I thought I'd open a thread to discuss some of the nuts and bolts of one doc's approach to opening a DPC. I'd like to keep the ideas open-source to share the knowledge for others interested in going it alone. There are other venues to promote/seek paid consultation services.
My anticipated start-up costs (low cost-of-living area):
$15,000 for non-disposable equipment (beds, ekg, optha/oto, spiro, holter, lights, basic furniture, computers)
$ 2,000 for consumables/disposables (syringes, dressing material...generally stuff that ends up in the garbage/hazards bin)
$ 2,000 start-up meds (likely will start with less than half this)
$ 2,000 LLC formation/issues/attorney
$ 3,600 first/last month rent including small improvements
$ 3,000 First year EMR ($2,000 follow-on years)
$ 750 Credit card machine and account set-up
$ 500 Uptodate per year (for those so inclined)
$ 4,000 direct-mail approx 20,000 homes with advert card (maybe a complete loss, but gets the word out)
$ xxxxx malpractice premiums
$ xxxx slip and fall coverage
$ xxx personal health insurance
$ xxx montly utilities (phones, internet, electricity); lease includes maintenance and water/sewer
$ xxx Bookeeping service. In long term, likely do myself.
$ x Payroll taxes etc, then pay
$ ???? I'm kicking around lab capability to check certain complex labs (TA/alk P, wbc, CRP, etc) inhouse after hours. Plan is to start without this capability but I'm prepared to purchase it the second or third time I really wish I had it.
$ ????? savings to stay afloat until profitable
Equipment/furniture cost above assume purchasing the majority of items used (not just serviceable but looks as new etc). The used values come from watching the prices on Craigslist, ebay, etc, for months. My actual spreadsheet equipment cost is around $12,000 (for those who excel at scrounging).
Office operational basics upon opening:
-No insurance accepted or processed.
-Straight family med. No narcs, bzd, stimulant, disability eval, weight loss, cosmetics, b-12, etc.
-All payments credit card only with auto-pay (easy to set up).
-sign-up includes first and last month fees. Failure to pay follow-on generates state-mandated 30-day notice of end of doc/patient relationship.
-typical 24/7 electronic access for flat fee.
-two tier payments; upper-tier one flat fee per month, second lower-tier is lesser charge with co-pay per office visit.
-after-hour visits with co-pay
-time will tell but: no extra charge for bedbound patient home visits for limited number of patients (see on the way home types)
-no special fees for procedures
-Contracted two 60 hour weekends off per month (6p fri to 6a monday twice per month). In future with partner I'd swap call.
-No vacation first year.
-No assistant. Because I have large savings buffer, I plan to hire an assistant as soon as enrollment would essentially pay the assistant's salary and benefits.
-Basic waived labs capability (ua, hgb, rapid tests, etc); included in basic fee
-Out of office phlebo for routine labs
-In office phlebo by me if needed
-Spiro, EKG, holter, injections by me
-Chaperone by family. Consideration for clustering pap visits with PRN help.
-No office immunizations to start, prepared to procure if demand is there. Adds $$$/headaches a bit.
-Office large enough for same-minded partner and med assistant in the future
-Online scheduling; voicemail scheduling for the online impaired
-Secure online messaging
-Local lab contracted to communicate with EMR
-No imaging (I already own a POC USN). Local urgent care for plain films until 10pm.
Money summary:
$25,000 to open is possible.
$ 5,000 monthly fixed cost (no assistant) to stay open.
Clearly having large cash reserves (e.g. one year operational and household expenses), would be ideal. Alternatively, having a second (spousal) income and/or having access to secure local evening/weekend moonlighting opportunities could be used as supplemental income until afloat.
Options:
Not for me, but offer cash-only urgent care/PCP services and charge a fixed fee per visit (e.g. $100 per visit) to supplement income. My malpractice company would charge a different rate for running an UC.
Crazy nuclear option if you open a DPC, it isn't working, and you are about to be homeless:
Charge $20/month/any age. $20/month x 600 patients is $12,000 per month. This would cover overhead and household expenses. Not an ideal solution, but the concept provides me at least some kind of security knowing that I could do this and not end up homeless. If I couldn't attract 600 patients at $20/month (or 400 patients at $30/month) then arguably I have made some serious strategic errors in choosing a practice location, or, I really am in the wrong line of work.
How much is enough money thoughts:
My personal income goal is to make MGMA average FM after overhead (fixed costs) are taken. Beyond this I personally would need to measure my interest in seeing more paying patients vs working for free (special needs patients, etc). The latter option has always proven 100% rewarding and it's option that I've not had in years.
I'm obviously early on in this process but am open to discuss what I've learned and to hear what I need to learn about.
My anticipated start-up costs (low cost-of-living area):
$15,000 for non-disposable equipment (beds, ekg, optha/oto, spiro, holter, lights, basic furniture, computers)
$ 2,000 for consumables/disposables (syringes, dressing material...generally stuff that ends up in the garbage/hazards bin)
$ 2,000 start-up meds (likely will start with less than half this)
$ 2,000 LLC formation/issues/attorney
$ 3,600 first/last month rent including small improvements
$ 3,000 First year EMR ($2,000 follow-on years)
$ 750 Credit card machine and account set-up
$ 500 Uptodate per year (for those so inclined)
$ 4,000 direct-mail approx 20,000 homes with advert card (maybe a complete loss, but gets the word out)
$ xxxxx malpractice premiums
$ xxxx slip and fall coverage
$ xxx personal health insurance
$ xxx montly utilities (phones, internet, electricity); lease includes maintenance and water/sewer
$ xxx Bookeeping service. In long term, likely do myself.
$ x Payroll taxes etc, then pay
$ ???? I'm kicking around lab capability to check certain complex labs (TA/alk P, wbc, CRP, etc) inhouse after hours. Plan is to start without this capability but I'm prepared to purchase it the second or third time I really wish I had it.
$ ????? savings to stay afloat until profitable
Equipment/furniture cost above assume purchasing the majority of items used (not just serviceable but looks as new etc). The used values come from watching the prices on Craigslist, ebay, etc, for months. My actual spreadsheet equipment cost is around $12,000 (for those who excel at scrounging).
Office operational basics upon opening:
-No insurance accepted or processed.
-Straight family med. No narcs, bzd, stimulant, disability eval, weight loss, cosmetics, b-12, etc.
-All payments credit card only with auto-pay (easy to set up).
-sign-up includes first and last month fees. Failure to pay follow-on generates state-mandated 30-day notice of end of doc/patient relationship.
-typical 24/7 electronic access for flat fee.
-two tier payments; upper-tier one flat fee per month, second lower-tier is lesser charge with co-pay per office visit.
-after-hour visits with co-pay
-time will tell but: no extra charge for bedbound patient home visits for limited number of patients (see on the way home types)
-no special fees for procedures
-Contracted two 60 hour weekends off per month (6p fri to 6a monday twice per month). In future with partner I'd swap call.
-No vacation first year.
-No assistant. Because I have large savings buffer, I plan to hire an assistant as soon as enrollment would essentially pay the assistant's salary and benefits.
-Basic waived labs capability (ua, hgb, rapid tests, etc); included in basic fee
-Out of office phlebo for routine labs
-In office phlebo by me if needed
-Spiro, EKG, holter, injections by me
-Chaperone by family. Consideration for clustering pap visits with PRN help.
-No office immunizations to start, prepared to procure if demand is there. Adds $$$/headaches a bit.
-Office large enough for same-minded partner and med assistant in the future
-Online scheduling; voicemail scheduling for the online impaired
-Secure online messaging
-Local lab contracted to communicate with EMR
-No imaging (I already own a POC USN). Local urgent care for plain films until 10pm.
Money summary:
$25,000 to open is possible.
$ 5,000 monthly fixed cost (no assistant) to stay open.
Clearly having large cash reserves (e.g. one year operational and household expenses), would be ideal. Alternatively, having a second (spousal) income and/or having access to secure local evening/weekend moonlighting opportunities could be used as supplemental income until afloat.
Options:
Not for me, but offer cash-only urgent care/PCP services and charge a fixed fee per visit (e.g. $100 per visit) to supplement income. My malpractice company would charge a different rate for running an UC.
Crazy nuclear option if you open a DPC, it isn't working, and you are about to be homeless:
Charge $20/month/any age. $20/month x 600 patients is $12,000 per month. This would cover overhead and household expenses. Not an ideal solution, but the concept provides me at least some kind of security knowing that I could do this and not end up homeless. If I couldn't attract 600 patients at $20/month (or 400 patients at $30/month) then arguably I have made some serious strategic errors in choosing a practice location, or, I really am in the wrong line of work.
How much is enough money thoughts:
My personal income goal is to make MGMA average FM after overhead (fixed costs) are taken. Beyond this I personally would need to measure my interest in seeing more paying patients vs working for free (special needs patients, etc). The latter option has always proven 100% rewarding and it's option that I've not had in years.
I'm obviously early on in this process but am open to discuss what I've learned and to hear what I need to learn about.
