The Stress-O-Raptor at DeePeeCee Land – The Ups and Downs of DPC
Author: Landen Green, DO
Direct Primary Care is not all fun and games—it’s not always laughing with patients during extended visits. After three years in DPC, it has felt more like a Stress-O-Raptor Roller Coaster at Deepeecee Land than a Lazy River Relaxation at ‘Cherry-Picking’ Gardens.
It’s been a wild ride! Like any roller coaster, owning a DPC clinic has its waits, its ups, and its downs.
Waiting in Line: Like most coasters worth riding, you have to wait in line. So, screen in front of me, YouTube pulled up, I sat and watched a certain charismatic DPC doctor give a passionate, engaging lecture from the 2017 DPC Nuts and Bolts Conference. I learned two big things:
- There was hope for me to be the doctor patients needed while still enjoying being a doctor, and
- Watching YouTube late at night can lead to seeing some pretty sketchy people.
Stress was low, excitement high. I read books, watched more videos, met with mentors, shadowed DPC doctors, and attended DPC conferences—soaking in everything before facing the beast itself. Once I stepped foot in line, my ride was inevitable.
So, I strapped myself in. Bars lowered across the belly I wished I didn’t have. The clicks assured my safety (I hoped). Excitement peaked. I hadn’t even begun to move—I was just settling into the idea that I was about to ride this DPC Roller Coaster. And… 3…2…1—rails unlock, coaster is rolling. No getting off now… here comes the climb.
The First Climb: Tick, tick, tick… Stress builds as I work to launch my DPC practice. Stress from self-doubt: Will this work? Will people get it? Can I do this? More stress from paperwork—setting up a business entity, websites, supplier accounts, GPOs. More stress from decisions—choosing a name, logo, membership fees, location. And stress from considering others—Is this selfish? Can I feed my family this year? Tick… tick… tick. Stress going up, up, up.
No matter how much I read, watched, and learned about DPC, or how much I practiced while shadowing, nothing compared to doing it myself. The stress was high.
The First Drop: Patient One is here! It took three months (I had quite the first climb), but they’re here. Then patient #2… then #3… 5… 10… 20… 30. Okay, I can do this. People are getting it. I got this! Oh, this is actually fun. HANDS UP!!!
The Second Climb: Stress builds again. Just like a roller coaster ticking up, this is actually a good sign—I made it this far, I survived, and that means another downhill must be coming. Things are great! I have patients, I am busy… but then too busy. A good problem to have, but still stressful.
At about 150 patients as a solo provider with no staff, I hit my limit. So, I hired a nurse, hoping for my next “WEEEEE moment.” It didn’t happen. By the time I hired help, I was already overwhelmed. Onboarding and training a nurse while continuing to care for active members and growing the practice just added to the stress. Tick, tick, tick. Up the stress continues to go.
The roller coaster tricked me. By the time my nurse was comfortable and truly helpful, the growth caught up. My wife (also a family medicine physician) decided to join one day per week—her onboarding added to the stress, too. And here I am again. Still ticking upward, hoping for that next DROP.
Now, at around 350 patients with my nurse, stress is high. I hope I’m at the peak of my next downhill.
The Second Drop: It’s coming soon—I can feel it… I hope. My nurse is in a groove, and I love having her. I started a waitlist, which will allow me to put a hold on new patient intakes and focus on keeping my current patients healthy and happy. This is where I hope my hands shoot up again! Weeee… Downhill, smooth sailing!
The Third Climb: It’s always nice to know what’s coming. Learning from other DPC docs, it seems like the next big climb is up to me. I could just coast for years with slow turnover. But the hope is that a big climb would lead to an equally awesome ride down. As things smooth out and the practice finds its groove, I ask myself: Do I want to maintain this steady pace, spend more time with family, and enjoy the ride for a while? Probably. But for how long?
Like many other DPC doctors, I will likely choose to climb again… tick, tick, tick back up the stress ladder—opening a new location, hiring a full-time doctor, writing a book, or dive deeper into other business ventures.
When It’s Over: When the bars rise from my belly and I finally stand up to get off the DPC coaster, I have no idea what that will look like. But I know stretching my legs in retirement will feel good, and I will have no regrets about getting on the ride in the first place.
That moment is still 20–30 years away, but I’m already trying to learn from those ahead of me. A smooth and graceful transition out of DPC into retirement isn’t something with many resources. Ideally, I’d connect with like-minded doctors who could buy the practice at market value and continue providing high-value care. But I’m unsure where the balance lies between setting a new doctor up for success and obtaining fair value for the practice.
Thankfully, by the time I get off the ride, thousands of DPC doctors will have done so before me. Just as I learned from them while I waited in line, I know I’ll learn from them after getting off. And with that knowledge, I hope to help those who take the ride after me—just as I strive to do now.
What a great article as it is helpful to know we are all experiencing this roller coaster ride! Thank you!