Designing Your DPC Practice and Panel Through the Lens of Ikigai

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One of the most interesting themes that emerges when physicians talk about transitioning into direct primary care is the concept of ikigai—the intersection of what you love, what you are good at, what you can be paid for, and what the world needs. Many physicians describe DPC as their “ikigai,” where those four elements come together.

What is less commonly discussed, however, is how this same philosophy can—and should—be applied to designing a practice and patient panel.

In business and marketing, we often talk about identifying an “ideal patient” or “ideal customer” or “persona.”  While this exercise can be helpful, it can also be limiting. Many physicians have broad interests and skill sets, and a patient panel that is too narrowly defined can become emotionally and professionally exhausting. Seeing the same clinical scenario repeatedly, without variety or intellectual stimulation, can lead to burnout—even in a practice model designed to prevent it.

Instead, I’ve come to think about patient panel design through the same Ikigai framework. When applied intentionally, the collective makeup of your practice and patient panel—not each individual patient—can fulfill each component of your ikigai.

What You Love

At its core, medicine is a calling. For many of us, what we love most about medicine varies widely. Some are deeply motivated by the science of disease and preservation of life. Others are energized by lifestyle medicine, functional medicine, or integrative approaches. Some are passionate about lipidology and longevity, chronic disease prevention, or the long-term care of cancer survivors.

Traditional models sometimes force physicians to narrow their scope unnaturally based on the marketing of the corporations. In contrast, DPC allows you to intentionally design a practice that includes the kinds of patients and clinical challenges you genuinely enjoy. Your patient panel should reflect the parts of medicine that keep you intellectually engaged and emotionally fulfilled.  It’s not cherry picking – it’s intentionally marketing aspects of medicine you love when you put yourself out there, and allow patients to gravitate to you.

You may be capable of practicing across the full spectrum of primary care—but that does not mean every aspect excites you equally. Recognizing what you love, and ensuring your practice allows space for it, is essential for longevity.

What You Are Good At

Each physician brings unique strengths to the exam room. Some are exceptional diagnosticians. Others excel at patient education, complex care coordination, behavior change, or managing nuanced chronic illness.

These strengths are often what attract patients to you in the first place.

When designing your patient panel, it is worth asking: Which patients benefit most from my particular skills? Ensuring that a portion of your panel aligns with your strengths not only improves outcomes but also reinforces professional satisfaction. It allows you to practice at the top of your ability and differentiate your practice in a meaningful way from your local competition and allows your patient sto benefit from your above-than-average skillset.

Equally important is understanding your growth areas and not building a panel that disproportionately demands skills you do not enjoy or do not wish to develop further.  By focusing intentionally on drawing patients and creating a model that allows you to be your best self that is better than the average keeps you competitive in the business side of medicine.

What You Can Be Paid For

This is often the most uncomfortable part of the conversation—but also one of the most important.

Direct primary care exists to improve access and restore the doctor–patient relationship, but it must also be financially sustainable. A practice cannot serve anyone well if it cannot keep its doors open.

Not every service you offer needs to be something you love or personally deliver. Some services exist to support the financial health of the practice so that other, more mission-driven work can continue. This may include certain visit types, employer partnerships, or ancillary services that create stability.

Acknowledging the financial realities of running a practice is not selling out—it is pragmatic. When your practice is financially sound, you are better positioned to serve patients, innovate, and grow.  And it allows all aspects of the practice to flourish.

What the World Needs

This final component is often overlooked, yet it may be the most impactful.

Every community has unmet needs. Sometimes those needs align perfectly with your passions; other times, they do not. Understanding your local healthcare landscape—demographics, access gaps, employer needs, and population health challenges—is critical.

I recently read a post from a DPC physician who had to close their practice. One of the comments suggested that location and market fit may have played a role. That observation is important. Even the best-designed practice can struggle if it does not meet a real need in its community.

Being responsive to what your region needs does not mean abandoning your vision. It means integrating that reality into your planning so your practice can grow sustainably rather than stagnate.  It allows you to be inspired by some things you may not have seen and allows you to flex your calling into something that is not always internal to you but something that is around you.

Bringing It All Together

When we think about designing a DPC practice, we often focus on ourselves—our goals, our values, our frustrations with the system. But true sustainability comes from expanding that lens.

A resilient practice is one where:

  • Some patients reflect what you love
  • Some benefit most from what you do best
  • Some support the financial stability of the practice
  • And some represent the needs of the broader community

No single patient must fulfill all four pillars. But collectively, your panel should.  Your “personas” or “ideal patients” as you design the business plan should reflect all of these aspects so that collectively your practice becomes an intentional manifestation of your ikigai.

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About Vasanth Kainkaryam, MD

Dr. Kainkaryam is a "Doctorpreneur" and Founder of 4 Elements Direct Primary Care, and host of the 4 Elements of Health Care Podcast is a triple board-certified Internist, Pediatrician, and Obesity Medicine specialist, and holds a Masters in Health Informatics. He has held a variety of roles as a community physician and regional medical director in a large health system, as a medical director of a healthcare startup, a Chief Medical Officer of a federally qualified health center and a Physician at the VA and at correctional institutions. 4 Elements Direct Primary Care & Wellness Space is his "ikigai" - a convergence of his previous experiences, as he disrupts the traditional model of health care by infusing his personal philosophies of care with evidence-informed medicine and personalized care. He is evolving his practice into the 4 Elements Vitality Institute, which is under construction and also is the Chief Medical Officer of a men's health startup called Bastion Health. Dr. Kainkaryam's "4E Philosophy" is how he works with his patients: engage, educate, empower and encourage. Similarly, his podcast focuses on four elements while looking at the healthcare experience through the lens of the patient: the doctor, patient, system and society. He is an author of a children's book titled "To See the World: A Rose-Colored Perspective," a husband to an Anesthesiologist and a father of three daughters, and assures us that despite his fascination with the number four, he is planning on keeping his number of children at three! You can follow him on social media at @the.doctor.vk