What I Learned Watching Someone Else Start

On beginnings, uncertainty, and building a practice that’s yours.

Recently, I had the pleasure of welcoming a new colleague into the Direct Primary Care fold. Dr. John Italiano launched Thrive Family Health straight out of residency—something I’m not sure I could have ever done myself. I know others like him exist, and perhaps they’re more common than I realize, but witnessing it firsthand was something else entirely.

When I visited his office not long ago, I found myself asking questions like a complete newbie. How did you find this?—pointing to the autoclave. Wait, you got a body composition scanner for how much? Is that a sink?—referring to a portable sink in the exam room, something I had genuinely never seen before.

Dr. John is in the earliest phase of practice ownership—the phase many have only read about or heard described. He’s finalizing contracts and certificates, patiently sourcing equipment and supplies on Facebook Marketplace, and thoughtfully creating a space that reflects his vision. He’s scheduling his first meet-and-greets while simultaneously furnishing and styling his office. It’s a season that requires patience, creativity, and a steady sense of direction—especially when there’s no clear sense of how long the road ahead might be.

Dr. John is a kind soul. He’s also passionate, determined, and innovative. Watching him enter this space reminded me of a phrase we often say in DPC: When you’ve seen one DPC practice, you’ve seen one DPC practice.

But being in his office expanded my understanding of that saying. It doesn’t just apply to the final product—it applies to the beginning, too. We don’t all start from the same place, even if we’re moving toward similar values.

When I began planning my own DPC practice, I was still working in a fee-for-service model. I transitioned directly into locums work to bridge the financial gap, assuming I’d have a slow, steady ramp—maybe one or two patients at a time, with enough time and space to get my bearings along the way.

That’s not how it went.

Within two months, the demands of my practice had already outpaced my expectations. I ended my locums contract 2 months early—the beginning felt like trial by fire. My entry point into DPC looked a lot different than John’s. Dr. Amat, the original owner of DPC of West Michigan, was phasing out as I was starting. She was my mentor, early advisor, landlord, and later the namesake of my practice.

I stepped into an established ecosystem. It wasn’t a full panel (a handful of her patients and a handful of my own to start), but it came with a physical space, furniture, supplies, and an incredible assistant—someone I quickly promoted to Practice Manager. I had a lot to learn, and I had to learn it fast. I moved forward without much pause, guided more by necessity than reflection, and skipped many of the early steps Dr. John is navigating now.

So as I walked through his office, I felt a genuine sense of awe.

There is no single way to start a DPC practice. No exact formula for how it should be structured or built. There are principles, shared values, and hard-earned lessons—but there’s also a tremendous amount of discretion in how you apply them. That ambiguity can feel deeply uncomfortable for physicians trained to follow algorithms and checklists, especially when the usual signposts are missing.

But over time, you learn how to orient yourself. You stop scanning for someone else’s map and start paying attention to what consistently points you in the right direction.

I think many physicians hesitate because they’re waiting for certainty—for permission, for a proven formula, for reassurance that they won’t get it wrong. But DPC quietly teaches you something radical: there is room to figure it out as you go. Room to adapt. Room to recalibrate without losing your way.

You don’t have to start the same to arrive somewhere meaningful. And once you’ve practiced medicine in a way that aligns with your core values—once you’ve felt what it’s like to move with intention rather than instruction—it becomes hard to return to something rigid. What begins as discomfort eventually becomes freedom. And freedom, it turns out, is a powerful teacher.