald guy. Why do you settle for a seven minute appointment for your health, for God’s sake?” Concierge and DPC medicine are transforming the way doctors provide, and patients consume, healthcare. It’s more affordable, convenient, accessible, but most importantly, it restores the sacred doctor-patient relationship. You will get an insider’s account of how Dr. Paul started his own practice, Plum Health, along with the trials, tribulations, and successes along his journey.

As someone who is interested in Key Performance Indicators (KPIs) that actually measure customer success, I loved the KPIs he measures at Plum Health: How many hospitalizations have we prevented? How many urgent care and emergency department visits have we prevented? If a patient has a weight loss goal. Management of their anxiety or depression, have we helped them meet that goal? How much money have we saved our patients? Have we decreased morbidity and mortality in our communities? These are much more difficult to measure accurately, but they get much closer to the truth regarding Plum’s efficacy as clinicians.

I hope this book is read by doctors looking to get back to why they became a doctor in the first place, rather than serving insurance companies and an unsustainable fee-for-service business model. And if you’re a patient, seriously consider finding a DPC doctor.

We have had the pleasure of interviewing Dr. Paul two times, and a third one coming up on this book on June 26, 2020. You can listen to the first two interviews here…

This is a screen shot from GoodReads.com, a site that has 15 reviews for Startup DPC, our book about how to start and grow a direct primary care practice. One contributor wrote an in-depth review of our Startup DPC book, and for that we are grateful.

This is an extremely kind review, and we’re grateful for our readers and supporters. Our goal is to help as many doctors start and grow their direct primary care practices as possible. This model, and this movement, is essential to helping our patients and communities live healthier lives.

- Dr. Paul Thomas

How to get Media Coverage for your Direct Primary Care Practice

How to get Media Coverage for your Direct Primary Care Practice

Getting media coverage for your direct primary care practice is a challenge and an opportunity. You probably did NOT go to journalism school, and you probable have NOT worked at a public relations firm, so you probably don’t have an extensive list of media contacts.

That’s okay! We’re going to start building a list for you.

First thing, read your local publications and listen to your local public radio and watch your local television stations. Who is reporting on health care issues in your community? Can you reach out to them on Twitter or send them an email? If so, you can start to build a relationship with this journalist and become a trusted source for them.

Journalists need to quote experts when they write a news article, and you could be that go-to expert for their next piece on health care.

Reach Out to Journalists When You Have a Newsworthy Event

You might be launching your practice, or hosting a ribbon cutting ceremony at your office, or celebrating 5 years in business. If so, you should send an email or a text with a press release to all of the journalists on your media list. If they’ve worked with you in the past and you’ve helped them on a story in the past, they are more likely to help you with your news-worthy story.

This is where building relationships is helpful! The more relationships and the stronger relationships you have with folks in the media, the easier it will be for you to tell your stories about your practice.

An Example of Getting Media for our Direct Primary Care Practice

Last month, I was gearing up to speak at the Michigan Academy of Family Physicians annual conference on Mackinac Island. I looked through the speaker list and I reached out to everyone I wasn’t connected with. I wrote a quick “my name is Dr. Paul Thomas with Plum Health DPC in Detroit, and I’m looking forward to seeing you and meeting you on the Island.”

The moderator for the first session for the day was Robin Erb, a local journalist with Bridge Magazine in Detroit. She responded to my message on LinkedIn and she expressed interest in writing about our practice. I shared my schedule with her, and we had lunch together and talked about Plum Health. We also met up on Mackinac, I attended her session, she attended my presentation, and a few days later, she published the article about Direct Primary Care and our practice, as well as the broader DPC movement.

In short, if you want media coverage for your DPC practice, you have to connect with journalists via email or on social media, and give them something newsworthy to discuss in their article about you.

@plumhealthdpc Direct primary care is a relatively new practice model for health care delivery - we had a great write up in Bridge Michigan that goes deep on the topic and gets into the nuance and details #DirectPrimaryCare #PlumHealth #BridgeMichigan #RobinErb #HealthCare #HealthCareJournalism #DPCMovement #PrimaryCare #Michigan #Detroit ♬ original sound - plumhealthdpc

Best of luck! Here’s a little inspirational video on how you can get media coverage for your DPC practice:

@plumhealthdpc Getting media coverage for your direct primary care practice can be difficult, and in this short video I breakdown how we reached out to a local journalist to help them tell our story at Plum Health DPC! #directprimarycare #plumhealth #familymedicine #bridgemichigan #detroit #healthcare ♬ Music Instrument - Gerhard Siagian

-Paul Thomas, MD with Startup DPC

Sample Voicemail for a Direct Primary Care Office

Sample Voicemail for a Direct Primary Care Office

Throughout starting and growing a direct primary care practice, you will need to continuously refine your operations. One of the most important parts of growing a practice is having an excellent experience for your patients and potential patients when they call your office line. If you can answer your phone within a few rings and address any concerns quickly and with kindness, you can reap continuous business and referrals from satisfied patients. Answering the phone in a timely manner is crucial. But, in the event that you cannot answer the call due to a capacity issue or a cell signal issue, having a phone tree or voicemail is very important.

One thing I’ve learned over the years is that pharmacies expect the voicemail to say not only the practice name, but also list the doctors within that practice.

Here’s an example of our daytime voicemail:

"You've reached Plum Health DPC, the offices of Drs. Thomas, Orlich, and Rabaut. Please leave a voicemail and we will return your call as soon as possible. Alternatively, email [our email address]. Our office hours are 9 am to 5 pm, Monday through Friday. If you've reached our voicemail during this time, you can try calling back in 1 hour. Our fax number is [our fax number]. If this is an emergency and you cannot wait, please dial 911 or go to your nearest emergency department."

Here’s an example of our after-hours voicemail:

"Thank you for your call. You have reached the after hours line for Plum Health DPC, the offices of Drs. Thomas, Orlich, and Rabaut. Please leave a voicemail and we will return your call as soon as possible. Alternatively, email [our email address]. Our office hours are 9 am to 5 pm, Monday through Friday. If your concern is non-urgent, please call back during our office hours. Our fax number is [our fax number]. If this is an emergency and you cannot wait, please call 911 or go to your nearest emergency department."

Obviously, our goal is to have every phone call answered promptly with a calm and kind demeanor. Sometimes, due to cell service issues or capacity issues, these call can be missed. Setting up a voicemail for these contingencies is important.

-Dr. Paul Thomas with Startup DPC

Paul Thomas MD and Startup DPC Featured on Physician Estate

This week, Paul Thomas MD and Startup DPC was featured on Physician Estate. Here’s the full interview:

Direct Primary Care vs Traditional Fee-for-Service Medicine

Direct Primary Care Practice vs. Traditional Fee-for-Service. We wanted to know more about DPC practice and how it is different from fee-for-service from the perspective of an experienced DPC doctor. We were lucky enough to have a Q&A interview with Dr. Paul Thomas of Plum Health DPC. Dr. Paul Thomas is a board-certified family medicine physician practicing in Corktown Detroit. His practice is Plum Health DPC, a Direct Primary Care service that is the first of its kind in Detroit and Wayne County.

In this Q&A blog post interview, he will share about his practice, challenges and milestones in his journey, and tips for physicians who are planning to start their own DPC practice. Are you a physician interested in starting your own DPC practice? This blog post might be helpful for you!

On Background

1. Please tell us a bit about your personal story, growing up, and medical training.

• I started volunteering in Detroit for homeless and uninsured folks in 2017. I really love taking care of people, but the further and further I got into my training, the less and less time I spend with my patients. Until I get to the end of my residency, I’m spending 10 or 15 minute per patient, and spending a lot more time charting, writing things in the medical record. I thought this was really unsustainable, I felt burned out–I didn’t want to do that anymore. 

• So I wrote a business plan in the last year of my residency, and I launched my practice, Plum Health DPC. And 4 years later, I’ve been doing really well with the practice–we’ve grown, we’ve hired 2 more doctors and we had a second location. 

2. What made you develop interest in Direct Primary Care? Motivating factors? Did you pursue any formal education/training that focuses on Direct Primary Care? If so, what was it?

• I developed an interest in Direct Primary Care because I felt like it was the only way out of a dysfunctional, industrial complex. I didn’t have any formal training in this, I wrote a business plan, I worked with a friend who started a suit company, of all things to write a business plan.

• I went on a road trip, visited a few mentors across the country who helped me formulate my plans and refine my business plan and make it so that I could develop a thriving practice here in Detroit, Michigan.

About Plum Health – A Direct Primary Care Platform

3. What is Plum Health? As a platform that specializes in Direct Primary Care practice, what is its unique value proposition? Tell us the story behind its creation. 

• In Plum Health, we believe that healthcare should be affordable and accessible for everyone, so we really do our best to lower the cost in Detroit and beyond. We contract with a local imaging vendor, a medication wholesale supplier, etc. to lower the costs of all those things. 

• So if you come in for a lab draw, you might get a TSH for $6, that’s what it costs here. But if you go to a hospital, it might cost you $125. So we really try to reduce the cost of healthcare for people. 

• Our unique value proposition is that we have time for our patients. Because our patients pay a monthly membership to be a part of our practice, we have this nice recurring revenue from our patients. We then get to spend more time with them as an individual–we have 1-hour appointments, and we can really listen to them and take care of them and all their concerns.  

4. Generally, how do you help educate physicians in the US who are interested in starting their own Direct Primary Care practice? Do you provide any services, courses, coaching, etc?

• I’m so glad you asked this. I’ve written 2 books about this. The first is called Direct Primary Care–it focuses on how Direct Primary Care serves people in the greater healthcare ecosystem, how you can lower the cost of healthcare for everyone (medications, labs, imaging, etc.) We also discuss how we’ve done this in an equitable and sustainable way in our hometown of Detroit, Michigan. 

• For the book How to Start Your Direct Primary Care Practice, we’ve had so much success here in Detroit. Because I’ve been a speaker at the American Academy of Family Physicians Direct Primary Care Conference and the Nuts and Bolts Conference in Florida, I’ve had a lot of people reach out to me and asked how we were successful, how we did this. To answer that, I wrote a book–it’s called Start Up DPC, how to start and grow your Direct Primary Care practice. I wrote in step-by-step how to start your Direct Primary Care practice. I’ve got a ton of great feedback on this book! We’ve had a lot of people reach out and say how impactful the book has been for them, and we’ve helped other doctors launch their own practices.

• I’ve been doing consulting throughout this, so people pay me some money each hour that I consult with them, and I’ve also taken everything I’ve learned and put it into some courses on my website https://startupdpc.com. I really walk doctors step-by-step through how to start and grow their practices, and I go beyond just the words, I show you how to do it physically. I show you how to do it online and how to leverage your Facebook page and other social media channels to grow your business etc.

Challenges and Milestones in Starting A Direct Primary Care Practice

5. What are some of the mistakes you made when you were still starting out with your Direct Primary Care practice? If you had to redo the whole journey, what would you do differently?

• The biggest mistake was I was thinking too small, I should have hired a medical assistant sooner. I thought I could do everything by myself, and I could–I could draw blood, count all the lab samples and the meds, I can answer all the phone calls, and I did that for about 450 patients, and I hired a medical assistant. And as soon as I did that, it freed up so much of my time to market the practice and help me grow my business.

• So if I had to redo the whole journey, I would have hired someone sooner. As a business owner you want to control everything, but sometimes you have to delegate and relinquish that control so you can focus on your strengths to help you grow your business. 

6. Share a few very milestones you achieved in your Direct Primary Care journey.

• One of those big milestones was hiring a medical assistant, another doctor to help me lower the cost of healthcare in Detroit. I’m very happy to share it with my partner who is Dr. Raquel Orlich.

• Another milestone for me is getting to 500 patients, and 200 patients for Dr. Raquel, and now she’s over 250 patients. These are the milestones that we celebrate because we’re actively learning the cost for healthcare in our community, we’re helping patients, we’re liberating doctors from the dysfunctional fee-for-service medical industrial complex system. 

7. How do you see Direct Primary Care evolving over the next 5-10 years? How does the political climate and ever so polar political opinions affect the evolution of DPC? 

• I only see Direct Primary Care growing over time because people hate having to deal with their insurance for their basic healthcare needs. It puts up so many barriers between people and our doctors. Direct Primary Care doctors are problem solvers. We go above and beyond to solve problems for our patients and make our healthcare journey easier. So when you have doctors actively working on behalf of patients, it’s only going to grow because patients see value in that kind of work that doctors provide. 

• As for the political climate, or let’s say medicare for all passes, which does not apply for Donald Trump, or presidential candidate Joe Biden at this time, neither of these political parties want to see medicare for all at this point. But let’s say even if it does pass 20 years from now, the United States government will not be able to outlaw elective procedures. Americans will always be able to opt for paying above and beyond for health insurance, etc. 

• In a nutshell, I don’t foresee paying above and beyond your health insurance for better healthcare experiences through Direct Primary Care or concierge medicine. I don’t ever see that being outlawed in the US.

Direct Primary Care vs. Traditional Fee-for-Service

*This section is for patients and doctors that are not yet aware of DPC

8. In a nutshell, what do you think is the major difference of Direct Primary Care practice vs. Traditional fee-for service? 

• The number of patients. Fee-for-service doctors have 2,500 patients a year, and they have to see 1% of their panel each day. So they have to see at least 25 patient visits a day. In our model, we only need 500 patients to have a robust, thriving practice. We make about the same amount of money as a fee-for-service doctor. 

• That being said, I have 5 times fewer patients and 5 times more time for each of those patients. It makes a huge difference.  

9. Why should a patient consider enrolling in a Direct Primary Care practice over the traditional fee-for-service?

• You are going to have 5 times more time with your doctor, you’re going to have your doctor’s mobile number and email address, you’re going to be able to reach out to them whenever you need them and not the other way around. 

• We’re not fitting you into our schedule, we’re making time for you anytime you need us. 

10. If you are explaining about Direct Primary Care to a layman who doesn’t have a medical background, what would be your 2-minute explanation to make him/her understand Direct Primary Care practice?

• We really believe that healthcare should be affordable and accessible for everyone. You should sign up for Direct Primary Care practice if you want to have your doctor’s mobile number and text them anytime you need them. Basically if you want to have a better healthcare experience. 

• My patients have my undivided attention for 20-30 minutes to an hour if they need it. I help them with their medications, etc. We take care of everything. If you want that kind of service for yourself and for your family, we’re happy to help you. We do that to all our patients, we deliver high quality, high value services. 

Favorites

11. Favorite book that talks about Direct Primary Care; and favorite book in general about any topic

• My favorites are the 2 books that I’ve written. Startup DPC and Direct Primary Care: The Cure for Our Broken Healthcare System are available on Amazon. Pick those up, you’ll really understand my ethos, and the ethos of the Direct Primary Care movement. People have a lot of great things to say about them. 

• My favorite book in general about business is Crush It by Gary Vander Truck. If you want to know how to market your business, your Direct Primary Care practice, you can learn a lot from reading Gary V. 

12. As someone who is an advocate of Direct Primary Care practice, what are your favorite resources for Direct Primary Care?

• I would say my website https://startupdpc.com. I really took the time to compile all the resources in the ecosystem and give it to you in a palpable, easy-to-understand, easy-to-digest format. 

13. Favorite bloggers that have the same passion as you when it comes to Direct Primary Care

• I blog a lot about this subject, I haven’t seen anyone “out blog” me, so check out our blog at https://startupdpc.com/blog. See for yourself.  

14. Favorite quote

• “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better.” –Theodore Roosevelt

Tips for Physicians Who Are Planning to Start Their Own Direct Primary Care Practice

15. Many physicians find it challenging to start their own Direct Primary Care practice. As someone who’s been in the Direct Primary Care business for quite some time now, what do you think physicians should first do when they are starting out? Any tips and/or strategies you highly recommend?

• I really recommend you read my books because I put them all in there. 

• My biggest tip is that doctors think that when they start their Direct Primary Care practice, it’s for everyone. You ask them who’s your ideal customer and they say “everybody”. But it’s not true. You really have to hammer down and hone in on who your ideal customer is. If you don’t, you’re going to try to serve everyone, and your business is going to fail.

Paul Thomas MD has written two books on Direct Primary Care - both can be found on Amazon, here: Startup DPC and Direct Primary Care.