How to Communicate Your Value as a Direct Primary Care Doctor During Times of Coronavirus

The Coronavirus is here in the United States and it’s causing new infections, hospitalizations, and deaths. People are scared about their own health and they’re worried about the health of their communities. People are looking to their doctors for answers during this time. In this blog post, I’m going to address the following:

• What can you do during this coronavirus pandemic?

• How can you communicate the value of your Direct Primary Care practice during this time?

• What are the most effective mediums of communication?

• What are some examples of successful Direct Primary Care doctors who are communicating clearly during this time?

What can you do during this coronavirus pandemic?

As a primary care doctor, you are uniquely positioned to address the public and the concerns of the public with excellent information. You want to provide the public with information that is evidenced-based. Avoid making prognostications or letting your opinion seep in. Stick to the facts and best practices.

Additionally, keep an even keel and a calm demeanor. If you look anxious or scared, your patients will pick up on this. If you look calm and collected, your patients will take note and they’ll be more trusting of your advice.

How can you communicate the value of your Direct Primary Care practice during this time?

You can communicate your value by telling folks what you do and how you’re uniquely situated to triage patients. Let people know that you can help them and guide them to the best care possible. This is what you’ve been trained to do - to triage patients, to treat people with medical concerns - now you just have to communicate that ability with your broader audience.

What are the most effective mediums of communication?

Your most effective means of communication are Facebook Live streams, Facebook videos, and YouTube videos. It’s difficult for people to read a lot of information about the coronavirus, so if you can break it down in a digestible format as a video, you will be able to reach a broader audience. You can supplement this video content with written content either in the notes below the video on Facebook or LinkedIn or as a separate blog post.

Examples of successful Direct Primary Care doctors who are communicating clearly during this time

There are a number of Direct Primary Care doctors communicating information clearly to their patients and their communities. I’ll use myself as an example to start and then showcase a few others. So this is a Facebook Live video that I put up on Facebook. It received 180 reactions, 117 comments, 85 shares, and 4,500 views to date. I then downloaded the Facebook live video, uploaded the video onto YouTube and created a blog post around the content. We had 10 new patients enroll in the 24 hours after posting the video.

The next video was not a live video, and a second update on the Coronavirus. I discussed why we’re enacting social distancing and how it can slow the spread of the viral infection. This video received 108 reactions, 27 comments, and 55 shares after posting it.

Dr. Delicia Haynes and her video

Delicia Haynes has a great presentation style and I love what she says here: “It’s Time for Precaution not Panic: Tips For Individuals and Business Owners to stay COVID-19 Free.” Dr. Haynes is the Founder at Family First Health Center in Daytona Beach, Florida.

Focus on her body language, the lighting, her tone of voice, and her speech pattern. She looks directly into the camera, she has nice lighting on her face, and she is in the center of the camera. These are all great. She keeps an even tone of voice and she speaks at an even pace. These are good things as well.

What if you don’t like to be on camera?

If you don’t like to be on camera, it’s a missed opportunity. However, you can make up for it by sending patients emails with photos of yourself in the office. Photos are important because people are way more likely to engage with visual media than with written posts.

HOW CAN I LEARN MORE ABOUT STARTING A DIRECT PRIMARY CARE Practice?

If you want to learn more about starting and growing your direct primary care practice, look no further than our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

Thanks for reading and watching, and best of luck in your direct primary care journey!

- Dr. Paul Thomas with Startup DPC

Startup DPC Show Episode 8: DPC Doctors advocating for policy solutions

On this episode of the Startup DPC Show, I sit down with Dr. Chad Savage of YourChoice Direct Care in Brighton, Michigan. Dr. Savage and I practice about 45 minutes away from each other - he’s in Brighton, MI and I’m in Detroit, MI. We’ve gotten to know each other well because we attend the same conferences and sometimes end up on the same flights to and from these conferences!

We both spoke during the opening main-stage session at the DPC Nuts and Bolts Conference in November 2018, hosted by the Docs 4 Patient Care Foundation. Dr. Savage is a relentless advocate for his patients, for his profession, and for the broader DPC movement.

Paul Thomas MD, Lee S. Gross MD, Ellen McKnight MD, Chad Savage MD, and Josh Umbehr MD at the DPC Nuts and Bolts Conference in Orlando Florida. Drs. Gross, Savage, and Umbehr are also involved in the DPC Action organization.

Dr. Savage is also a Board Member of the new DPC Action organization. In this Startup DPC Episode 8, we talk about direct primary care, the legislation that's impeding the DPC model, and the opportunities for future legislative changes that could improve health care options for individuals, families, and businesses.

What is DPC ACtion?

DPC Action is a non-profit organization dedicated to promoting and advocating for improved access to affordable health care through independent Direct Primary Care practices.

There are several political advocacy groups for medicine, but none were focusing on the independent direct primary care doctor. DPC Action speaks for the independent DPC doctor. The organization is largely self-funded, but does take donations on their website, here.

Dr. Savage talks about adding value, both for his patients, and in changing the legislation. The current legislation isn’t designed perfectly for the practice of direct primary care medicine.

DPC Action and Dr. Savage are working with Congressional leaders, Senators, the White House, and representatives from the Treasury Department and the IRS. One of their first meetings was with the Secretary of the Treasury and Dr. Savage worked with some adversarial forces during this meeting.

This meeting bore fruit, however, and it affected future legal changes affecting HSA spending and direct primary care practices.

Current Legislation Affecting DIrect Primary Care practices

Currently, the use of HSA funds to pay for direct primary care practice is debatable and murky. There is not a clear answer on this issue. We discuss the IRS Code 213(d) and 223 and how these are a barrier for the direct primary care model at this time. Here are the basic definitions of these IRS Codes:

HSA-qualified medical expenses are defined by IRS Code, Section 213(d) and include amounts paid for the diagnosis, cure, mitigation, treatment or prevention of disease for the purpose of affecting any structure or function of the body.

Internal Revenue Code (IRC) Section 223 allows individuals who are covered by a compatible health plan, often referred to as a High Deductible Health Plan (HDHP), to set aside funds on a tax-free basis up to the contribution limit to pay for certain out-of-pocket medical expenses.

Legislative Solutions to our current challenges in direct primary care

As a solution to these barriers, Dr. Savage and I discuss S 3112. Dr. Savage is a prolific writer, and he penned this opinion in Real Clear Politics regarding S 3112:

S. 3112 — which has a companion bill in the House, Congressman Chip Roy’s HR 5596 — would lift unnecessary HSA restrictions, let Americans spend HSA dollars how they see fit, liberate employers, and unleash Direct Primary Care.

Furthermore, this legislation would help HSA owners take full advantage of an incredibly low-cost and high-service care model: Direct Primary Care (DPC). These clinics offer substantially reduced medications, imaging, labs and other services. Though President Trump’s June 2019 Executive Order partially addressed and expanded HSA use for DPC providers, S. 3112 would solidify these corrections in law. This step would make HSA dollars go farther and provide more quality services.

HOW CAN I LEARN MORE ABOUT STARTING A DIRECT PRIMARY CARE Practice?

If you want to learn more about starting and growing your direct primary care practice, look no further than our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

Thanks for reading and watching, and best of luck in your direct primary care journey!

- Dr. Paul Thomas with Startup DPC

Which is the Best Direct Primary Care Conference?

Why should you attend a Direct Primary Care Conference?

If you are looking to start and grow a direct primary care practice, you should definitely attend one or all of the major direct primary care conferences held in various locations across the US. These will be especially important for in-person networking and meeting other courageous physicians who are starting and growing their direct primary care practices. It will also show you what’s possible for you, your practice, and your future.

All of these conferences are excellent, and they each have their strengths and weaknesses. In general, these conferences are great places to learn about the practice of direct primary care and to connect with thought leaders and colleagues. There’s a distinct ethos of the DPC movement, and you can immerse yourself in this environment and learn some of those intangibles that are hard to pick up through other mediums.

You can find doctors who are practicing in your community and start building some mentoring relationships that can be valuable over the long term. You can also find a cohort of DPC docs who are at a similar stage in their journey. Take the time to connect with these doctors as well, as you will likely face similar challenges in your individual practices.

What are the three major Direct Primary Care Conferences?

The three major direct primary care conferences are the AAFP DPC Summit, the Docs 4 Patient Care Foundation DPC Nuts and Bolts Conference, and the Hint Summit. In short, you can benefit from all three conferences. It might come down to cost and geography for you, but there’s value with each conference. 

Here’s what’s on tap for 2020:

The American Academy of Family Physicians (AAFP) DPC Summit

The AAFP DPC Summit in June or July of each year caters to independent direct primary care physicians, and DPC doctors set the agenda. There are typically three days of educational sessions with a broad range of topics. The location bounces around the country and has been in Chicago (2019), Indianapolis (2018), Washington D.C. (2017), and Kansas City (2016). The 2020 conference will return to Kansas City from July 17th to 19th.

The focus is on the independent Family Medicine DPC practice, but there’s also information for larger DPC practices as well as more corporate DPC structures. The content and speaker selection is driven by a group of ten or so practicing DPC doctors and a few medical students and residents. There are scholarships available for medical students and residents, and the application can be found on the AAFP website. Further, Internists, Pediatricians, and Medicine-Pediatric doctors have also been known to attend.

In 2017 I was a panelist at the AAFP DPC Summit on starting a direct primary care practice, in 2018 I was a main-stage speaker and delivered “DPC Hustles Harder”, and in 2019 I was a main-stage speaker discussing how to build your personal brand to grow your direct primary care practice.

Dr. Paul Thomas of Plum Health DPC delivering his “DPC Hustles Harder” Presentation at the AAFP DPC Summit on building a strong business brand and a strong personal brand to grow your Direct Primary Care practice.

The Docs 4 Patient Care DPC Nuts and Bolts Conference

The DPC Nuts and Bolts Conference presented by the Docs 4 Patient Care Foundation is in Orlando each November, usually during the first or second full weekend in November. Dr. Lee S Gross organizes the Nuts and Bolts Conference, and he is a relentless advocate for the DPC model and movement. After the 2018 Nuts and Bolts conference, he posted this on his Facebook page:

I spent this weekend with some of the most inspirational and brave physicians I have ever met. It is time for physician leaders to step up and take back control of health care on behalf of our profession, our patients, and our nation. It is time for us to call out those that put themselves in between the doctor and patient.

I’ve saved this specific quote from Dr. Gross because it’s so damn inspiring – I’ve read this aloud at the AAFP DPC Summit 2019 and got chills as I said it on stage in front of 300 or more doctors.

Within this quote is a great mission statement: I believe that it’s time to take back health care for our profession, our patients, and our nation. Inspiration from Dr. Gross and other attendees comes standard at the Nuts and Bolts Conference.

The DPC Nuts and Bolts Conference is valuable in that there’s excellent DPC content and a strong showing of practicing and prospective DPC docs. The only point of contention with this conference is that there are some political overtones and some speakers with a political agenda.

Dr. Paul Thomas of Plum Health DPC at the podium during the Docs 4 Patient Care Foundation Nuts and Bolts Conference, sharing about passion, purpose, authenticity and caring. — with Ellen McKnight, Chad Savage, Josh Umbehr, and Lee S. Gross at Rosen Hotels & Resorts Orlando.

The Hint Summit

The Hint Health Summit is usually held in San Francisco each year, but in 2020, it’s moving to Denver. Hint Health sponsors this conference, and they describe themselves as “the direct primary care solutions company that partners with visionary provider organizations to build successful DPC programs.”

Paul Thomas, MD of Plum Health DPC at the Hint Summit 2018 - the conference topic was Breaking the Status Quo in health care and ZDoggMD was the keynote speaker!

I attended the Hint Health Summit in 2018, and I enjoyed it immensely. I got to rub elbows with speakers like Zubin Damania aka ZDoggMD, Garrison Bliss, Clint Flanagan, and Zak Holdsworth. For the Hint Summit, Hint Health has a bigger budget and can afford big name speakers like ZDogg MD and Marty Makary et al. But, they are trying to sell you a product, the Hint billing platform.

The one criticism that I have is that the content is tailored for larger DPC groups and more corporate DPC structures. Because of this, the content was not as valuable for an independent DPC practice like mine relative to the content presented by the AAFP and the Docs 4 Patient Care Foundation. However, I have heard that there may be some changes to the 2020 Hint Health Summit content and format.

This is a good opportunity to introduce this concept: it matters who you spend time with, and by spending time with successful and inspiring people, you can raise your frequency and increase your chances for success. Motivational speaker Jim Rohn famously said that we are the average of the five people we spend the most time with.

By immersing yourself in these conferences with exceptional DPC docs, you will pick up on the pearls, the tips, and the idiosyncrasies that make these doctors successful. Your choice to attend these conferences will depend on costs, distance traveled, and proposed content.

All three conferences are great for networking. They will raise your frequency and show you what’s possible for you and your practice in DPC and beyond. 

HOW CAN I LEARN MORE ABOUT STARTING A DIRECT PRIMARY CARE PRACTICE Right Now?

If you want to learn more about starting and growing your direct primary care practice, look no further than our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

Thanks for reading and watching, and best of luck in your direct primary care journey!

- Dr. Paul Thomas with Startup DPC

Startup DPC Mailbag: Questions about Starting a Direct Primary Care Practice right out of Residency

This is Dr. Paul Thomas with Startup DPC (https://www.startupdpc.com/) and I receive new questions each day about how to start and grow a Direct Primary Care practice. I believe in the power of the Direct Primary Care model to restore our broken healthcare system for both patients and doctors. That's why I'm really passionate about this topic and why I'm on a mission to educate my fellow physicians and the public about their options in the direct primary care model.

Our questions today come from a Resident Physician in Florida. Here's the questions:

If I have a big student loan debt, can I still start a direct primary care practice?

1. How did your decision to pursue DPC work affect your student loan repayment strategy?

I graduated from Residency with a student loan burden of $170,000. This was the average student loan burden for graduates in 2013. In 2019, the average student loan burden increased to $190,000. That being said, I went on a straight 10-year repayment plan, and I spent about $2,000 each month on my student loans.

In order to do this, I didn't splurge on unnecessary expenses and I focused on the practice I wanted to build. I also started moonlighting as soon as possible in residency to have enough money to pay down my student loans and have a comfortable lifestyle.

In short, my large student loan debt did not deter me from starting my direct primary care practice. My mission of serving others via this DPC model outweighed any misgivings I had about a large student loan balance. If you have a dream of starting a DPC practice, you can do it, even if you have a big loan balance.

How do you build a strong personal brand while a Resident Physician?

2. As residents, we’re mostly responsible for our patients. We connect with some of them but don’t know how to engage them while they wait for us to complete residency, what was your strategy?

This question is really about building a strong personal brand, and how do you build a strong personal brand in during your Residency training. It comes down to engaging with people in your community in a positive way.

Be a leader, a volunteer - work with different free clinics or hold a board position. Reach outside of your network and get to know professionals from other fields, like law, finance, philanthropy, the food and beverage industry, the hospitality industry, and others.

You can also take time to build your presence on one or all of the following social media channels: Facebook, Instagram, Twitter, LinkedIn, YouTube, TikTok, or SnapChat. If you build a strong personal brand on these channels, you'll be more easily able to invite your audience to become patients of your direct primary care practice.

I take a deep dive on these concepts in my course on Attracting Patients to your Direct Primary Care practice, here: https://www.startupdpc.com/take-action

Can you work a second job (moonlight) while starting your direct primary care practice?

3. Private practice finance is a big issue, didn’t working multiple jobs interfere with your time commitment to your private practice patients?

No, you can work 20 hours a week pretty easily while you start your direct primary care practice. For me, I was moonlighting for 12 hours on a week day and 8 hours on a week end day and earning enough to support myself and pay down my student loans.

I worked at an urgent care for $70 to $80 an hour, which allowed me to grow my direct primary care practice organically. I worked at my DPC practice 4 days each week and at the urgent care 2 days each week. I was able to care for and manage my DPC patients easily over that 4 day work week, as I had fewer patients at that time.

HOW CAN I LEARN MORE ABOUT STARTING A DIRECT PRIMARY CARE PRACTICE?

If you want to learn more about starting and growing your direct primary care practice, look no further than our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

Thanks for reading and watching, and best of luck in your direct primary care journey!

- Dr. Paul Thomas with Startup DPC

Praise for Startup DPC

We work really hard to help doctors start and grow their direct primary care practices, and we get results! We help doctors attract new patients and grow their practices. It’s enjoyable to do this work and it’s nice to get some positive feedback from our doctors who have been successful. This doctor took one of our courses and had some nice things to say:

A nice note from one of our customers who took one of our courses on Startup DPC. You can visit these courses at our Take Action page!

Here’s another piece of praise for our work at Startup DPC, this time for the Attract New Patients to your Direct Primary Care Practice Course:

HOW CAN I LEARN MORE ABOUT STARTING A DIRECT PRIMARY CARE PRACTICE?

If you want to learn more about starting and growing your direct primary care practice, look no further than our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

Thanks for reading and watching, and best of luck in your direct primary care journey!

-Paul Thomas, MD

Startup DPC Mailbag: How Much Money Do You Need To Start a Direct Primary Care Practice?

Just about everyday, I get some great questions about starting and growing a direct primary care practice. A colleague just read my book and asked the following questions:

How much money do you need to start a direct primary care practice?

This is a question I recently received from someone interested in the direct primary care movement. And, it's a good question. I'll start by saying that I've addressed this question in great detail in my course on Writing a Business Plan for your Direct Primary Care practice.

So, for a full answer to this question, please go to our Take Action page and check out the Business Plan course!

To answer the question more directly, a direct primary care practice can be started with $5,000 or with $50,000. It depends on how expensive your lease is, how many staff members you have, how much equipment you need to buy, and how resourceful you are.

For many doctors in the direct primary care movement, they know how important it is to keep their overhead low. A lower overhead leads to a lower price point for patients and therefore a more sustainable medical practice.

For me, I launched my practice with about $20,000 in the bank. I bought a $700 exam table, a $1,700 EKG machine, and a $700 pulmonary function test (PFT) machine. I spent about $600 each month on rent, $450 each month on my malpractice insurance, $300 monthly on the electronic medical record system, $500 monthly on medications, and $500 monthly on lab work. Those were the biggest expenses when I started, and my monthly expenses for the first few months of practice were in the $3,000 monthly range.

This low overhead made it easy to break even for operations, and I broke even for operations with around 85 patients or 85 members in my practice.

A quick breakdown of the Startup Costs for our Direct Primary Care Practice

How much money do you need to start a direct primary care practice? Here's some basic numbers during my first few months of operation with our direct primary care practice at Plum Health DPC:

• One-time purchases:

  • Exam table $700

  • EKG Machine $1,700

  • Legal services/patient contracts $2,500

  • PFT Machine $700

  • Bookcase $200

  • Comfy Chair $200

  • Basic supplies and equipment: $1,000

  • Small Business courses/educational resources on how to operate a business successfully: $1,000

• Monthly costs:

  • Lease on a space $600 monthly

  • Malpractice Insurance $450 monthly

  • Electronic medical record system $300 monthly

  • Cost to purchase medications $500 monthly

  • Cost of laboratory services $500 monthly

  • Cost of misc supplies and equipment $500 monthly

In my first 9 months of practice, my overhead costs averaged at $3,664 monthly.

By month 9, my revenue was at $7,679.10, aka profitable!

Conclusion: You could start a very simple DPC Practice for $5,000 to $10,000, because we started our direct primary care practice for a relatively small amount of money.

Again, I take a deeper dive into these startup costs for a direct primary care practice in our business plan course.

#Startup #DirectPrimaryCare #StartupCosts #Overhead #ProfitAndLoss

What is the typical startup cost for a direct primary care practice?

Every direct primary care practice is different! When you’ve seen one DPC practice, you’ve seen one DPC practice, meaning that each clinic is going to be unique based on geography, demographics, state laws, and the doctor’s preferences. Therefore, there’s going to be a wide range in startup costs for a Direct Primary Care practice.

If you’re just buying supplies to furnish a small office, you should plan on spending $10,000. If you need legal help to set up contracts, you should add in $2,500. If you include things like your first month’s rent, malpractice insurance, the cost of your electronic medical record, internet, utilities, and phone lines, you should budget an additional $5,000. If you have a medical assistant on staff, you can plan on spending $3,500 each month for their salary. So, startup costs for a modest one or two room office might be $17,500 without a staff member or $21,000 with a staff member, which could include your first month of operation.

What is the average malpractice insurance cost for a family medicine doctor?

The next question is harder for me to answer. I only know what my experience has been like. For me, I purchased malpractice insurance for $450 each month. I was told that Wayne County’s malpractice insurance rate is the highest in the State of Michigan, so this cost is likely much lower in other areas of the state.

The price of the policy does decrease as we add more doctors in the practice.

Are you able to make a decent living as a direct primary care doctor?

Yes! Yes, you can make a good amount of money as a direct primary care doctor. It depends on how good you are at running a business, the cost of your overhead expenses, the prices you charge your patients, and the number of staff members that you have.

The person who asked this question went on to say: “ You have roughly 500 patients paying you about $69 each month, which comes out to only $34,000 each month! And then you have overhead costs like rent, utilities, taxes, staff payroll, etc… Additionally, you’re placing yourself on call for your patients around the clock. Is it worth it?”

For me, I didn’t start a direct primary care practice to make money. I started my direct primary care practice to take care of my patients on my own terms, to develop a fulfilling practice of medicine, and to treat my neighbors and patients with kindness and respect. I definitely want to make money and I need to make money to be successful, but it’s not the main motivation for my practice. In fact, nothing pays like autonomy - I can practice medicine how it’s supposed to be practice and I am not at the mercy of a giant hospital system telling me what to do or how many patients I must see in an hour or in a day.

How is direct primary care different than concierge medicine?

That’s another can of worms, and I’ll leave you this blog post that I wrote for Plum Health DPC, which is one of the most frequently visited pages on our blog and a top hit on Google when you search for DPC vs concierge medicine. Here’s that blog post!

How do you offer your direct primary care services to small businesses?

We offer the membership services to small businesses in our neighborhood. We have several small businesses enrolled in our services at Plum Health DPC. The employer usually pays for the monthly costs of the employees, and the employees pay for any additional services like labs, meds, or imaging services. Here’s our sales page for employer groups via Plum Health DPC.

How can I learn more about starting a direct primary care practice?

If you want to learn more about starting and growing your direct primary care practice, look no further than our courses on how to start and grow your direct primary care practice. We at Startup DPC have begun compiling some of the best content available on this blog and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

How can I find a Great Direct Primary Care doctor?

If you’re looking for a great direct primary care doctor and you’re in the Detroit area, we’re at Plum Health DPC. If you’re not in the Detroit area, there’s a great website called the DPC Mapper where you can find a DPC doctor near you!

Thanks for reading and watching, and best of luck in your direct primary care journey!

-Paul Thomas, MD

Startup DPC Show Episode 7: Conversation with a Doctor with 12,100 Instagram Followers

The Startup DPC Show aims to educate doctors who are starting and growing their direct primary care practices. If you want to take a deeper dive into starting and growing your direct primary care practice, check out our courses where we walk you through different skills that you need to be successful in your DPC practice.

Our guest today is a second year family medicine resident physician at UMass in Boston, Dr. Rami Wehbi. Dr. Rami is smart and savvy when it comes to many things, and it's remarkable that he has 12,100 followers on his Instagram channel, @DrRami.DO.

Direct primary care is different from fee-for-service medicine in several ways, and one of the big ways is that doctors have to reach out to their patients directly to get them to sign up for their services.

Family Medicine Resident disheartened by the current state of primary care

Dr. Rami has always been motivated to have a private primary care practice. He wants to take care of his patients on his own terms. He then searched for private practices that were successful. He first found concierge medicine, and then he found direct primary care. He reached out to me a few years ago and we hit it off. Together, we recorded an awesome episode for his Beyond Medicine Podcast, which can be found here. Dr. Wehbi is smart and kind, and he knows how to build a great following, either via podcasting or through his social media channels.

Paul Thomas MD of Plum Health DPC and Rami Wehbi DO a second year resident at UMass Family Medicine Residency Program, talk about challenges and opportunities in the Direct Primary Care space.

Educating Doctors about the Direct Primary Care model and movement

A big part about what drives me as a person is my mission to educate other doctors about the direct primary care model and movement. Further, I want to help doctors create the best direct primary care practices that they can, and that’s a big reason for this Startup DPC website, courses, and content.

Family Medicine Resident inspired by the potential of the direct primary care model

For Dr. Wehbi, it’s inspiring for him to see our successful direct primary care practice and other successful DPC practices across the country. Dr. Wehbi wants to be able to deliver a higher quality of primary care services. The average primary care doctor has 2,400 patients in their panel and they often see 25, 30, or even 35 patients each day. That means that these fee-for-service or insurance-based doctors have to see 3 or 4 patients each hour. These quotas are often written into the doctor’s contract.

For Dr. Wehbi, it’s mind-boggling that doctors would be expected to see 35 patients each day.

For me, it’s mind-boggling that you’d be expected to see 35 patients in a day and expect people to get quality care. It just doesn’t make any sense.

In our direct primary care practice practice, we have 640 patients total as of this blog post and my panel has 460 patients. I usually see 1% to 2% of my panel each day, so around 4 to 10 patients each day. This allows me to have 30 minutes to 1 hour with each patient and to really develop those strong, trusting relationships that can lead to better health.

What happens when patients need to see a specialist in the Direct Primary Care model?

Because we have fewer patients, we have more time to dedicate to our patients. We have more time to think and care and demonstrate compassion. We also have more time to look things up and to read up on a new diagnosis or the updated management of an old diagnosis. Further, we can work with our local specialist colleagues and develop cash-pricing for their specialty services. Finally, we leverage an e-consult platform called Rubicon MD to get specialty consults done in a matter of 4 to 12 hours.

Why would i pay for a membership-based service when I already have Insurance?

Well, you can restructure your insurance coverage to make it a more of a catastrophic coverage plan, meaning that you pay a lower premium and carry a higher deductible. Then, you can pair that low-premium, high-deductible health insurance plan with a direct primary care plan. This could end up saving you money as those insurance premiums can be quite expensive, and you can get better health care services as you have a trusted doctor at your fingertips.

Direct primary care for employer groups

For employer groups who buy insurance through the current fee-for-service insurance-based system, there is a ton of money lost on the middle men, plan benefit designers, and insurance brokers. Direct primary care clinics offer a way to lower the cost of health care for employees and employers by removing these middle men and offering excellent care and service to employees. And, having best-in-class service for employees will be another benefit for large employers looking to attract and retain top talent.

DOES DIRECT PRIMARY CARE MAKE SENSE FOR A PATIENT WITH MULTIPLE CHRONIC MEDICAL CONDITIONS?

Yes, direct primary care is a great system for patients with multiple chronic medical problems. The idea here is that the direct primary care doctor will have more time to fully address all of these multiple medical problems and how they interact with each other. By spending more time with our patients, we definitely prevent several costly and stressful visits to the emergency department or urgent care center each year.

“The urgent care system is a symptom of a failed primary care system. If your doctor had enough time to see you when you cut your finger or had bronchitis, you wouldn’t even have to go to an urgent care.” - Dr. Paul Thomas

For example, we recently had a patient who cut their finger at 5:30 pm on a Monday evening. They called me and I came in to sew up the laceration right away.

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I was driving home from the office and I received a phone call from one of our #PlumHealth members - it was 5:23 pm. I quickly turned around and headed back to the office, meeting my patient at 5:30 pm. He was washing dishes when a glass 🥃 broke in his hands and created this V-shaped laceration. We ran it under some warm water 💧 to flush the wound, cleaned it with an antiseptic, and injected 💉 some lidocaine into the wound edges. We pulled back the flap to make sure there wasn’t any more glass sitting in the wound. Then, we used some 5-0 (very thin) suture material to close the wound, keep the skin flap vitalized, and minimize the appearance of the scar. We wrapped up just before 6 pm - that’s 27 minutes from making the phone call to being all sewn up. Best of all, because he’s a member of the #PlumPack, there’s no charge. This procedure would have cost at least $150 at the urgent care and perhaps $1,500 at the emergency 🚨 department. These are some of the many reasons that I love being a #directprimarycare doctor. This is why I do what I do - to deliver affordable, accessible healthcare.

A post shared by Paul Thomas MD (@plumhealthdpc) on Feb 3, 2020 at 4:50pm PST

This model of care allows you to take full ownership of your patients - you can take radical responsibility for your patients.

Where to Find an Excellent Direct Primary Care Doctor?

If you’re looking to find an excellent direct primary care doctor in your neighborhood, check out the Direct Primary Care Mapper, here. If you’re in Detroit or Southeast Michigan, don’t hesitate to reach out to our Plum Health DPC clinic here in Corktown.

How can you start your own direct primary care practice?

Many medical students, medical residents, and doctors are looking for the best way to start and grow their direct primary care practices. Fortunately, Startup DPC has begun compiling some of the best content available on this blog and in our courses.

The best place to start is to take our Direct Primary Care Business Plan course, available here. From there, you can learn how to attract new patients to your direct primary care practice and how to find the perfect location or build out the practice of your dreams.

Thanks for reading and watching, and best of luck in your direct primary care journey!

-Paul Thomas, MD

Startup DPC Show Episode 6: Interview with Harvard-Trained DPC Pediatrician

Harvard-Trained Pediatrician Starts Her Direct Primary Care Practice in Dallas Texas

Welcome to Episode 6 of the Startup DPC Show, and in this episode we have the pleasure of speaking with Tonya McDonald, MD. Dr. McDonald is a Pediatrician and the founder of Radiance Pediatrics in Dallas, Texas. Dr. McDonald trained at Harvard Medical School, graduating in 1998 and she completed her Pediatrics Residency at Baylor College of Medicine.

Dr. McDonald is a Pediatrician and the founder of Radiance Pediatrics in Dallas, Texas. Dr. McDonald trained at Harvard Medical School, graduating in 1998 and she completed her Pediatrics Residency at Baylor College of Medicine. She is the featured Direct Primary Care doctor for our Startup DPC Show, Episode 6.

Dr. McDonald was recently interviewed by Harvard Medical School’s Magazine in a section called The New Black Bag. Here’s a segment of the interview:

This past spring, she opened Radiance Pediatrics, a direct primary care practice that provides in-home and virtual pediatric care to families who pay a flat monthly fee. For this fee, families get extended visits, same- or next-day appointments, telemedicine visits, and direct access to McDonald through phone, text, and email.

“In some ways, this is a throwback, an old-school approach to medicine,” she admits. “But it gives me the opportunity to help rebuild the doctor-patient relationship. It’s a gift to be able to truly bond with families.”

Not long ago, McDonald was part of the 78 percent of U.S. physicians struggling to cope with burnout, a problem some have labeled a public health crisis.

“In the past five years, I was seeing up to thirty children a day, feeling sad that I couldn’t practice medicine the way I wanted,” McDonald says. “Insurance dictated what I could do.”

McDonald knew it was time for a change. And she’s far from alone.

As shown in the interview from HMS above, Dr. McDonald is a quintessential physician on the front lines of the healthcare system, dealing with a packed schedule and not having enough time to fully take care of patients. I also love that she says that she now has the opportunity to rebuild the doctor-patient relationship - I put that in bold for emphasis. Now that we have some context, let’s jump into the interview!

Dr. McDonald’s Startup DPC Story

Dr. McDonald had heard about direct primary care ten years ago, but put it in the back of her mind. Three years ago, while working for Children’s Hospital of Dallas, she got tired of seeing 24, 25, or 30 high-risk pediatric patients each day. This was especially difficult when she was taking care of high-risk, high-needs children with complicated medical problems and adverse social determinants of health. Having only 10 minutes for these patients didn’t work for Dr. McDonald.

The final straw was when her pediatric group was “restructured” to an even higher volume practice with multiple physician extenders in the group. She was laid off, took a severance package, and started planning her transition into direct primary care.

Caring for an underserved community with Direct primary care

Dr. Tonya McDonald is serving pediatric patients and families on the south side of Dallas. Dr. McDonald states that there’s a lot of money in Dallas, but most of that wealth is concentrated in Downtown or on the North Side of the city. She goes on to say that the south side of Dallas has a majority minority population - about 40% African American and 30% Hispanic. The median income in the community is roughly $55,000 each year. She alludes to the historical context of living in the south with restrictive housing covenants, which accounts for income inequality and segregation in this area. Dr. McDonald wants to serve in this type of community because she’s a black, female Pediatrician and she enjoys taking care of people in this population. She also alludes to making an impact by being a role model for kids who may not be able to see a black pediatrician, and she also discusses how it’s empowering to serve in a medically underserved community.

Photo of Dr. Tonya McDonald making a house call, courtesy of Harvard Medical School’s a New Black Bag series.

How Direct Primary Care can Address Health Disparities

Dr. Tonya McDonald discusses how some people hear about a “members only” clinic and think that it’s exclusively for the rich. On the contrary, she takes care of folks who are truly in the middle - these are the folks that make too much to qualify for Medicaid or Children’s Health Insurance Program (CHIP) but they don’t make enough to afford private insurance. These patients are willing to save up and cash pay for their healthcare services, but they didn’t have access to affordable options. Now that Dr. McDonald is in the market, these families now have that option to save up and cash pay for an affordable, accessible pediatrician. These families understand the value of direct primary care and the cost savings therein.

How much does a pediatrics direct primary care membership cost?

For Dr. Tonya McDonald and her Radiance Pediatrics practice in Dallas, she charges a monthly membership that costs $125 per month for children from birth to 2 years of age, $100 per month for children 2 years of age to 15 years of age, and $75 per month for adolescents and young adults from 16 to 26 years of age. She also has some discounts available.

Membership Fees:

One Time Enrollment Fee: $100 Per Child

Introductory Monthly Fee For First 25 Families:

0-2 Years - $125

2-15 Years - $100

16-26 Years - $75

Discounts Available: 3 Or More Enrolled Children; Foster Care Children; Full Annual Payment; In-State College Student

Knowing the market when setting your prices

Dr. Tonya McDonald took a look around at the different healthcare costs in the marketplace, namely the costs for home births, doulas, midwives, and similar services. She notes that families in her community were often paying $5,000 to $12,000 for 9 months of care from a midwife and $2,000 to $3,000 for perinatal care from a doula. In that context, paying $100 each month for high-quality, evidence-based pediatric care is not that much money.

“People who value you will pay you what you’re worth.” - Dr. Tonya McDonald

Dr. McDonald also talks about folks in her community who pay $125 for lash extensions plus $75 every 2 to 3 weeks for maintenance of her lashes. In that context, paying $100 each month for high-quality, evidence-based pediatric care is not that much money. She goes on to say that “People who value you will pay you what you’re worth. And those who don’t want to pay you what you’re worth probably wouldn’t pay you consistently for the long term, even if you were half the price because they just don’t value you.”

What are the monthly expenses like for a house call only Pediatric Practice?

Dr. Tonya McDonald works out of a co-working space and she’s surrounded by other entrepreneurs. These folks are smart risk-takers, they’re all about new ideas, and they help her to become a better business person. By renting space at a co-working space, she doesn’t have to use her home address as her business address. She also has storage space for her supplies as a part of her rent, which is $300 per month.

She bought a separate car via her business because it’s easier and cheaper to maintain with commercial insurance. Buying this relatively inexpensive car helps to build credit for her business as well. She buys a lot of her supplies via Henry Schein and Amazon, and she even splits supplies with other local pediatricians. This helps to keep her overhead low.

They are not able to dispense medications in Texas, because it’s not legal for physicians to dispense medications in Texas. This is one of the rare exceptions in the DPC landscape, as virtually every other state in the US allows for physicians to dispense medications from their offices, but not Texas.

Malpractice Insurance is $71 monthly for claims-made coverage. She shopped around and looked at 4 different carriers and also negotiated. She states that as a DPC practice, you have a lower volume, you don’t have 2,000 or more patients, so you should be paying a lower malpractice insurance rate. She expects her malpractice insurance to max out at $300 per month.

What do you do for Pediatric Vaccines in your direct primary care practice?

Dr. McDonald has partnered with some pediatricians in town to purchase single vaccines from their bulk stock. She has a PedsPal account, so she knows how many vaccines she’ll need for the year, and she keeps a log of what she uses and pays the pediatrician for these vaccines. She then bills her patients directly for the vaccine cost, at cost. If her patients are uninsured, she directs them to the county health department for their pediatric vaccines, which are $5 per shot. Finally, children over 7 can get their shots directly from the pharmacy, covered by the insurance with no copays, so she directs families to this option as well. For a few of her patients, she can give the vaccine and bill through VaxCare, which bills the patient’s insurance for the vaccine.

Thank you for reading! To watch the full conversation, see our YouTube video below.

Resources for starting and growing a direct primary care practice

If you’re interested in learning more about starting and growing your direct primary care practice, head over to our courses where you can learn how to attract more patients to your practice, write the perfect business plan, or find the perfect space for your growing DPC practice.

Sincerely, Dr. Paul Thomas

How to Get More Referrals For Your Direct Primary Care Practice

How to Get More Referrals for your Direct Primary Care Practice

Direct primary care doctors often want to know how to get more referrals to their direct primary care offices from the local healthcare ecosystem. How do you get the nursing staff and discharge coordinators to send patients from the hospital, emergency department, specialist clinics, or urgent care clinics to your direct primary care practice?

One good way is to go to those places and meet with the nursing staff, front desk staff, and physicians. Our practice in Detroit is called Plum Health DPC, and we've gone to all of the local urgent care clinics and emergency departments to make sure that our practice is listed as a Primary Care office accepting new patients. We’ve also visited the handful of specialist offices in the Detroit community to make them aware of our services.

What you should bring with you:

1. A flyer describing your services, usually an 8.5 x 11 inch page with information on the front and back. Bonus points if it’s in full color.

2. A stack of business cards with your name, title, email address, street address, and phone number.

3. Your smiling, positive, outgoing self. Use positive body language to communicate that the patients being referred to your office will be in good hands.

To go above and beyond, maybe you could act like a drug rep and bring lunch - a box of Jimmy Johns or something similar - to the emergency department break room and introduce yourself to all of the ED workers. You can bring lunch to the specialists’ offices and urgent care clinics in your community as well.

Good luck with your journey! - Dr. Paul Thomas

Here’s a portion of our promotional flyer that we hand out to our local businesses and local healthcare ecosystem, like the emergency departments, specialist offices, and urgent care clinics.

Managing Your Google Search Console for Direct Primary Care Doctors

Over the last 3 months, we've gained 143 new patients in our Direct Primary Care practice - 42 in November, 57 in December, and 44 in January. One of the big things that helps us get there is Search Engine Optimization (SEO). If you're not familiar with this skill, and how to use SEO to your advantage, you're missing out on patients who could use your service.

You see, everyday, people are trying to solve their health care challenges. They’re looking for kind, compassionate, caring physicians to help them with their medical problems. They’re looking for affordable care and convenient service.

To find this service, patients turn to Google and use search terms like “affordable doctor near me” or “family doctor accepting patients near me.”

So, one of the biggest and most important ways for patients to find you is through Google and Search Engine Optimization related to this platform. Every month, Google sends me a report for Plum Health DPC showing my performance over the last 1 month and last 3 months.

This last month, we had about 39,200 impressions on Google and 649 web clicks via the Google platform. That’s about 1,300 impressions each day and 21 clicks each day! If you know that it takes about 20 web visitors to create 1 new enrollment, all of this information is encouraging.

Over the last 3 months, we’ve had roughly 40 to 50 new enrollments each month, and a lot of our success comes from managing our Google Search Console effectively and doubling down on Search Engine Optimization.

Essentially, you want to find the Google Search terms that are meaningful for your business in your Google Search Console report and then create content around those search terms.

If you’re struggling with your growth and you haven’t gone “all in” on search engine optimization, let this be a wake-up call regarding the power of this Google search engine platform. I know that these may not be the most comfortable topics for a doctor, but these are the tools that you’ll need to master in order to create a thriving Direct Primary Care practice.

If you want to take a deeper dive on these concepts, check out our Take Action page or take our course on Attracting More Patients to Your Direct Primary Care practice. Thanks for reading and watching! - Dr. Paul Thomas

Over the last 3 months, we’ve had 118,000 impressions on Google and 1,760 clicks through to our Plum Health DPC website. All of this is a part of our strategy to grow our practice. You can learn more about these techniques with our course on Attracting New Patients to Your Direct Primary Care Practice.

Over the last 3 months, we’ve had 118,000 impressions on Google and 1,760 clicks through to our Plum Health DPC website. All of this is a part of our strategy to grow our practice. You can learn more about these techniques with our course on Attracting New Patients to Your Direct Primary Care Practice.