A year ago, as I was knee deep in setting up my DPC practice, Doug Farrago had me share my experiences and thoughts in real time on DPC News which resulted in my 10 part DPC Diary series. Last month, my practice celebrated turning 1 year old and I wanted to provide an epilogue to the Diary series with 5 lessons learned from year 1 of running a DPC practice. 

Consistency is Key

When I opened my DPC, like most people who start a DPC, my big focus and concern was patient acquisition. At the start, I took time to meet with anyone who looked in my general direction and attended all sorts of networking events. In the first few months I felt panic and frustration because even the people who found the DPC concept “awesome” or would “talk to their spouse” about joining typically didn’t join. I felt like I was wasting time, but as time went on, new patients came in, sometimes referred from people I hadn’t talked to in months. Trust underlies the doctor patient relationship and trust takes time to develop. Even when people know who you are and what your DPC is about, they will wait until they meet a pain point before joining. A year since opening, there are people in my community who talk about my practice and send people my way. Some people are still thinking and that’s ok. Continuing to build relationships in the community and providing excellent medical care ensure continued growth, even if it takes time. 

Churn Hurts

Anyone who has worked in an emergency room or urgent care knows when it rains, it pours. Around month 9 we had several families leave in rapid succession due to getting insurance or moving away (none due to dissatisfaction with service thankfully). While I knew about churn and expected churn sometime, it still hurt. No matter how many times you repeat to yourself “it’s not personal, it’s business,” the cancellation still stings, especially in the startup phase when income from every patient matters and you carry doubts about whether you’re cut out for running a DPC practice. There’s the theory of running a practice and the reality of running one and the category of emotions definitely falls exclusively under the reality of running a practice. 

Help Helps

Many DPCs start with the help of a spouse or business partner (ironically, however, most 50/50 doctor partnerships end up splitting). I was lucky enough to bring on a friend of mine from residency. She has been absolutely key to helping the practice grow. Having someone alongside helps share the tremendous load of opening and running a business while practicing medicine. They also serve as moral support for the good and bad times. Not everyone can afford hiring immediately, can initially bring someone on, or has a spouse to share the work. In these instances, maintaining relationships with your local business and local DPC communities becomes even more important. I’ve made friends with several local business owners who are a source of support and I have an incredibly strong and supportive group of DPC docs around me in Virginia who I am glad to call friends as well. 

Evaluate Expectations

Dr. Tom White made a profound comment at the DPC Summit: “instead of asking how many patients someone has, we should be asking how being in a DPC has improved your quality of life”. Most of us know bad metrics can frustrate without even providing meaningful information. One pervasive topic of conversation amongst DPC and especially early DPCs is patient number. During my residency years when I was talking to dozens of DPC docs, I had that question in mind to better understand growth and used average numbers to gauge how my own practice was doing. However, in the last year of doing DPC myself and asking smarter questions to other DPC docs, I’ve learned there are many factors to growth, and average number at a certain time period is not the best metric to follow. When evaluating expectations overall, I’ve learned there are two ways to evaluate expectations: 1. The more classic and obvious- figure out why you met, missed, or exceeded expectations  and 2. Evaluate the expectation itself. Usually just one needs to be done, but sometimes doing both can help as well. 

Keep Learning

Have you ever written a draft of anything and think it’s great because you spent so much time on it only to go back a few hours or days later to find numerous flaws? Opening and running a business is kind of like that. There’s always so much going on and, no matter how much due diligence goes into each decision or new project, there’s usually something that could have been done better. As physicians, we demand perfection of ourselves and our work; we also realize the more we learn or do, the more there is to learn. This combination of traits makes running a business a perfect endeavor for us. Plenty of nitty gritty to tackle daily and a never ending stream of lessons to learn. 

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Operating a DPC for a year has been challenging and rewarding. I had been actively studying and engaging with the DPC community for about 4 years before opening my own practice, so I always considered opening my own practice like a PGY-4 fellowship year, a natural next step after residency. However, for any residents reading this, opening your own practice is not for everyone. It is a huge financial and time commitment. Luckily, nowadays there are plenty of successful DPCs growing and looking to hire, offering another option for those interested in DPC. For any students reading, keep following the DPC community. By the time you’re ready to become a DPC doc, I anticipate the landscape will have changed to offer so many more opportunities and entering the space will only become easier.