Direct Primary Care Model

[RNtoMD87]

This is something I have just heard about. Do any FM docs have an opinion on this healthcare model?

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[mabinante]

Yes...been doing it out of residency about 2.5 years. Phenomenal. You can start your own or there are plenty of docs across the country that are hiring.

Most people are paying out of pocket for healthcare anyway (healthshare, no insurance, high deductible plan) so DPC helps to curb the out of pocket costs.

 

[Matthew9Thirtyfive]

Yes...been doing it out of residency about 2.5 years. Phenomenal. You can start your own or there are plenty of docs across the country that are hiring.

Most people are paying out of pocket for healthcare anyway (healthshare, no insurance, high deductible plan) so DPC helps to curb the out of pocket costs.

Did you join a practice or start your own?

 

[mabinante]

Started my own. Southern California. From scratch, 0 patients on day one. In an area about 30 miles from where I trained....and it has worked for me. Atlas.md EMR has been a godsend for me (and hundreds others). If you sign up....we each get $300 (shameless plug). But seriously...I rotated with the founder, Josh Umbehr, out in Kansas that has been doing it for about 7 years or so. He is on Hannity all the time. He does all the consultation for free. His EMR is $300/month and a one stop shop....simply incredible. Billing, collection, payment, scheduling, inventory management/prescribing, messaging....really makes it simple.

 

[bronx43]

Yes...been doing it out of residency about 2.5 years. Phenomenal. You can start your own or there are plenty of docs across the country that are hiring.

Most people are paying out of pocket for healthcare anyway (healthshare, no insurance, high deductible plan) so DPC helps to curb the out of pocket costs.

What are you charging if you don't mind my asking.

 

[RNtoMD87]

I love the idea of cutting out the insurance companies.

My question is, if you don’t have insurance and instead choose to pay the extortion fee, what do you do about emergency care? Say you get in a car accident

 

[bronx43]

I love the idea of cutting out the insurance companies.

My question is, if you don’t have insurance and instead choose to pay the extortion fee, what do you do about emergency care? Say you get in a car accident

You're not exactly cutting out the insurance, since no one should go without catastrophic insurance. You're simply arbitraging the difference the patient pays for catastrophic insurance and a cadillac plan by providing the majority of their care for cash.
For the patients that already have a good insurance, your selling point would be the ability to spend more time and be more accessible.

 

[VA Hopeful Dr]

What are you charging if you don't mind my asking.

Before I sold mine, rates ranged from $50 to $80/month based on age.

 

[Matthew9Thirtyfive]

Before I sold mine, rates ranged from $50 to $80/month based on age.

Did you do any sort of sliding scale based on income, or is that not financially feasible?

 

[VA Hopeful Dr]

Did you do any sort of sliding scale based on income, or is that not financially feasible?

I did not but it easily could be done. Simply take a few more patients since most costs are fixed.

That said, I would want to make it an informal arrangement - not something you talk about. Otherwise then you'll have lots of people wanting to do that and end up needing to do what the free clinics do and make them prove they can't afford your services.

Most of the DPC folks I knew who did this sort of thing reserved it for established patients that fell on hard times - you already know them and they already know and like you/your services.

 

[Matthew9Thirtyfive]

I did not but it easily could be done. Simply take a few more patients since most costs are fixed.

That said, I would want to make it an informal arrangement - not something you talk about. Otherwise then you'll have lots of people wanting to do that and end up needing to do what the free clinics do and make them prove they can't afford your services.

Most of the DPC folks I knew who did this sort of thing reserved it for established patients that fell on hard times - you already know them and they already know and like you/your services.

That makes sense. Thanks.

 

[Atlas Shrugged]

How does vacation work? Do you have someone cover you or just give all of your patients a heads up that you will be unavailable for a set period of time.

 

[VA Hopeful Dr]

How does vacation work? Do you have someone cover you or just give all of your patients a heads up that you will be unavailable for a set period of time.

I've done both. When I started I had no one to cover so I gave my patients a month's heads up. I'd still check my e-mail/texts twice a day on vacation, but if it was something I couldn't handle they'd have to go to urgent care or the ED.

Once another DPC doc opened up in town we covered for each other on vacation.

 

[bronx43]

I've done both. When I started I had no one to cover so I gave my patients a month's heads up. I'd still check my e-mail/texts twice a day on vacation, but if it was something I couldn't handle they'd have to go to urgent care or the ED.

Once another DPC doc opened up in town we covered for each other on vacation.

Why did you sell your practice? Sounded like an optimal set up.

 

[VA Hopeful Dr]

Why did you sell your practice? Sounded like an optimal set up.

We moved and I couldn't take it with me.

 

[Reboa]

What's lifestyle and salary like? I'd imagine less patients, longer visits, full of real medicine less bureaucratic bs?

 

[VA Hopeful Dr]

What's lifestyle and salary like? I'd imagine less patients, longer visits, full of real medicine less bureaucratic bs?

Lots of variation.

Definitely fewer patients, longer visits, and very little paperwork. I had things set up where established patients got 30 minute appointments, new patients got 60. My goal was a panel of 600. Had I hit that before selling, I'd have gotten right at 200k/year.

The lifestyle varies greatly. I offered my patients my e-mail address and cell phone number as part of the deal. So I was on call 24/7. Some days that meant a fair amount of work, other days none. There are DPC doctors who don't offer those services but the general gestalt is that if you don't offer that you will grow much more slowly.

 

[Make Or Break]

Lots of variation.

Definitely fewer patients, longer visits, and very little paperwork. I had things set up where established patients got 30 minute appointments, new patients got 60. My goal was a panel of 600. Had I hit that before selling, I'd have gotten right at 200k/year.

The lifestyle varies greatly. I offered my patients my e-mail address and cell phone number as part of the deal. So I was on call 24/7. Some days that meant a fair amount of work, other days none. There are DPC doctors who don't offer those services but the general gestalt is that if you don't offer that you will grow much more slowly.

Just wondering but what’s holding you back from starting another DPC? It sounds like you had a pretty sweet gig.

 

[VA Hopeful Dr]

Just wondering but what’s holding you back from starting another DPC? It sounds like you had a pretty sweet gig.

Starting a practice, even a fairly basic one like DPC, is both expensive and time consuming. I also have no desire to take the months long zero income hit again (nor moonlight on weekends to cover that).

 

[deleted480308]

Starting a practice, even a fairly basic one like DPC, is both expensive and time consuming. I also have no desire to take the months long zero income hit again (nor moonlight on weekends to cover that).

I don’t remember, how exactly did you go about finding patients?

 

[VA Hopeful Dr]

I don’t remember, how exactly did you go about finding patients?

Radio ads and SEO.

Prior to that I did mailings, Facebook and Google ads, and talking to other offices. Doing all that I was getting around 5-8 new patients per month.

The first week the radio ads went live I got 10 new patients. After that I averaged 40/month for the next 6 months before I cut down on the ads.

 

[Make Or Break]

Radio ads and SEO.

Prior to that I did mailings, Facebook and Google ads, and talking to other offices. Doing all that I was getting around 5-8 new patients per month.

The first week the radio ads went live I got 10 new patients. After that I averaged 40/month for the next 6 months before I cut down on the ads.

How much were you paying for advertising per month?


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[VA Hopeful Dr]

How much were you paying for advertising per month?


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At the height of it, around 10k. At the kind of stable going forward part, around 3k.

 

[bronx43]

At the height of it, around 10k. At the kind of stable going forward part, around 3k.

That's steep. What was the most expensive advertising method? Was it good ROI?

 

[VA Hopeful Dr]

That's steep. What was the most expensive advertising method? Was it good ROI?

Radio and yes, it increased my new patient volume by a factor of 6 or so.

 

[Make Or Break]

Radio and yes, it increased my new patient volume by a factor of 6 or so.

Do you still think this is valid? I feel like radio advertising is decreasing in effectiveness but it may just be my millennial voice telling me that.


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[VA Hopeful Dr]

Do you still think this is valid? I feel like radio advertising is decreasing in effectiveness but it may just be my millennial voice telling me that.


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The youth director for the lt. gov is a friend and he said Pandora/Spotify ads hit that demographic pretty well.

But basically anyone over 35 is still a good radio demographic.

Search engine optimization is a good one too but more passive.

 

[Matthew9Thirtyfive]

Radio and yes, it increased my new patient volume by a factor of 6 or so.

Did you sell the DPC angle in the ad or just say you were taking new patients?

 

[VA Hopeful Dr]

Did you sell the DPC angle in the ad or just say you were taking new patients?

Sold the heck out of the DPC angle. My old city had plenty of family doctors, I was something brand new.

 

[FamilymedMD]

Did you do any sort of sliding scale based on income, or is that not financially feasible?

We donate memberships to the local free clinic. That gives them a resource for patients who need more care than they can handle but it also spares us from delving into patient finances, etc.

 

[Matthew9Thirtyfive]

We donate memberships to the local free clinic. That gives them a resource for patients who need more care than they can handle but it also spares us from delving into patient finances, etc.

That’s so cool. Do you donate a limited number? How do you determine who gets it?

 

[FamilymedMD]

We would limit the number depending on our capacity, etc. but so far haven't needed to do that. We leave determination of who qualifies to the free clinic but we could add conditions to the donation if we wanted.

 

[SqEdSaint]

Who processes all your referrals?
Now that you are in a regular practice are you more or less happy than when you were doimg DPC?

 

[VA Hopeful Dr]

Who processes all your referrals?
Now that you are in a regular practice are you more or less happy than when you were doimg DPC?

My MA handled it. We found the specialists that would take cash pay (and offer good discounts). It was pretty easy.

Both. I both miss and don't making all the decisions myself. I miss being able to have pretty relaxed days and still earn a living but I don't miss always being on call. I miss really spending time getting to know my patients but that can be a bad thing if you're either having a grumpy day or its a patient that you don't want to spend lots of time with.

You get the idea. Each system has its pros and cons.

 

[Make Or Break]

My MA handled it. We found the specialists that would take cash pay (and offer good discounts). It was pretty easy.

Both. I both miss and don't making all the decisions myself. I miss being able to have pretty relaxed days and still earn a living but I don't miss always being on call. I miss really spending time getting to know my patients but that can be a bad thing if you're either having a grumpy day or its a patient that you don't want to spend lots of time with.

You get the idea. Each system has its pros and cons.

What’s your take on using telemed specialists? I hear it’s become an option for dpc models.

Also if you don’t mind me asking, what were you pulling in per year as your income with all the work you were doing?


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[Make Or Break]

We would limit the number depending on our capacity, etc. but so far haven't needed to do that. We leave determination of who qualifies to the free clinic but we could add conditions to the donation if we wanted.

Are there any tax benefits to doing this?


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[FamilymedMD]

No, other than I make less money by taking these patients than I would if I filled those memberships with paying patients.

 

[VA Hopeful Dr]

What’s your take on using telemed specialists? I hear it’s become an option for dpc models.

Also if you don’t mind me asking, what were you pulling in per year as your income with all the work you were doing?


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I used them and really liked it.

Yearly is tricky as the practice was growing every month up to the day I sold it. My last monthly income (also my highest) was 10k. That was with 450 patients. Had I hit the full 600 patients I would've been right at 18k per month.

 

[Make Or Break]

I used them and really liked it.

Yearly is tricky as the practice was growing every month up to the day I sold it. My last monthly income (also my highest) was 10k. That was with 450 patients. Had I hit the full 600 patients I would've been right at 18k per month.

Aside from being on call everyday, how many hours would you say you worked on an average day? How many hours was your worst day?


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[VA Hopeful Dr]

Aside from being on call everyday, how many hours would you say you worked on an average day? How many hours was your worst day?


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Office was open M-F 9-5. If we weren't busy I'd often take a long lunch and leave early (4ish). I hardly ever came in early or stayed late.

 

[Matthew9Thirtyfive]

Office was open M-F 9-5. If we weren't busy I'd often take a long lunch and leave early (4ish). I hardly ever came in early or stayed late.

That sounds like the life.

 

[VA Hopeful Dr]

That sounds like the life.

Like everything in life it has its pluses and minuses.