Staying Focused My Friend

When you first decided to embrace the Direct Primary Care (DPC) model, you likely had a clear vision: to provide comprehensive, accessible, and relationship-centered care without the constraints of insurance-based payments. Many physicians who make this transition are driven by a desire to reclaim the doctor-patient relationship and practice medicine on their own terms.

Yet as your practice evolves, opportunities arise that can tempt you away from this founding vision. These “add-on” services often promise to supplement your income or expand your practice offerings, but they can become dangerous distractions—not unlike that chocolate cake in your refrigerator at 11 PM when you’re trying to “eat healthy.”

The allure is understandable. Perhaps it’s a medical device company offering revenue sharing for in-office procedures, or a supplement line that seems perfectly aligned with your holistic approach. Maybe it’s moonlighting opportunities that promise to ease financial pressures during your startup phase. “Just one shift a month,” they say, which we all know is code for “kiss your Saturdays goodbye for the foreseeable future.”

These offerings aren’t inherently problematic – the danger lies in how they shift your focus, time, and energy away from building the core DPC practice you envisioned. Each new service divides your attention, potentially delaying the growth of your patient panel and diluting the quality of care that made DPC attractive in the first place. Before you know it, you’ve gone from “revolutionary physician reclaiming medicine” to “harried entrepreneur selling vitamins between patients” faster than you can say “passive income stream.”

Much like a physician who strays from their practice’s core mission, organizations that were founded to champion and advance the DPC movement face the same seductive pull toward diversion. When these professional groups begin entertaining alliances with side projects, special interests, or shiny new initiatives that don’t directly strengthen the DPC model, they too risk abandoning their first love – the pure vision that sparked their formation. Their effectiveness wanes as they spread themselves thin across projects that, while perhaps worthy, dilute their commitment to the movement they pledged to serve. It’s the organizational equivalent of downloading Tinder “just to see what’s out there” while in a committed relationship. Moreover, when leadership allows this wandering focus, they’re not just making a strategic error – they’re violating the fiduciary responsibility entrusted to them by their members. Physicians didn’t join these organizations to fund leadership’s midlife crisis projects; they joined for focused promotion and support of the DPC model they believe in.

As an osteopathic physician, I’ve faced this challenge personally. My training equipped me with skills in osteopathic manipulative treatment, prolotherapy, and platelet-rich plasma therapies that patients value tremendously. The pull toward focusing primarily on these modalities has been strong – they’re deeply satisfying to perform, patients experience tangible relief, and frankly, they would keep my schedule perpetually full. Plus, I look significantly more impressive performing a high-velocity, low-amplitude thrust technique than I do explaining for the thousandth time why antibiotics won’t help a viral cold. (Though I’ve been told my “disappointed but not surprised” face when patients request Z-paks is quite remarkable.)

But I’ve deliberately kept the reins pulled back on these procedures, not because they lack value, but because allowing them to dominate my practice would divert me from my original vision: providing comprehensive, full-spectrum family medicine. I entered this profession to form long-term relationships with families, to care for patients from birth through their elder years. And I especially cherish the privilege of bringing new life into the world – there’s simply nothing that compares to the joy of delivering babies, even if it means being woken up at 3 AM so often that my family has started leaving the coffee maker pre-loaded for my middle-of-the-night dashes to the hospital. Had I surrendered to the easier path of procedure-focused practice, I would have lost those irreplaceable moments that remind me why I became a physician in the first place – like the time a four-year-old patient solemnly informed me that I should check his teddy bear’s ears first because “he’s more scared than me.”

The path to a thriving DPC practice isn’t through diversification in the early stages – it’s through doubling down on your core offering until it reaches sustainability. Only after your practice has established a solid foundation should you consider carefully selected additions that truly enhance your original vision rather than divert from it. Think of it as dating – you need to be exclusive with your DPC model before you start seeing other healthcare delivery systems on the side.

Ask yourself regularly: “Does this opportunity bring me closer to or further from my vision for patient care?” If an add-on service doesn’t directly support your founding principles or requires significant time away from building your core practice, it may be wise to decline – at least for now. Your future self will thank you, even if your current bank account is giving you the silent treatment.

Your decision to practice DPC was revolutionary in itself. Honor that choice by giving your practice the focused attention it deserves to grow into the vision that inspired you to make the leap in the first place. After all, if you wanted to juggle a dozen different roles and still feel perpetually behind, you could have just stayed in the insurance-based system and enjoyed the character-building experience of trying to document a complex patient encounter in seven minutes while simultaneously filling out prior authorization forms and pretending to listen during administrative Zoom meetings.

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