Isn't it amazing how different every practice, every population, every physician is? That's why I think it's so great that we can all chime in about our own experiences. I've always attracted higher needs patients (think fibromyalgia, childhood trauma, mental health issues, etc) so I know that I need to account for that.
My advice to any new DPC doctor:
- You are a wonderful physician and you could be dropped off naked in the middle of nowhere with nothing. Anything in addition to that is just there to make you comfortable or to help you do a better job of doctoring. If it doesn't do one of those two things, you don't need it.
- You are smarter than you think you are. We have developed learned helplessness thanks to the modern medical system. If a housekeeper, mechanic, and electrician can all run their own businesses, so can you. I remember when I started, I worried I wouldn't know how to fax something or send a referral or buy supplies. But if you can run a household, you can run a business. If you can figure out how to use your email and buy something on Amazon and order a pizza online, you can figure out the technology.
- Define your niche. Who are your favorite patients? Define them as closely as you can. Mine are people who are uncomfortable or unhappy in medical offices, most likely come from working class backgrounds or are creative or the black sheep of the family, who prefer to avoid medication if there's another way, whole families (rather than kids see peds, mom see gyn, dad sees IM), who lead interesting lives and tell me all about their lives, maybe struggle with depression/etoh/childhood trauma/etc. Where do those people congregate? What other services do they use? Who are the best people to connect with to find your population? For me, midwives, acupuncturists, urban farming organizations, and word of mouth through current patients have been my best referral sources. If you love seniors, you might want to target estate planners, travel agents, volunteer organizations in which most of the volunteers are seniors, churches, etc.
- Low overhead means increased flexibility. Try to keep that overhead down. The best way of doing that is to question everything. Anytime I think I need to buy something, I instead ask myself if there's something I already have that would serve the same function and if it's something I actually need or if it fulfills some emotional fear. Anytime I think I need to hire help, I first ask myself if there's an inefficiency I could fix instead.
- But don't be afraid to pay money to improve your happiness. I hate paper so I pay for Shoeboxed. I hate admin so I have an EMR that has everything completely integrated. I get stressed out being on call if people can text or call straight through to me so I have a phone system that allows for good boundaries. I don't pay for inefficiency. I do pay for sanity.
- Have good boundaries. If you feel uncomfortable or stressed about something, you probably need better boundaries.
- Have a back up plan for income the first year or two so you aren't stressing about it. Being able to turn away patients who are not a good fit should not be a luxury.
- Be yourself. Present a version of you that appeals to your target population but that you can enjoy being day in and day out. Offer services that are needed for your target population. But if you don't enjoy doing something, then don't. You do not have to be the same as some other DPC. There isn't a rule that you have to text or you have to offer EKGs or you have to do IUDs or you have to jump through flaming hoops while juggling. Patients are used to having to go all over for everything and just the fact you sit and listen, have open access, etc is just astounding to most people. If not offering a particular extra is a deal breaker for a particular patient, just let them go. You are already doing something that almost no one in your area is doing.
- Check out the prices for DPCs in comparable geographic areas but then do what works for you. Currently a quarter of my patients are under 10. The majority are under 40. I'd be killed on age based fees so I do a flat monthly fee based on number of family members. But that's not how it is for everyone! Also, don't be afraid to adjust your prices. I opened before the ACA and Medicaid expansion took full effect so I had a lot of patients with very very low incomes who were desperate so I kept my prices low. After the Medicaid expansion covered the worst off of my patients and once there were other DPCs in my metro area charging twice what I did, I went ahead and increased my prices. I lost a total of one family. No big deal.
- It will take awhile for both you and the patients to get used to this different way of doing things. I got really anxious the first few times I diagnosed a rash with just a few photographs and a conversation with the patient. I was so used to FFS, it was hard to remember that we only had to have an appointment in order to charge them money. Conversely, I see patients in the office without a problem if they just have a lot of questions or need to discuss something and are more comfortable in person. I don't have to have a billable diagnosis to spend time with someone.
That's all I can think of right now but I'm eager to hear other opinions!