It has been three and a half years since I made the jump from a "normal" insurance-based practice to a direct primary care (DPC) practice. To clarify, we take no payment from third-party payers (insurance or government), instead charging a flat monthly fee for all care, ranging between $35 and $65 per month (depending on age). We charge no copays, do most common procedures for no additional charge, and offer "client bill" labs (the patient pays us and we pay the lab a negotiated price) with minimal mark-up (CBC is $4.50, TSH is $8).
While this may seem an impossible business model, at 725 patients, we are profitable enough to pay me a "reasonable" salary (one that pays my bills and lets me save some) that is rapidly increasing. My collections this past month were more than $8,000 higher than a year ago, with minimal increase to office overhead. Furthermore, my quality of life and level of the care I can give is far better than it ever was in my old practice (I average around 10 patient office visits per day). I am happier, my patient satisfaction is very high (with very few patients leaving the practice), and my staff tells me they'd quit before they'd go back to the old type of practice.
If this all sounds like a fantasy, the part that I am omitting is how difficult it was to get to this point. The object of this article is not to explain the details of my practice (I've done that in previous articles), but to give some advice for those considering making the change from the hamster wheel of insurance-run primary care to the relative freedom of direct primary care. Not all who try DPC succeed. So what are the most important things to do to create a sustainable practice?
1. Have a vision
Over the last few years in my previous practice, I was increasingly despondent about the quality of care I was giving. I was desperately trying to give excellent care in a system that was alienating me from my patients. I saw DPC as the antidote for that struggle. Instead of being rewarded for sickness, procedures, and brief office visits, I was rewarded for education, spending time with people, and keeping people healthy (all of which allow me to grow my panel).
My vision gave me the ability to get through the times when money was tight. Having a much better relationship with my patients was enough of a salve to put up with small balances in my bank accounts. Additionally, my vision was contagious, causing many of my patients to evangelize their family and friends on my behalf. Happy customers are good advertisement, but true believers are even more so.