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Getting started with direct care


The first step is establishing a vision for your practice.

If you are considering opening a direct care practice, the first step is to establish a vision. If you’ve always fantasized about having your own practice, you may immediately know exactly what your dream practice looks like. But if not, try this mental exercise.

Imagine your ideal practice setting

Start by considering your ideal work setting. Close your eyes and imagine walking through your office—what do you see? Is the space big or small? Are there marble floors and water features, a clean and sterile-appearing environment, or is the setting more homey and shabby chic? Is your practice bustling with patients and staff, or is it calm and tranquil?Maybe you want your office to be child-friendly or you envision yourself bringing your dog to work. Try to think of any little thing that would bring joy to your workday and jot down your thoughts in your bullet journal.

Think about your ideal workday
Now imagine your ideal workday. If you are a morning person, maybe you would prefer to see patients at 7 AM and end the day early. Or perhaps you value time at home with the kids in the morning (or sleeping in!) and would prefer to get a later start.Do you like to work through lunch and see as many patients consecutively as possible, or does it feel more comfortable to pace yourself, taking several scheduled breaks throughout the day?Maybe you imagine working a three or four-day week to have more free time.Again, write down your thoughts on what the ‘perfect’ workday or week looks like to you.

Keep in mind that you are just beginning to develop your vision, and your wants and needs will evolve over time. That’s OK! One of the best things about opening a practice is that you are free to experiment and if you don’t like the way things are going, you have the power to change them.

Consider your values and mission

Now that you have some ideas about what your ideal practice could look like, let’s home in on your values and mission. Take some time to really think about what motivates and excites you about being a doctor. Is it important that you care for a certain type of patient, or manage a particular disease process? Do you feel driven to be on the cusp of the latest innovations in technology? Are you passionate about social justice, research, or preventive care? Keep a list of these intrinsic motivators as they occur to you.

Some doctors may struggle with establishing a guiding mission, especially if they have spent years being misused by the system. If you fit into this category, a great way to plan your future is to look to your past. Start by thinking about the first time you realized you wanted to be a doctor, and what inspired you. Fast-forward a bit and see yourself writing your personal statement for your medical school application.What did you write? Think back to the moment you got your acceptance letter to medical school. What was the future you envisioned?

Create a mission statement

Over the years, a variety of factors may have derailed your vision, but you can find your way back. A great way to start is by creating a mission statement.It also helps to write down your values and ideas about services and office hours that you would like to offer.Remember, you can always change these down the road. Here are mine, and feel free to borrow from them if they resonate with you.

Mission: To provide high-quality, evidence-based direct primary care at affordable rates by eliminating third-party payers and minimizing overhead expenses.

I chose this mission because I am passionate about primary care. Studies show that managing chronic disease and providing cancer screening saves lives. The direct care model allows me to offer this care affordably and gives me the time I need to develop true relationships with my patients.

Values:Provide quality medical care that empowers patients to improve their physical and mental well-being. Be accessible to patients while allowing for physician work-life balance. No gimmicks.

For optimal results, physicians and patients must work as a team. Our job is to educate and provide tools, but only the patient can take the steps needed to improve their health. I also remind myself here that if I don’t take care of myself, I can’t care for anyone else. Finally, as a cash-based doctor serving budget-conscious patients, I feel it is essential that I maintain trust with my patients by offering evidence-based treatments and avoiding nonscientific practices, no matter how lucrative or popular.

Services:Primary care by appointment only.Telephone access and internet-based consultations when appropriate.Provide lab draws and reduced-price laboratory fees.Minor procedures such as biopsies, ingrown nails offered.Gynecologic/ pap tests.Reduced cost in-house psychologist, dietician, and massage therapist.

I know that I function best on a schedule. Patients who walk-in with acute issues (especially minor, self-limiting conditions) derail my office flow, so I discourage the practice. Instead, I reserve a few slots per day for same-day issues. I enjoy doing procedures, so I learned to draw my own blood samples, a service my patients value. And as a huge advocate of mental health care, I incorporated low-cost psychotherapy into my practice practically from day one. Seeing the need for additional services, I added an affordable dietician and massage therapist exclusively for my patients.

Office Hours:Monday: 11 AM-5 PM, Tuesday-Thursday: 9 AM-2 PM.

When I first opened my practice, I saw patients from 8:30 AM to 5:30 PM, Monday to Thursday, and used Fridays for ‘admin’ time to run the business (and errands). Once my practice was full, I changed to seeing patients only on Tuesdays through Thursdays, and eventually, I moved my start time to 9 AM, which allows me more time in the morning to get organized and to complete ten minutes of meditation—something that I’ve been working for years to incorporate as a habit.

Because you are in control, your schedule can evolve to accommodate your needs and wants. For example, last year I started a pandemic backyard vegetable garden but found myself frustrated that by the time I got home it was too dark to check on it. It may sound silly but watering the plants and picking salad greens makes me ridiculously happy. Getting home earlier also motivates me to exercise in the evenings, which I know I need to do for my health. So, after consulting with my office manager, we cut my afternoon hours on Tuesday through Thursday and added back clinic hours on Mondays.

Now that you have started to visualize your dream practice, are you starting to get a little bit excited? You should be because you can make it happen!Over the next few articles, I’ll show you the steps to make your dream become reality.

Rebekah Bernard, MD, is a family physician in Fort Myers, FL and the author of How to Be a Rock Star Doctor and Physician Wellness: The Rock Star Doctor’s Guide.

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