DPC Enrollment: Should You Pace Growth or Open the Floodgates?
My kneejerk response to this question is to advocate for pacing enrollment; however, after exploring the nuances of these divergent points of view, I have concluded that there’s no one-size-fits-all answer. Instead, the best choice depends on financial situation, operational capacity, long-term goals, and personal well-being. Here me out…
1. Financial Considerations
- Cash Flow Needs: If your financial situation allows for a gradual build-up, pacing enrollment can help ensure a sustainable workload and patient experience. However, if you need to reach a certain income threshold quickly to cover personal or business expenses, rapid/steady enrollment might be necessary.
- Startup vs. Established Practice: A newer practice may require faster enrollment to cover overhead costs, whereas an established practice may have more flexibility to pace growth.
2. Operational Readiness
- Staffing & Infrastructure: If you’re solo or have limited support, a paced and controlled intake of patients can prevent burnout and ensure high-quality care. This was the case early on in my practice, forcing me to consider an assistant much sooner than I expected.
- Systems & Workflow: When enrollment is paced, a structured onboarding process, including meet-and-greets, educational materials, and initial visits, may allow you to fine-tune your processes. A sudden influx of patients can strain resources and compromise the patient experience, especially if you don’t have any systems in place. I used internally brief pauses in enrollment to allow me time to refine processes when needed.
3. Provider Well-Being & Sustainability
One of the reasons I opened a DPC was to have more control over how I spend my professional and personal time, recognizing that there is no such thing as balance. I wear multiple hats, so I sometimes need to make personal tradeoffs to dedicate more time to the practice, practice tradeoffs to devote more time to teaching, personal responsibilities, etc. My practice is not full yet, and I have DECIDED that I am okay with this in exchange for the flexibility to make these tradeoffs.
- Avoiding Burnout: Rapid enrollment would exhaust me. If this is you, decide if it’s worth compromising self-care and/or patient care.
- Long-Term Satisfaction: Pacing growth allows me to maintain control over my schedule, protect personal time, and uphold the values that likely led me to DPC in the first place.
- Emotional Bandwidth: Developing meaningful patient relationships is integral to my practice and takes time. A slower, more intentional growth model prevents the emotional drain that can come with onboarding too many patients at once.
4. The Impact on Patient Interest & Perception
How you structure your enrollment process directly affects patient demand and engagement. This may be a bit more controversial, and it may not work in all markets, but here’s my opinion anyway.
- Scarcity Creates Value: When enrollment is paced or limited, it can increase patient interest by creating exclusivity. Patients may perceive the practice as in high demand and exclusive and that spots are not always available. Lucky them.
- Building Anticipation: Our pauses are short, scheduled, and intentional. Prospective patients who see a well-structured waitlist or scheduled enrollment periods may be more invested in joining your practice (or at least not lose interest) than casually signing up without commitment.
- Avoiding Disappointment: On the flip side, if too many patients enroll too quickly and experience delayed access to care, frustration can set in, leading to higher attrition rates. One logical counter to this argument is that patient experience is dictated by expectation. If you set the expectation of 2-4 weeks for their first appointment, which takes 6 to 8, you may need to change the expectation (or slow enrollment).
Objective Markers to Guide Your Decision
If you’re unsure whether to pace or open enrollment widely, consider these benchmarks:
- Monthly Revenue Goals vs. Fixed Expenses: If your revenue covers at least 80% of your fixed expenses, you may be able to pace enrollment.
- Capacity Threshold: If you’re at 75% of your ideal panel size or scheduling new and/or existing patients beyond your desired threshold, consider slowing enrollment to maintain quality service.
- Waitlist Demand: If a significant number of people are waiting to join, structured group onboarding or scheduled intake months may be more efficient.
A Possible Middle Ground: Group Meet & Greets
The owner of Culver Pediatrics shared this concept, and I had never considered it until now, but I love the idea! Scheduling group meet-and-greets to onboard new patients may allow one to keep up with real-time demand while maintaining control over one’s schedule. This approach reduces redundancy, decreases schedule interruptions, and allows potential patients to experience your practice environment before committing. It fosters community, making your practice feel more exclusive and valuable. For better or worse, it may introduce unspoken factors that encourage patients to self-select.
If you’re concerned about balancing growth with sustainability, structured group events may serve as a middle ground—offering engagement and efficiency without overwhelming your operations.
Final Thoughts
At the end of the day, you are running a business and need to do what is necessary to keep it going. Only you can decide if your success depends more on drinking from the fire hose or slowing the pace. I do encourage you to consider the objective factors above before coming to a final conclusion. Regardless, a sustainable enrollment pace ensures that you don’t trade one broken system for another. The key is finding a rhythm that meets your financial goals and long-term happiness in practice.
What say you? I’d love to hear how other practices handle/handled enrollment during the early days of their practice.
ALSO
I am opening a new practice in July, I currently work in a FFS with a 3100 patient panel (can’t wait to lower my panel). Does anybody have a recommendation on how many is too many to onboard in a month? I suspect a lot of my patients will be joining me (estimate in all I have read is plan for 5-10%). Also how do you curb enrollment exactly? I am planning on using atlas MD and have a sign up link on my website, would I take that down or allow them to sign up and just contact them to let them know they are currently on a wait list?
So everyone has a slightly different way of doing things right. I initially had my enrollment link on my website, but that was short lived (like 2 weeks). Instead I put an intake form (which sent me an email), then I could filter enrollments in a way. Then I got more sophisticated and created a “Calendly” link for patient’s to sign up for Meet & Greets. When patients sign up they have to answer questions like…were you a former patient, how did you hear about us, etc. This has evolved a bit over the last year too. NOW, patients have to email my assistant if they are interested. If we are open for enrollment they get an enrollment link from her. If we are not open for enrollment, they are informed and added to the waitlist. We have templates for all of these responses. …. Maybe I should write a part 2 to this article.