So, you’re thinking about Direct Primary Care (DPC) for your practice style? Great choice. DPC continues to grow rapidly with now over 1500 practices across the U.S. Many feel (myself included) it’s the only way forward for primary care while achieving real value based care: improved access, lower costs, higher quality of care and higher patient-physician satisfaction. But how can newly trained physicians jump all-in on DPC right out of training? There seems to be so much involved with startups not to mention the costs involved. While I truly believe DPC can be done right out of training with hard work, budgeting and guts, there is another option—working as an employed DPC physician at an independent physician owned clinic.
Working in DPC as an employed physician has some clear advantages over starting your own clinic. First, you can start practicing on day one with very little up-front time or money invested. There are many physician owned DPC clinics across America looking for physicians to join them (find some here). You can also find an area of the country you like and find DPC clinics, many of which may be hiring (map). They already have the office space, the name, the logo, the EMR, the staff, the equipment, the paperwork and the patients already lined up for you. They just need you.
Another advantage is the benefit of working with other DPC docs right in your own clinic. Let’s face it, starting your practice after residency is a little intimidating for most of us. It’s great to have other docs in the same office to share cases and concerns from time to time. Plus, those established docs know so much about the business side of medicine that few residents get to experience in training. Learning how the business of medicine really works is eye opening and a great benefit in itself.
Even better, when joining an established practice you will mostly likely be making more money a lot faster than starting your own. Most clinics will be covering overhead costs while filling up your panel with eager new patients. Some may even guarantee generous salaries right from the beginning which you would not have starting out on your own.
Finally, being an employed DPC physician allows you great autonomy in your work with little risk to you. Basically, all the benefits of DPC—autonomy, lower patient volumes, more time with patients, a life outside of work—with little start up risks, time or money. Most clinics will allow you to set your schedules and care for patients as you see fit. You just need to care for patients.
Now, there are some conditions you should be aware of when being employed in DPC. You’ll be under a contract that you will have to follow which might include work schedule, number of patients, call schedules, non-compete clauses and compensation structures. You should read over those well and be clear on them. Do not fear, however, as most of these independent physicians are eager to work with new physicians to simplify these agreements. The biggest issue will be how you will be compensated and you need to understand clearly how that works. There may be lower compensation in the beginning as patient panel size has to build so you need to be aware.
Overall, going the employed DPC route can be a much easier, cheaper and faster way to get into the DPC model. Joining an established DPC group allows instant access to physician colleagues, patients, and a learning environment with little financial or business risk to you. This allows you most of the benefits of DPC that primary care physicians desire right out of training. Just be sure to have a clear written agreement regarding the benefits and compensation of being employed. Best of luck.
Dr. Shane Purcell, MD is a family medicine physician in Andersen, SC. He practices at Direct Access MD along with his co-founding family physician, Dr. Amy Cianciolo, MD. He is a founding member of the DPC Alliance and has spoken about DPC at numerous conferences, residencies, and medical student groups.