When I converted my practice to Direct Primary Care (DPC), the trail wasn’t as common as it is now. I had to make my own mistakes. Now that I’ve been through the process I have the power to share my mistakes and what I have learned from them so others don’t have to make them too. I feel that I’m contributing to the betterment of healthcare while also saving future DPC doctors angst, stress, and money.
As doctors, we can be very confident in ourselves. When I first thought of converting, I heard over and over again that somewhere between 10% and 20% of patients tend to convert, so I ran my numbers assuming 15%. I thought I’d have a full panel, making equal wages in no time. Oh boy was I wrong. The first 3 months, my conversion was tiny--it could have been something like 1%.
Just recently I was on the phone talking to a doctor in the process of converting his practice to DPC next month. He said he has a verbal commitment from 10% of his patients. I asked, “how many people have given you any money--supplied a down payment to open a membership with you?” He said, “nobody.” I told him to, “be conscious of that because I’ve found that verbal commitments don’t mean anything.”
I wish I’d known not to be confident in patients converting until you have money from them. I would have taken a non-refundable deposit, such as 1-3 months of membership.
In fee-for-service medicine (FFS), you don’t advertise you just join networks and they supply patients. When I converted to DPC, I was a new business owner, so I went to a local advertising agency. They told me I needed:
In hindsight, it was like being at the used car lot. I also spent a bunch of money on:
I now know websites don’t cost thousands of dollars. They cost a little bit of time and a bit of know-how, or they cost a little bit of money for someone to build one quickly. Also, websites in this business are for information, not marketing. Your website exists to tell patients what services you offer and to provide your phone number so they can call you. It doesn’t really drive new patients to your practice.
I would caution people to stay away from spending a ton of money on social media and web development. For me, none of those avenues were fruitful. Instead, I now know that satisfied patients create more patients. If you provide patients with quality care, they will tell their friends.
A lot of doctors are taking a significant risk by assuming their practice will be a financial success at the outset. Based on my experience, they need to be able to find or borrow 12-15 months of income and operating expenses. Without that cushion, you get stressed and might end up back in the FFS world.
People often talk about supplementing income. For moonlighting, the low-hanging fruit is urgent care and ER work. That said, it’s important to keep in mind that in most cases they’re only going to use you if you have a Medicare number, so if you terminate your prior relationships when you convert to DPC, you’re also cutting a cord on some of your moonlighting opportunities. I’ve seen doctors unknowingly make the mistake where they cut all the cords and the employers for whom they were moonlighting now say, “I can’t bill for you anymore.” You should cut the cords, but ensure that you are ready.
Some doctors supplement their income by operating a hybrid, but I personally think it hurts your DPC practice. Patients can sense that lack of commitment, and I also think it’s unfair to your DPC practice that people are paying for your time and you’re giving it away on a FFS basis.
Instead, I believe you’re going to be better and build quicker if you commit fully to DPC. Much of my success came from being completely committed. When we had a slow start, I had no alternatives, so I had to figure out how to make my DPC practice work. That’s what led us into the employer world, which is the best thing that ever happened. Necessity led us to figure out and launch employer health plans. If you have one foot in the FFS world, you don’t have that necessity so you’re less likely to be successful.
Doctors coming from a busy practice often assume they need a nurse and an office manager. Assuming you need staff is a dangerous assumption. Plenty of DPC doctors don’t have staff, and I’d suggest anyone converting start out solo before they start staffing up.
All the DPC doctors I’ve ever seen fail have done so because they made an expensive financial mistake. They built a building, for instance, or got some high-tech equipment. When I hear a new DPC convert say “I got this cosmetic laser…” I think “okay—now I know your situation better than you do.” Commercial real estate is for a commercial real estate company—if you want to start one of those, great, but tying it into your DPC practice can be deadly.
When I first converted, I thought a membership-based practice can’t be that hard to set up. I kept the EMR I was using (a FFS EMR—it was expensive, robust, and provided a bunch of services I didn’t need anymore). For my membership modeling, I used QuickBooks. The whole thing was a disaster. We didn’t start with a payment on file, so every month, patients had to go in and pay for us, just like they pay their water bill.
Then I found the trifecta of Hint, Elation, and Spruce. The most valuable thing I can say now is that these three platforms work. I wouldn’t waste any time and money using things that aren’t built for a DPC practice.
We would say “no” when patients asked, “do you take Blue Cross Blue Shield?” These conversations often ended one sentence later, typically with an, “okay, thank you,” and the patient hanging up. Looking back, I now realize that we missed opportunities to explain all we do.
One day, I overheard someone on my team explain that we don’t take Medicare, and I thought, well, we don’t take Medicare, but we do take care of a lot of Medicare patients. We changed the answer from, “no we don’t take your insurance” to answering the question they should have asked, “Do you take care of people who have my insurance?”
Now we say, “We take care of a lot of people who have that insurance plan.” Then we explain how the membership practice works:
It was like an aha moment, so we switched the answer in all our clinics to, “we take care of a lot of those types of patients, and this is how.” It’s helped a lot of patients understand better how we can provide them helpful care.
Despite all the difficulties and mistakes, converting to DPC is still one of the greatest choices I made. It’s a better lifestyle and allowed me and many other doctors to reclaim our lives and take better care of our patients.
If you have any other questions, my company MyMD Connect is here to help DPC doctors get set up. MyMD Connect isn’t profitable--it’s structured not to make money itself, but to help physicians get DPC practices up and running. The good people over at the Hint Community are also especially helpful at answering questions on your quest to join DPC. We all got into medicine to help people, so I hope some of my mistakes will help new doctors take the same powerful step on the journey to improve healthcare.