Five years into DPC: what I’d do differently

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Emerald Health DPC is five years old this year. Here are a few things that I would change if I was starting over now, and some things that I’m glad I did.

Pricing

Like a lot of people do at the beginning, we started with discounted rates for couples and family members. We ended up raising our prices a couple of years ago and tried to get everyone on the same rates, but there are a few still at the initial discounted rates. If I were starting over, I wouldn’t discount for couples or family members at all.

On pricing, we set our original prices by looking at the DPCs in surrounding areas. Instead, I would look at the median income of the area, to see what the community could actually support and take that into consideration. 

Staying visible

We came out of a fee-for-service practice, so we filled quickly and barely had to advertise. When we added a nurse practitioner, it was like starting all over again, but 10 times harder. Four years in, people were still asking who we were and what’s Direct Primary Care? I wish we had kept networking and low key advertising the whole time, even when we didn’t need the patients.

SOPs from the beginning

When it was just my partner and me, we knew everything that was going on with the practice and didn’t write a lot down. Once we hired, keeping everything in our heads wasn’t going to work, so we finally wrote our SOPs. It’s much easier now than it would have been then. You can record your screen while you do a process and have AI turn the recording into a written SOP. Now whenever we add a new process or service, we try to do the SOP as soon as possible. 

If nobody can find the SOP that they need, that doesn’t help your team. Decide on a folder structure and a naming convention before you write the first one, so you don’t end up with a messy Google Drive, and make sure everyone knows where to find them..

Labs

Until recently, we had patients going to Labcorp and the lab at our previous fee-for-service office. Drawing blood just wasn’t something that we wanted to do, and maybe we were too stubborn about it. Our patients are very happy with it, and I wish we had started sooner.

Aesthetics

If I did it again, I’d wait to add aesthetics until the DPC side was more settled. I would talk to more people who did aesthetics, particularly those in DPC. I would develop a better business plan and add things slowly, to keep overhead costs lower. And I would learn more about marketing and advertising earlier on, because the aesthetics market is completely saturated, and aesthetics is a WANT, not a need.

What I’d do again

To start, I would absolutely open a DPC practice again. After that, I would go to a DPC Alliance Mastermind early on (went the weekend before we opened!), attend as many DPC summits as possible, and stay in touch with my DPC mentors and colleagues. Besides the autonomy and freedom of DPC practice, one of the greatest joys of the past five years has been meeting so many amazing people through DPC.

DPC gives me the time to do different things. Starting the DPC Life podcast has been great for staying connected with my DPC friends, meeting new friends, and helping other doctors on a larger scale than I ever thought would be possible. I saw many DPC docs getting overwhelmed and dangerously close to burning out just when their DPC practices were really taking off, so I launched a CRM specifically for DPC doctors to help reduce the overwhelm.

Looking back, I wouldn’t change too much of how we grew the practice. I’ve learned a ton about business, and even more about people and myself than I expected. I’m far more confident now in what I can learn and build compared to five years ago. So, to the new DPCs and DPC curious doctors out there, reach out to your nearby DPC docs and learn as much as you can from their mistakes and experiences. The DPC community is unmatched for their positivity and generosity, and you’ll hardly ever find a DPC doc that isn’t willing to share their knowledge

Remember, National DPC Day is November 1, the day when people start enrolling in insurance plans. Get the word out by sending them here.

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About Anne Gonzalez, MD

Dr. Anne Gonzalez runs Emerald Health DPC in Western North Carolina. That was enough, until she kept seeing DPC doctors struggling to do it all themselves: marketing, patient follow-up, scheduling, social media. She developed Harmony Ops, a DPC specific CRM, so you don’t have to figure it out alone. Your practice can grow without all that extra effort eating up your life. When she’s not seeing patients or tinkering with automations, she hosts the DPC Life Podcast. Established DPC doctors talk about what works, and she coaches new DPC docs on creating their brand vision and messaging. Turns out, once you escape fee-for-service medicine, the sky really is the limit--which is why she’s got more projects than she probably should have.