Join Dr. Phil Boucher and Dr. Marina Capella as they delve into the practical steps and legal considerations involved in transitioning from a fee-for-service practice to opening your own pediatric Direct Primary Care (DPC). Drawing from Dr. Phil’s firsthand experience, this episode provides valuable insights on navigating contracts, understanding non-compete clauses, and strategically planning your exit to ensure a smooth transition to DPC without jeopardizing future endeavors.
Link To Podcast: How Do I Prepare To Leave My FFS Practice For DPC?
00:00.00
marinacapella
Okay, we’re recording welcome back to another episode of dpc pediatrician thanks for joining us today. We’re going to work to answer the question of how do I prepare to leave my fee for service practice in order to open up my own pediatric dpc. Now I personally don’t have much experience with that because I switched over from pediatric urgent care to dpc but Phil you have experienced with leaving a fee for service practice where you are a partner for dpc. So I’d love to ask you questions on this episode about how you did that.
00:27.52
Phil Boucher
Right.
00:35.28
marinacapella
And so where did you even start that process. What did you have to think about.
00:40.30
Phil Boucher
So I was a partner like a owner of a pediatric practice with about 10 other pediatricians and so there’s lots of like layers to an partnering like going through a divorce I’m sure would be like ah.
00:54.27
marinacapella
Yeah Adam.
00:57.36
Phil Boucher
When it comes to okay where do you even start? Well I mean the first thing like the very first thing that I tell pediatricians when I’m talking with them whether they’re employed whether they’re an owner whether there’s something else in ah where they work with their whoever employs them as a pediatrician is to get a copy of your contract. Because a lot of people sign the contract and it’s probably sitting in a folder in some drawer or it’s in your gmail or somewhere like that and you don’t even think about it anymore because it’s been yours and you were never when you signed the contract you were never thinking about leaving so the most important thing to do is get an actual copy of your contract. If you’re afraid like that’s going to throw up all the red flags for your employer the way that I would do it is I would say like you you literally might not have a copy of your contract, especially one. That’s actually been like signed by all parties because usually they they handed to you sign it. They put it in a drawer or something like that you might have had a a provisional copy but not 1 that’s not actually signed. Um, I would say hey we’re updating our will with our attorney and we just need to get all of our employment contracts. Do you have a copy of my contract that I can send to my attorney to have on file. Ah you know for our will and everything like that because that’s a legitimate reason to need a copy of your your contract because if you were to.
02:13.99
marinacapella
Aha.
02:14.76
Phil Boucher
Die like somebody has to figure out how it works with your getting out of your employer and all those sorts of things like that’s a legitimate reason that doesn’t raise the red flags of hey I just wanted a copy of my contract like I’m kind of curious about the non-compete portion of that. Um, so get a copy of your contract that is first and foremost the most important thing.
02:17.53
marinacapella
Um, yeah.
02:25.48
marinacapella
Ah, aha.
02:33.13
Phil Boucher
So you actually know what’s spelled out and there’s 2 really important things in there 1 is how much time you have to give them and 2 is the non-compete and those are the 2 biggest things where pediatricians feel like okay I really don’t know what is going to happen here I don’t know if it’s ninety days or if it’s six months or 1 year and I don’t know what the non-compete says because I didn’t think that was going to be an issue down the road. Um, those are the 2 main things that you need to secure is the knowledge of this is what it looks like when it comes to ah how much notice I need to give and this is how much notice or this is what the non-compete looks like because those are the 2 biggest. Things that are going to come up as you prepare to open.
03:12.28
marinacapella
Excellent, Yeah, okay, so once you have a copy of your contract. How do you make sense of it because as we know Legal language can be quite complex and difficult to interpret in terms of Okay, what’s the practicality of this What does this mean for me.
03:21.83
Phil Boucher
Yeah.
03:29.66
marinacapella
Trying to leave the practice did you work with a lawyer or someone else to figure that out.
03:33.70
Phil Boucher
Absolutely it is well worth your time and money to work with an attorney because there are such contract nuances in there that you no matter how much training you have as a doctor and how smart you are do not understand all of those little legal these terms. And conditions and it is not worth your time to try and do it and honestly there’s been a few train wrecks in the dpc groups that I’ve seen where people assumed based on their reading of it that they were okay and then their practice went after them and they like had to close or they had to move to a further distance because.
03:58.30
marinacapella
Yeah.
04:11.40
Phil Boucher
They just assumed that everyone would play nicely. Ah, assume that they won’t play nicely and so have an attorney that can say this is what you signed this is where we’re at and this is what we need to do to make sure that you are not in breach of your contract because oftentimes especially if you are an owner or a partner in a practice. There’s money to untangle as well and so you don’t want to put that at risk like the money that you’re due either in accounts receivable or as you’re buyin and your buyout and all of those sorts of things because you just said well I I read the contract and this is my interpretation of it spend the five hundred bucks spend the thousand bucks spend the two thousand bucks whatever it is.
04:41.93
marinacapella
Ah.
04:49.56
Phil Boucher
To have that Attorney give you that piece of mind and know that you are. You’re doing everything within your contract and it is well worth your money to do it on the front end, especially if you make it clear that you have representation like they’re going to. Back down a little bit and be like well we’re not going to be able to pull a fast one because they already have somebody that’s representing them. Those are important things to just keep in mind and to make sure that you get this the legal support that you need. Um I would think of it like. Yeah,, we’re gonna do it Appendicitis This kid’s pretty Sleepy. We Probably don’t need anesthesiology. They’ll probably find No no, no, you want the anesthesiologist there for the appendectomy even in the sleepy kid really dumb analogy but you want the attorney to be there by your side as you go through.
05:29.31
marinacapella
Ah.
05:39.24
Phil Boucher
Leaving your fee for service practice. Whatever the setup is.
05:40.84
marinacapella
Ah, gotcha Yeah, were you able was it a good situation financially for you because I have a friend who’s leaving her fee for service practice. Um, and she says that just reimbursements have become so difficult over the time that she didn’t get as much out of it as she had hoped. So.
05:59.16
Phil Boucher
Yeah, ended ended up being fine for me I mean making sure that I didn’t breach my contract and then put all of that the accounts receivable and those things at risk was really important and worthwhile from a financial standpoint I wouldn’t anticipate a lot of like financial windfall.
05:59.18
marinacapella
Did it end up being okay for you.
06:08.70
marinacapella
Yeah.
06:17.40
Phil Boucher
From leaving the practice because it can be really expensive these days to run for a fee for service practice and so I would just look at any of that as kind of bonus money grave you money? um that that you might be coming into as you exit, but that’s another good reason to have an attorney that can tell you this is what you’re due. This is how they calculate what’s due to you.
06:17.24
marinacapella
Yeah.
06:25.34
marinacapella
Um, yeah.
06:36.19
Phil Boucher
Because the thing about the fee for service practice is. There’s a lot of money sitting there and accounts receivable How does that work when insurance pays you like for your services after you’ve left or do you have to wait a certain amount of time to figure that out like ah you know, not everybody pays their bill.
06:38.84
marinacapella
Um.
06:52.88
Phil Boucher
What about the kid that you saw three months ago that had strep throat that was a 9 9 2 one four that doesn’t pay their bill like how does that money actually reach you? Well, there’s formulas that should be in the contract that spell that out of what you should expect to get when you leave and it’s not worth your time trying to figure all that out.
06:59.96
marinacapella
Um, yeah.
07:09.25
Phil Boucher
It’s important that somebody is figuring that out for you Whether it be the attorney and then working with an accountant whatever that might be to make sure that you’re you get what you’re due and you’re not having to try and run those reports yourself to figure that out.
07:09.67
marinacapella
Ah ha.
07:22.42
marinacapella
Gotcha. Okay, so once you got your contract you worked with the lawyers to figure things out what it would look like or what it should look like how did you break break the news to your partners in the practice. Ah.
07:34.90
Phil Boucher
A resignation letter that I put on each of their desks. Um yeah I think you I think one of the things that ah will come as a surprise to you is how replaceable you as a pediatrician are.
07:38.41
marinacapella
Yeah, yes.
07:50.75
Phil Boucher
Whether you are employed whether you’re a partner or anything along those lines and I don’t say this to like put a lot of ah dark clouds over it but they’re going to move on with the business and you’re not going to be a part of it anymore and so you can’t expect them to like be your friends or throw you a goodbye party if you’re leaving and you’re going to go do something that.
08:06.90
marinacapella
Yeah.
08:10.15
Phil Boucher
To be honest, they’re probably going to be jealous of when they see the lifestyle and the way that you get to care for patients. So I would assume that they’re not going to throw you a goodbye party and buy you a big cake and let that concept trickle down to all of the ways that you’re going to interact with them. But that by the time that you give them your notice.
08:16.34
marinacapella
Ah.
08:21.48
marinacapella
Naha.
08:28.71
Phil Boucher
And you say you’re going to leave and the worst thing they could do is they could be super I mean the best thing that can happen is they could be super excited for you and give you high fives and send patients to you and all those things. The worst thing is they can make it really challenging to leave and make lots of headaches and lots of drama.
08:35.66
marinacapella
Ah.
08:44.15
Phil Boucher
And so if you assume that there’s going to be lots of headaches and lots of drama and prepare yourself in that way then at least it can’t be any worse than you you predicted like there’s a stoic concept. Um, ah of premeditationio mallorum which is like plan for bad things I actually have there’s like a little stoic coin.
08:49.60
marinacapella
Um.
09:03.72
Phil Boucher
Um, that says that and it says all of the terms of our human lot should be before our eyes and then around that it says Exile torture Shipwreck Famine Like if you’re prepared for those things then the worst thing that can happen is shipwreck.
09:09.30
marinacapella
And.
09:15.60
marinacapella
Ah, ah yeah, ah.
09:21.10
Phil Boucher
And then okay I’m prepared for a shipwreck here’s what’s going to happen if there’s a shipwreck I Already know what I’m going to do So if you prepare for the bad thing then if it happens then I was prepared for it and then anything better is just well great. They threw me a going away party Lovely Um, what that looks like when you’re actually.
09:34.52
marinacapella
Yeah, yeah, it’s like the yeah yeah.
09:39.50
Phil Boucher
Telling them is to make sure you have your ducks in a row because if you know I have to give them ninety days notice well I’m not going to give them ninety seven days notice I’m probably going to give them 90 or ninety one days notice so that there’s only so much malfeasance that could occur in those that last time together and at the worst they could say well we are going to just let you go right now.
09:48.84
marinacapella
Aha.
09:58.26
Phil Boucher
And you can just pack your bags and go and that that could happen I mean they might breach the contract if that happens which is another good reason to have your attorney on board. But you know okay well they said Sayanara and cut me loose and so now I can get started on my practice and here’s what that means from a legal perspective.
09:59.10
marinacapella
Um, yeah.
10:17.80
Phil Boucher
All of those sorts of things so it was just a letter that I put on their desk I also did not get into the specifics of my specific plans or the model or anything like that I’m leaving the business period. You don’t have to go into the depths of why you’re doing it or the things that you want that they can’t offer like they will.
10:31.42
marinacapella
Um.
10:37.36
Phil Boucher
Decide How much they care about that and I’m probably sounding really jaded I’m not really jaded about it. But I do try and prepare Pediatricians in advance like this is the worst thing that could happen so that hopefully the worst doesn’t happen. But at least if it does then they’re not totally taken by Surprise when the people that they worked with and cared about and spent time with um.
10:39.57
marinacapella
Yeah.
10:47.39
marinacapella
Ah.
10:52.97
marinacapella
Ah.
10:56.91
Phil Boucher
Move on from them before or into a greater extent than they were expecting.
11:01.40
marinacapella
Yeah, no I think that’s really sage advice you know, prepare for the worst and hope for the best right? Um, but yeah, you should. You should be prepared for all possible circumstances that’s going to position you in the best possible place. Whatever happens.
11:05.68
Phil Boucher
Um, yeah, um.
11:18.39
marinacapella
Yeah, so how how did your practice react. How was that transition for you were there any surprises for you of anything you had to give up or any sacrifices you had to make in making that transition. Sure.
11:31.75
Phil Boucher
I Honestly probably can’t get into all the specifics of it from a legal perspective but it went about as I expected um it wasn’t worse than I expected but it wasn’t that great of a six months because I gave more notice than most do um.
11:36.90
marinacapella
That’s fine. Yeah.
11:48.82
Phil Boucher
In part because I was a partner in part because like the writing was on the wall that this was the right move for me to make and then we agreed on the the timeline together of like how soon I would leave. We also a week after I put my letter of resignation on their desks. We had a planned premature delivery of our sixth kid.
11:55.12
marinacapella
Um.
12:06.75
marinacapella
Oh.
12:08.45
Phil Boucher
Um, and then three months after that we moved into a new house that we have been building so there was stress and layer upon stress and layer. So it was a difficult time period. It wasn’t worse than I had expected though. But ah, my expectations were were pretty low at that point of how how things would go. Um.
12:14.70
marinacapella
Ah.
12:20.27
marinacapella
Um.
12:25.32
marinacapella
Her.
12:28.29
Phil Boucher
I Think for me, that’s probably all that I can or want to get into like reliving Traumatic experiences isn’t that much fun and so let me just like have you tell you that the other thing that you should do is prepare your spirit for that.
12:32.90
marinacapella
Um, yeah, that’s okay, that’s okay, yeah, ah of course.
12:44.45
Phil Boucher
By having you know good self-care practices or a therapist or at least a good support network around you that can help you as you make those transitions and people do things that you didn’t expect based on your previous years of co-employment and working together and caring about each other.
12:49.63
marinacapella
Um, yeah.
13:01.43
Phil Boucher
Um, so I mean I think those are those are like lessons learned from that.
13:05.75
marinacapella
Yeah, yeah, no thanks for sharing that because I do want people to have wide eyes wide open about the possibilities I mean this is like you said I can feel like a divorce of sorts right? And that’s that’s very real, especially if you’re leaving as a partner. Um, how? ah.
13:21.42
Phil Boucher
Right? ah.
13:23.34
marinacapella
Do you have any advice for people who are leaving feet or service but maybe not as a partner but just as an employee.
13:29.39
Phil Boucher
Yeah I think um, assume that the hospital. Okay, this is this is a really Debbie Downer podcast I’m sorry um, assume that the hospital assume that the hospital won’t be super excited about telling your patients where you’re going because it.
13:34.80
marinacapella
No, it’s nice. It’s very realistic.
13:44.64
Phil Boucher
It doesn’t serve them well to just give up all these patients and all the rvs that come from all of these patients and so if you’re employed by someone assume that they’re not going to send you off with a bunch of patients under your belt that they’re just going to say like he’s moving here here’s his website here’s how to book an appointment with him assume it will be. Your case has been reassigned to Dr So andso effective this date and that’s all you’re going to get from them and so what that means whether you’re in a ah a whether you’re a partner or whether you’re in a fee for service model. We are employed make sure patients know how to find you and so.
14:11.40
marinacapella
Ah.
14:22.45
Phil Boucher
In addition to like the first step being to get your contract is figure out a way that you can within the bounds of your contract make sure patients know where to find you the easiest way to do this which I think just helps ah you to develop this skillset around marketing too is if you have an online presence where you talk about pediatric topics. Here’s what’s going around the community here’s how to start peanut butter with your ah you know six month old ah here’s what to know about autism here’s what to know about an upcoming. Ah you know, flu vaccine or whatever it might be if you can establish like a little bit of a marketing channel presence.
14:57.40
marinacapella
Um.
14:58.90
Phil Boucher
That’s not like follow me here’s my new practice here’s all the things that went wrong with my old practice. It’s not that it’s simply here’s a lot of good information that I want to provide as an educational opportunity for my patients and for our local community if you can establish that.
15:03.61
marinacapella
Now.
15:14.33
Phil Boucher
Then you can say hey I know you had asked about um, starting ah peanut butter with your baby here’s what to do? Also I just put something on my Instagram about the way that we did it at our house. Ah then you then patients will naturally find you on those channels.
15:28.58
marinacapella
Yeah.
15:29.95
Phil Boucher
And then when they leave when they get that letter and it says Dr Boucher is no longer here. Ah your your ah case has been reassigned to so-and so they’re going to knee-jerk response of well I’m going to go figure out what happened or figure out what’s going on mostly um because I liked him and I want him to still be my pediatrician.
15:43.69
marinacapella
Um.
15:48.54
Phil Boucher
But it’s kind of weird to get a letter in the mail. Ah you know saying that he’s no longer in practice there. What’s the deal I’m kind of you know curious about what’s going on there and then they’ll go and find you and they’ll find oh well, he’s still putting out content. He’s still putting out information and it looks like he started this new practice and I’m going to go.
15:48.99
marinacapella
Yeah.
15:57.46
marinacapella
Ah.
16:03.22
marinacapella
Yeah.
16:05.86
Phil Boucher
Check it out and learn more because I liked him and you know he seemed like a reasonable guy I Wonder what’s going on or if he must be doing something cool. So if you can have a way that’s not advertising and it’s not salesy for patients to find you and connect with you before that time then great. It might be. You might like video you might like doing substacks.
16:11.70
marinacapella
Um.
16:25.53
Phil Boucher
You might like putting together. Whatever sort of ways that you can serve in the community and and provide that good information. But if you can be if you can have that pillar set up as you’re getting ready to depart then it will only serve you to make your patients be able to find you more easily and then find out about your model and things like that and maybe the practice is.
16:28.99
marinacapella
Who.
16:39.17
marinacapella
Yeah.
16:44.52
Phil Boucher
Overflowing and they don’t want those patients anymore and they want to have them all Follow you and great but I would assume that they’re not going to be super Gung-ho about you starting some competitor to them that provides things that they can’t provide and that they’re not going to be super. Excited to share that ah by at large that that you’re moving on and here’s how to find him and all those sorts of things.
17:06.35
marinacapella
Um, yeah I’ve heard other Pediatricians who leave you know, employed positions say that they can’t They’re not allowed to tell their patients where they’re going but they can say something generic like look me up online right? And so.
17:20.34
Phil Boucher
Writer.
17:23.66
marinacapella
And so it’s that’s where that’s where it’s important to you know establish your Google profile or like you know, have some sort of presence where if people look for you. They can find you right.
17:28.85
Phil Boucher
Um, right.
17:32.33
Phil Boucher
Absolutely yep, like in this day and age when you see ah something on the news or you hear about to do business or a business going out of business. You’re going to look them up like you’re going to have that curiosity and you’re going to go to Google you’re going to go to social media and and type in their name and then like it’s not hard to.
17:44.16
marinacapella
Yeah, ah.
17:50.68
Phil Boucher
Have that presence so that when people Google you they find you and so making sure that you’re able to get a handle on that and get like your Google profile to yourself. So it’s not owned by your practice like your name you know Phil Boucher Md is your intellectual property so you can get that Google my business.
17:52.91
marinacapella
Um, yeah.
18:08.11
marinacapella
Ah.
18:10.27
Phil Boucher
And um, disconnect it from the practice that you were at you can have those social media channels and those sorts of things. Ah just talk with your attorney because you want to make sure that you’re not doing anything that’s going to jeopardize your leaving but there are plenty of ways to.
18:16.64
marinacapella
No.
18:26.40
Phil Boucher
Put yourself out there in the community that people will know where to find you when they get that letter.
18:28.65
marinacapella
Yeah, excellent, all right? Thank you Thanks so much for sharing your experience your story at least as much as you could I don’t think this is a downer episode I think this is the please go into this with eyes wide open and knowing what you need to do to make it successful right.
18:35.72
Phil Boucher
Yeah.
18:45.58
Phil Boucher
Yes, I mean yeah, no I was going to say like when you see the non-comp compette to that was the other thing that we didn’t really get into much um, talk with your attorney about what that non-compete means if it says you can’t practice within twenty miles.
18:47.61
marinacapella
And so to kind of summarize. Yeah, go ahead.
18:56.38
marinacapella
Ah, yes.
19:01.78
Phil Boucher
Don’t assume that if it’s nineteen point four miles that no one’s going to be bothered by it. We had I mean we had conversations like this at the mastermind to where practices went after doctors ah like they have the time and they have the resources and they have the attorneys to make it really hard for you. And so take them at their word or figure out how to adjust things legally from a legal standpoint that then protect you assume that all those things are in place and assume that they actually mean what they say and it’s not like yeah I know they said twenty miles but
19:31.65
marinacapella
Um.
19:33.79
Phil Boucher
Their kids were at my birthday party. My kids’ birthday party last weekend. They’ll totally understand I mean in theory like we would all hope that people would be like that. But when it comes to the legal business. There’s often not that. Ah you know those warm fuzzy feelings like it is just 7 pages of text.
19:48.32
marinacapella
Yeah.
19:52.53
Phil Boucher
That are really going to determine your future now. It’s also important when you’re talking about non-competes not to assume that because you saw something on the news or on a Facebook group that non-competes aren’t enforceable ah in this state or that state like actually talk with your attorney and find out if that is the case rather than relying on. Ah, Medscape article that you saw or a Facebook post where somebody was able to do this or that get the actual attorney’s opinion and their expert advice before you make decisions that are kind of in the gray area of your contract.
20:17.53
marinacapella
Um, yeah.
20:26.83
marinacapella
Ah, yeah, definitely I used to live in California where um hospital system still right noncompete into the contracts but they’re ah, allegedly, not not enforceable. But even then they can still threaten to harass you basically like you know.
20:32.32
Phil Boucher
But.
20:40.15
Phil Boucher
Totally.
20:43.16
marinacapella
And you can end up wasting a lot of time and emotion and energy in that process. So yeah I would say even in states where it’s not enforceable. You can’t just brush it off right? You have to be careful about that excellent well to summarize some of the things you’ve said today look at your contract.
20:54.76
Phil Boucher
Right on.
21:02.60
marinacapella
With an attorney very carefully including that non-copee clause make sure that you tell your patients how they can find you within the constraints of your contract and also sometimes you know prepare for the worst and hope for the best. So.
21:17.30
Phil Boucher
Um, yes.
21:19.41
marinacapella
Thanks so much Phil for sharing your experiences to the extent that you could.
21:22.16
Phil Boucher
You bet.
