You have to spend money to make money. An adage I’ve always known, but the saying definitely hits different when all you’re doing is spending money. Last week, I mentioned the spending abyss and I wanted to dive deeper this week because all I’ve been doing recently it seems is spend money.

Everyone has their own financial situation when making the decision to open a DPC. Debt consideration is usually the biggest in everyone’s mind. I’m fortunate to only have medical school debt which I paid more than required every month during residency. I also benefited from some help from family. The freeze on interest during the pandemic has also been incredibly helpful (now, if only there was some global loan forgiveness…). Family is usually the other restriction for residents thinking about starting right out. Being single with no kids or expensive hobbies has been great for my financial health. Finally, side gigs. I worked urgent care almost all of PGY-3, and I worked a lot, on average 80 hours a month extra. This allowed me to build up a pretty decent nest egg and I did not have to take out any additional loans to fund my business. I will be continuing to work with the same urgent care this year. They have a full time offering which is only 28 hours a week and provides decent salary with full benefits. Of course, the one downside of staying on with the urgent care is I can’t take Medicare patients for the first year. As mentioned previously, I do have a partner in my DPC who is also working urgent care and we plan to cover for each other when one of us is out of the office.

I’ve learned there is an order to do things, and taking care of these steps before starting to spend money helps. The steps are form LLC –> get EIN –> open business bank account and fund it –> find the criteria for and get a business credit card. For whatever reason, I didn’t look into getting a business credit card until I was already buying stuff which was a huge mistake since most cards have cash bonus when you spend a certain amount within the first few months. I also got held up because the card I chose required a document which had my business name and corresponding address when I only had documents with my home or virtual address. I ended up having to get my county business license earlier than planned (also something to look into if your county has one or not) and luckily the process was quick. Everyone probably has their own reasons for picking one card over the other. I chose Capital One Spark 2% Cash Card because of the cash back and probably also because that’s what other people I know use (not an endorsement).

I chose my local Credit Union for my business bank account. Their online banking is not as slick compared to the big banks, but I chose them to keep in the spirit of supporting local business. My office park neighbors have been super helpful so far and the massage therapist a few doors down connected me with her accountant. His advice for me was just to keep track of all my finances. Since I had started making purchases with my personal accounts, his pro tip for me was to cut myself a check from my business account for everything spent so far, so that on paper all the expenditures are in one place. My expenses aren’t too complicated yet, so I will be doing my own book keeping and then touch base with him again in tax season. I am currently keeping all my expenses documented on a Google spreadsheet. There are companies out there which do free or relatively cheap book keeping like Xero, but I haven’t had a chance to explore yet and I’m doing ok with my spreadsheet so far. The main categories I’ve broken my spreadsheet into are: software, furniture/furnishings, admin (license costs), building (lease costs), advertising, and miscellaneous.

My biggest expense category so far has been furniture. I’ve always known the importance of budgeting to prevent overspending, but now I’ve also learned the importance of budgeting in order to get over the pain of spending money. I enlisted the help of an interior designer friend to help with designing the office (she did a fantastic job as you can see in the picture). She asked me for a budget and things important to me for each room and then begin working on the design. When she had picked out all the furniture within budget and it was time to buy, my stingy side came out and I started nitpicking certain things like Amazon furniture I wasn’t going to buy because I felt that the shipping was too expensive (Prime has spoiled me). While there were a few items, by sheer serendipity, which I managed to get for cheaper, overall I lost a lot of time and in some cases ended up having to pay more because I chose to try and undercut the previously agreed upon budget. Needless to say we came in way under budget, but I also am lacking a few things I wish I now had.

Other expenditures have been fairly reasonable. I did not have to do any major build out on my office space, and the renovation which was done was all included in my tenant improvement. I was able to also have a two month abatement with my lease, so I won’t have to pay rent until next month. Each of the software companies has given me some form of delayed or reduced cost for the first few months. For medical equipment, my GPO gives me pretty decent pricing with McKesson. Certain products you can get off Amazon for cheaper. The only annoying thing is some items only come in bulk like fluorescein which comes in a box of 100 min and others are cheaper in larger quantities such as kenalog which is half price in a box of 25 compared to individually. Coordination of the Virginia DPC docs has been helpful with this bit. One of the northern Virginia DPC docs sent me a few of his fluorescein strips and I’ve bought single vials of other medications at cost from other nearby DPCs. Having DPC friends in the area is always a big plus.

By the end of set up, I estimate that I will have spent between $10-12K total in start up costs. Some people spend that just on build out cost alone, so I guess I consider myself fortunate for not having too many major expenditures early on. Even knowing that, constantly spending money while not making money (especially now being in between ending residency and the start of my full time urgent care contract) feels pretty stressful and not something my super fiscally conservative self is used to doing. This upcoming week begins my marketing push which hopefully immediately precedes patients signing up. Next week I’ll likely talk about my marketing approach and reflect on how things went. Until then, thanks for reading and as always feel free to reach out with feedback, general comments, or questions at [email protected].

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