Mon. Sep 27th, 2021
Sweating at the farmer’s market

Opening a business challenges you in every way possible. And while it’s usually fun and exciting, I must say it is hard. Opening a DPC, especially in an area with no or few other DPCs, is especially hard. This week I want to dive into the difficulties of starting a DPC because I’ve always been told how hard starting a business can be, and didn’t know the details of the challenge, so, while I’m in the midst of it, I wanted to openly share some of mine.

Opportunity Cost: Everyone who’s gone through medical school knows about opportunity cost- the price of doing one thing over another. Starting a DPC straight out of residency has a huge opportunity cost. You’re not only giving up a comfortable attending salary, you’re also either spending your own money or taking out (yet another) loan to fund your practice. This piece is fortunately mitigated by many currently successful DPCs looking to hire like my friends Clint Flanagan at Nextera Health, Allison Edwards at Kansas City DPC, and many others which you can find in the classifieds section on this site. The reason I and many others choose to forgo the attending salary early is because I consider this time and money an investment in my future where I’m not bound by golden handcuffs.

Details: You need to have an opinion on everything. If you don’t know how to do something you better learn fast. Sometimes you don’t even know what you don’t know and by sheer dumb luck, figure it out just in time. I’ve dropped the ball here and there on mostly minor things. Even though you expect to miss the occasional detail, doing it always makes you kick yourself a bit- probably part of the perfectionism complex that comes with having gone through medical training. I consider myself fortunate to have helpful, supportive friends in my local DPC and business community who help me along. Doctors are life long learners, and doctors with businesses are lifelong double learners.

Anxiety: I’ve been able to mitigate this mostly through staying busy, but it does creep through every now and then. The first source of anxiety is from feeling like you don’t know what you’re doing. The imposter syndrome many of us have felt in training definitely rears its head again during startup. The other source, of course, is waiting for patients. Unlike our insurance employed peers in fee for service, we have to work pretty hard for our patients. I’ve been marketing for 3 weeks now and have had a few false starts, but very little else to show for it. From talking to others, the estimated time to traction (from starting a new practice in an area where no one knows you) is about 2 months. Meanwhile, I get to just sit here and try to stay busy to not think about sign ups.

These have been the biggest challenges for me and are the thoughts which creep into my head on the low days when I think “what have I gotten myself into?”. I still think opening a DPC practice is the right path for me and I can’t imagine myself ever working in FFS (my current side hustle at the urgent care confirms this), but I wanted to share at least one post about the challenges. The real question for anyone considering opening or joining a DPC is what challenges are you willing to face. Maybe you enjoy the confines of the FFS golden handcuffs, but for me and many others, the freedom to fight our own battles way outweighs the 9-5 slog of seeing 25-40 patients a day while fighting for insurance reimbursement.

“Nothing in the world is worth having or worth doing unless it means effort, pain, difficulty… I have never in my life envied a human being who led an easy life. I have envied a great many people who led difficult lives and led them well.” -Teddy Roosevelt

20890cookie-checkDPC Diary Part 6

By Kenneth Qiu, MD

Dr. Qiu will be moderating our Resident and Student section. Kenneth Qiu, MD recently finished his family medicine residency and has just opened a DPC practice in the Richmond, VA area ( He has been involved with the DPC community since medical school and has worked to increase awareness of DPC for medical students and residents across the country. He’s presented at three previous DPC Summits.

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