This handbook is the most comprehensive single resource for any aspiring direct primary care physician. It walks you though the process of starting your practice step-by-step, with detailed instructions, links to other resources, plenty of sample documents, and practical advice gathered from dozens of successful DPC practices.
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Familiarize yourself with these resources for aspiring DPC docs
There are three main DPC conferences each year.
Consider attending one - being surrounded by other doctors who've already made the leap is invaluable. All three conferences are at least partially geared towards aspiring docs who are either trying to decide whether to do DPC or in very early planning stages.
There is a YouTube channel that has compiled all the talks from these conferences for the past couple years in one place. Check out that channel here.
Regional DPC alliances
Doug Farrago's Guide
Make sure your DPC practice is feasible
Consider working as an employed DPC physician
Check if there are any legal hurdles to DPC practices in your state
Do you have a means of acquiring patients initially?
Are you likeable?
Make some initial decisions about your practice
Pick a business name for your practice
Note that your legal business name doesn't have to be related whatsoever to your public-facing marketing name! Choose a business name quickly and don't drag your feet. You want to incorporate as fast as possible so you can start engaging with vendors as a legal entity.
Google around for your state's online tool for checking name availability.
Pick a marketing name for your practice
If you're very well known in the community, you may want to include your name in the practice name for marketing reasons. If you plan to hire additional physicians or take on partners at some point, you probably don't. Click around on the DPC Frontier Mapper for ideas.
Some other considerations: make sure there are memorable social media usernames/handles available. Use a service like namecheckr.com to check availability for a name across all social media sites at once. You'll also want to make sure a decent domain name is available. Use Google Domains to check availability.
Decide on your business hours
Decide whether to give your practice a specialist "flavor"
Decide whether to run a "pure" or "hybrid" practice
Consider your fees and markups
Choose membership prices
Decide on a re-enrollment policy
Consider one-time cash-pay visits for non-members
Consider one-year contracts
Decide what services to offer to your members
Expand your mind
Not everything has to be 100% covered by a membership (though of course, you should include as much as is feasible). Many practices offer additional services—procedures, OB, physicals, preventative health screens, etc—on a cash-pay fee-for-service basis. Consider what to include in the membership, what to provide at-cost, and what to charge extra for.
As a DPC doctor, you're the linchpin of your patients' care. Watch this excellent talk by Drs. Lassey and Tomsen on expanding your scope of practice. Some services are a great way to attract patients, others can be lucrative add-ons to your practice. Consider expanding your scope to include: Consider whether you'd be willing to offer the following services:
stress/VO2 max testing
bone density testing
body composition analysis
coordination of hospital care
Choose the right entity structure for your practice
Determine what business structure is best for your needs
First, check out your state's guidelines on professional entities. Some states require you to operate as a professional entity (PLLC or PC) instead of a generic equivalent (LLC or Corporation). Here's a state-by-state rundown.
After figuring that out, decide whether an LLC or Corporation is right for you. Basic rule of thumb: if you want to add an additional physician/partner at some point a PC will be easier. If you know you'll stay a one-doc shop forever, a PLLC could make your life easier since it allows pass-through taxation. Basically all business revenue "passes through" the LLC to you and is treated by the IRS as personal income. This eliminates the need to do an independent corporate income tax return.
You may likely want to confer with an accountant to make this decision, or look at other nearby practices.
Draft an operating agreement/bylaws for the company
Incorporate the business through your state
File a DBA with your state
Apply for your Employer Identification Number (EIN)
All the forms and contracts you'll need to run your practice
Release of Records form
Patient History form
If hiring: Employee Contract
Optionally, run everything by a lawyer
DPC is for closers
Draft a business plan
Estimate initial upfront costs: including location renovation costs, equipment and materials, lawyer/accountant fees.
Estimate operating costs: rent, utilities, payroll, non-durables, lab kits, Rx.
Estimate revenues: your number of patients over time, and set revenue goals per month.
Using this information, determine how much money you must spend before you break even. For a great walkthrough of this calculation, check out Julie Gunther's DPC Startup Handbook.
If you need a loan: do your research
Consider completing a small business workshop
Open a checking account for your business
Apply for a business credit card
Update your contact info with everyone!
Once you've found a physicial location (see "Location") and set up your email hosting (see "Website"), tell people your new information! Update nearby hospitals and private practices, the DEA, state pharmacy board, state licensing office, city business licensing office, local labs and radiology centers, and anyone else in the medical community who knows you. You don't want referred patients or requisitioned lab results ending up at your old employer's office instead of your own.
This is also a great way to start a conversation with other doctors about DPC.
Think about your ideal space
Decide whether to buy, rent, or lease
Find a location
Arrange the front office space
Figure out the front-office check-in process
If you have employees: set up HR/payroll software
If you have employees: consider offering life, health, and accident insurance
Finally say bye to Medicare
Decide when to opt out of Medicare
Complete an opt-out affidavit
Mail affidavit at the appropriate time
You'll need to know some details of the opt-out process.
For participating providers in Medicare, new "batches" of Medicare opt-outs are made active on the first day of each calendar quarter (Jan 1, Apr 1, July 1, Oct 1). The Medicare carrier must receive your opt-out affidavit 30 days prior to the stated effective date (Dec 1, Mar 1, June 1, Sept 1, respectively). So if you start the opt-out process on December 2nd, the earliest you can be officially opted out is April 1. Plan accordingly.
If you are currently non-participating (NON-PAR), your opt-out will take effect immediately upon their receipt of your opt out form. If you are still employed or moonlighting, beware! You don't want to opt out with two months left before you quit.
Find an Advance Beneficiary Notice of Noncoverage (ABN) form online
Notify the state Medicaid program that you would like to privately contract with patients
Establish your sources of drugs, labs, and specialists
Join one or more group purchasing organization (GPO)
This is often the best and easiest way to get cash prices on medications, labs, and DME. In DPC, its common to join multiple. Groupsource or PedsPal can get you deals on medications and DME from Henry Schein. Healthcare Procurement Solutions gets you deals from Labcorp, Quest, McKesson, and Medline. Joining is free and can save you a lot of time negotiating with individual vendors.
If you choose to go this route, a lot of the todo items below are irrelevant. You'll be provided with low cash prices on labs from Labcorp/Quest, medications from Henry Schein, and DME from McKesson/Henry Schein.
Establish a relationship with a lab
Establish a relationship with an imaging center
Establish relationships with other providers
eBay and Amazon
Establish a presence on the internet
Select a domain name for your website
Make a website for your practice
Set up email hosting
This will let you receive email at an address with your new domain. Usually you can do this through whatever service you used to purchase the domain in the first place.
Google offers a business offering called GSuite that includes email hosting. The price is $5/user/month, which gets you email hosting in addition to a bunch of other Google services like Calendar, Docs, and Drive. Plus, Google will sign a BAA, so you can have HIPAA-compliant email thorugh a familiar Gmail interface.
Sign up for the services you need to run a practice
Electronic health record
Having a second phone number for patients to call/text is vastly preferable to giving out your personal number. Many tools also let you route texts/calls from your "virtual number" to the device/number of your choice based on the time of day. This functionality is built into Bagel.
There's a huge diversity of tools out there, each of which offers a unique feature set and interface. Two good ones are Spruce Health and Hale, both of which offer secure messaging, phone calls, teleconferencing, and a dedicated mobile app.
Check out these other useful services
Find plans to protect you, your business, and your employees
Business interruption insurance
Commercial property insurance (if applicable)
Commercial auto insurance (if applicable)
AKA how to avoid the need for CLIA compliance
Decide whether to do any in-office testing
To do CLIA-waived tests: file for a waiver
Consider offering physician-performed microscopy (PPM) services
Maintain best practices
Set up a reminder to renew your waiver every two years
If you're a pure direct primary care practice, you're probably done already 🎉
Determine if you are a covered entity under HIPAA
Check for state laws regarding patient privacy
Complete a Security Risk Assessment
Draft a Notice of Privacy Policies (NPP)
Draft a Release of Records Authorization Form
Draft a Patient Consent Form
Gather and maintain proof of HIPAA compliance
Gather Business Associate Agreements
If you have zero employees, you're done already! 🎉
Find a biohazard/waste disposal service near you
Follow best practices when dealing with hazardous chemicals/waste
Maintain a list of hazardous chemicals in your office
Buy a fire extinguisher and mount it on the wall
Print the OSHA poster and put it on the wall
Put your employees through annual OSHA training
Know how to report incidents to OSHA
With more than 10 employees: draft an emergency action plan
With more than 10 employees: do incident reporting and logging
Practice teaching people about DPC
This is a make-or-break skill to have as a DPC doc. Get your 30 second description of DPC down pat. Iterate on your language and pay attention to what different types of patients find compelling.
If a patient wants to learn more about DPC, direct them to DPC Nation. DPC Nation is a patient-centric DPC educational website.
Create two Google My Business (GMB) profiles
You can directly provide Google information about your business, and they'll show a special business infobox on searches by people in your area. It's easy: go to business.google.com and fill out the form. You'll need a Google account.
You should create two profiles. This is important. One profile should be for your business ("Awesome DPC"), the other should be for you as a physician ("Alex Awesomepants, MD"). This way, Google will present good information to a potential patient regardless of whether they search for you or your practice.
Once you fill out the form, Google will send you a physical postcard with a verification code on it. They do this to ensure that you are a real business with a brick-and-mortar location that can receive mail. The postcard should arrive within 14 days.
Make a Facebook Page for your practice
Claim your profiles on online review sites
Chances are you have profiles on multiple major doctor review sites. Go claim your profiles and update your information! Your previous employer may have been managing these profiles on your behalf; if so, you'll need to contact them and ask them to unlock/unclaim your profile.
Get professional photos taken
Brainstorm ways to get free exposure
Make a list of ways to inform your community about your existence! Marketing is a numbers game; you've got to struggle along for a while before the seeds you've planted start to bear fruit. Don't be discouraged.
Be clever and strategic! Think about where lots of people go and are! Think about what you can do to curry goodwill with important figures or widely known people in the community! Winning over one super-social connector could provide you with a permanent source of interested patients. Think about subpopulations that stand to benefit in an outsized way from DPC: the elderly, the children of the elderly, athletic groups, worried moms, uninsured students, marginalized populations, struggling employers, health nuts, [fill in the blank]. Make a list of tight-knit communities where DPC could spread like wildfire: country clubs, rotaries, bingo/poker clubs. Think of free services you could provide to get people in the door or start a conversation: flu shots, cheap blood tests. Propose an interview to local talk radio stations. Ask your patients what convinced them to join - you’ll start hearing certain phrasing over and over again. Use that phrase in your marketing.
Get a logo
Custom printed stationery and marketing materials
Printing out promotional materials is a great way to put information about your practice out into the world. You never know who will see a flyer you send home with a patient. If you meet with an interested potential patient, give them a card or a brochure - they'll be more likely to get back to you if they have a physical reminder of your conversation. Put up signs around your community, especially if you're doing an open house/Q&A or offering a pre-enrollment deal.
It's remarkably easy to design these things yourself once you have a good logo. Check out Canva—it's a slick online tool that lets you plug your logo and business information into a bunch of excellent pre-designed templates.
Disseminate your marketing materials
Put your cards/flyers at local gyms, day cares, YMCAs, universities, grocery stores, benefits consultants, and health establishments of any kind. Think about who in your community has the greatest need for DPC. Then try to figure out where those people go.
Ask for referrals
Check for retiring physicians nearby
Network with other small business owners
Check out BNI, local Meetups, the Chamber of Commerce, Rotary, 1 Million Cups, NFIB, and Facebook Groups for local business owners.
Reach out to nearby self-insurance TPAs/brokers
Add your practice to the DPC Frontier mapper
Reach out to Health Sharing Ministries
Talk to the specialists you refer to
Consider paying for advertising
Make advertising partnerships
Set up a referral program