In this episode of “DPC Pediatrician,” Dr. Phil Boucher and Dr. Marina Capella address a crucial aspect of running a Direct Primary Care (DPC) practice: getting comfortable asking patients for money. They discuss pediatricians’ challenges when transitioning from traditional practice settings, where financial discussions were handled by others, to a DPC model that requires direct financial conversations.
Tune in to learn practical tips and strategies for confidently discussing fees and valuing your services.
Link To Podcast: Getting Comfortable with Asking for Money in Pediatric DPC
Welcome everyone. Thanks for joining us for another episode of DPC Pediatricians. Today we’re talking about how we get comfortable as DPC Pediatricians asking people for money. Because for most of us in our past lives as pediatricians, we worked in a group practice, we worked for a large hospital system.
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we were not the ones ever having to ask people for money or tell them our prices. In fact, sometimes when people would ask me, how much is this going to cost? How much is that going to cost? I had no idea.
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Right.
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It’s like shrouded in mystery in a typical clinic or hospital. And, So when I started my pediatric DPC, it was the first time that I had to get comfortable saying this is how much I value my time or a visit with me or the membership with me. And this is what I’m going to ask you to pay.
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And that was very uncomfortable in the beginning. Right. And honestly, I think. the short answer for how to get comfortable is just do it over and over and over again. And then once you realize, hey, I need this money to float my practice, to pay myself, to pay my overhead, to pay my staff,
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it becomes easier because it’s just a matter of logistics and numbers. And it’s like, hey, if I don’t charge this much, I cannot survive as a practice. And so I just have to do it. And the more you do it, the better you get. So- Over time, I’ve gotten better. In the beginning,
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I was underpricing myself a lot and I fixed that over time and I went up a little bit and then up a little bit more as I needed to, especially once I hired staff and I had to just make more money to pay my overhead. I think my prices are still very reasonable, though, for a pediatric TPC.
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How about you, Phil? Did you ever have to encounter that discomfort of asking for money?
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Not before DBC, because like you said, it was I don’t know how much it costs. It just costs what it costs. And it’s your insurance’s fault if it costs too much or too little. Like I have no control over that. And so I think it does take just getting comfortable with it.
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And once you’ve decided on your prices, you can mentally justify them. I don’t think you have to overly justify them to patients, though, when you’re having those conversations. The typical time that it comes up is at like a meet and greet, like, how much does this cost, though? This sounds amazing. How much is it?
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And so I think it’s a lot of framing the offer. And so here’s the offer. You get unlimited visits. You can text message. All those hassles that cost you hours and hours of your life in a traditional practice are gone. you get ease of access. We don’t have a waiting room. There’s no waiting.
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We’re going to answer the phone and we’re going to know who you are. So you’re not going to have to explain yourself. Like there are a lot of intangible benefits outside of just the medical care that come from pediatric TPC. And so I think if you can start by focusing on your offer,
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then when people are mentally making the price, they’re going to be like, wow, this must be way outside of the normal. Because That you can just text, like usually you have to call and wait on hold and press two and leave a message and hope for a call back in order to just ask a question about,
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you know, my kid’s diaper rash. And you’re telling me I can just text you and you’ll respond and tell me what to do about my kid’s diaper rash. Yes, we do that. That must be extremely expensive. No, it’s actually quite affordable because we don’t have to deal with insurance.
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We don’t have to deal with all the headaches that come from having a huge staff that argues with insurance all day long. The price is $145 per month for kids your age. Now, let me tell you that in my previous life, one sick visit would usually run either $179 out of pocket or $221 out of pocket,
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depending on what was covered and what was discussed and all those sorts of things. So if you, parent, do the mental math, of how many sick visits and all of those sorts of things and all of the hassle that goes along with it, well, it probably then makes sense to at least break even price-wise,
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but then get all those other benefits. And I think if you can kind of couch it in that way, then it makes it less about selling them and more about here’s what we offer and here’s why it might be beneficial to you.
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Definitely. Well, and other practices also, there’s just such a lack of transparency because maybe the base price of a visit is $169. But then the strep test costs extra and the administration of this costs extra. And just, you know, you get nickel and dimed kind of in that system.
4:49
Oh, totally. I’m the pro. More eye for your teeth. a hearing screen, filling out a form about your child’s, do they have autism or are they depressed? Those are charges. And I was a coding bro in my previous life. And I can tell you how much all of those things add up to and how many of them
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insurance covers or that they go to the patient’s deductible. And so you do get nickel and dimed all the time and patients get those bills and they have sticker shock. when they see that and they see, I thought this was covered or we barely even talked about constipation at the visit
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and I’m getting an add on to my checkup for constipation management. Like I just mentioned that sometimes he has a hard poop. They’re used to that reactive feeling when it comes to opening the bills or the EOBs from their insurance and like, Oh, I wonder how much it was going to cost this month.
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So when you tell them unlimited period, yeah. then that’s, I don’t have to think about it. And I know how much it’s going to cost per month so I can budget for it.
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Yes. I like how you frame that conversation with the family. It’s like, look at all the hassles that you will save, all the time that you will save, right? One of the mistakes that I made and then that I see some other pediatricians making, and I don’t blame them because I did it,
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is framing the conversation too much about DPC or about me instead of the family. And I think it’s understandable because we are so burned out or sick of the system. And we’re like, oh, my gosh, DPC is going to be my savior.
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And it’s the way I’m going to keep being a physician and be happy again as a physician. And so we’re thinking about all the reasons we’re doing it. But when we talk to families, we have to get good at talking about what’s in it for them. Because people are inherently… not maliciously, but just inherently selfish, self-centered, right?
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We’re always thinking about things and how they affect us. We’re not thinking about things generally and how they affect other people for the most part. We’re thinking about us. And so we have to create our message in a way that speaks to that inherent self-centeredness and convince the parents, like,
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this is so beneficial for you because of X, Y, and Z. And look at it from that perspective.
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Yeah. I think if somebody was trying to sell a car, 99% of people don’t know the difference between a V6 and a V8 and a four cylinder or anything like that. Like they want something that gets them from A to B. So if I’m a car salesman,
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I’m not going to be talking with the average consumer about how many cylinders are under the hood or those sorts of things. I’m going to be telling you about the experience of getting from A to B and the comfort that comes from knowing that this car is reliable and
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that it has these headphone things so that the kids can watch a show and not bother you. Like those are the features that are relevant to you. Even though I made this cool car and it has all these special features, like most people don’t care about all of the beneficial things to the car
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manufacturer or the really nitty gritty details. Like they want a car that gets them from A to B without their kids screaming and yelling and they don’t want a flat tire and those sorts of things. That’s what matters to them. So I think the more that you can focus on,
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here’s the previous hassles that you’ve had and here’s why those aren’t going to apply anymore. Yeah. And here’s what we do when it’s seven o’clock and you have a question or concern. And here’s what happens at 2 a.m. when you’re not sure if you need to take your kid to the hospital.
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And here’s what happens when you need a form filled out for camp today. Like those are the things that matter to the patients. They don’t care what EMR you have. They don’t care about all of these like technical behind the scenes things. They don’t care why it’s better for you that you only have seven patients per day
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and that it lets you have time to, you know, not be burned out and those sorts of things. I mean, they do care. But again, to your point, they care because when you are at the visit, you show up and you’re fun and engaging and chatty and you’re not just rushed from room to room to room.
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But it’s because they care about it for their own benefit. Yeah, exactly. Everybody cares about it for their own reasons. Like I want to have a fun experience when I bring my kid to the pediatrician. I want them to be looking forward to it and excited to do it.
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And if the pediatrician is grumpy and is running behind and we have to wait for 45 minutes, that’s not going to be very much fun for me as the parent. I would love a happy pediatrician. But at the end of the day, it’s about me and what helps me.
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And so if you can focus your discussion around the patient. and the hassles and experiences that they’ve had, or if they’re a new parent, here’s what you don’t realize is it kind of sucks when you have to go to the office and you have to wait for 45 minutes in the waiting room with all these other kids
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running around with your brand new baby. And then you get back to the room and your baby’s hungry, but they have to weigh them. They have to strip them down and then you have to wait for the doctor to come in. Here’s things that you don’t realize suck about the way that traditional practices take care of newborns.
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And here’s how we do things differently.
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Yeah, absolutely. Another thing I’d like to share that I’ve learned over time is that people have a hundred different types of money mindsets, right? Everybody grew up in different financial circumstances. Everybody finds themselves currently in different financial circumstances. Some people are, you know, penny pinters and some people are not.
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Some people have more of a scarcity mentality when it comes to money and some people don’t. And your job when you’re selling money, your services is not to fix or change people’s money mindset. If it’s a match, it’s a match. Don’t bend over backwards trying to convince someone that this is a good way to spend their money.
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Because if their perspective is never going to be aligned with what you’re charging, it’s just not going to work. Don’t waste your breath. Don’t waste your time too much on trying to do that. Just talk joyfully about what you have to offer and talk about all the positive experiences that families have had.
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And I think of it sort of like scattering seeds, right? I scatter seeds in my garden. I know that not 100% of them are going to germinate. Sometimes only 10% are going to germinate, sometimes 50%, sometimes 80%. And so my job is just to sow those seeds. It is not to guarantee that each of those seeds germinates.
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And that’s what we’re doing when we’re marketing is that we’re sowing seeds. And if they fall in fertile soil, if they fall on the ears of the right person, and they resonate, that’s going to be a good fit for me. But it doesn’t have to be everyone.
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what I think about when you say that is I had intending when I was in residency that said that if every single echo you get has congenital heart disease, then you’re missing a lot of congenital heart disease. You should have negative echoes and normal hearts and you still got to echo and Same for strep.
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If every single patient that you test for strep has strep, then you’re missing a lot of strep because you should be getting some negatives or your criteria is too high. In the same way, if every meet and greet that you do joins your practice, then you’re missing a lot of patients that could benefit.
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And whatever you’re doing is amazing because there should be meet and greets that you walk out of there and you say, there’s no way they’re going to join. And that’s okay, because I got to practice and I got to share. And maybe it’s not for them, but maybe they know somebody that would really benefit from it,
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that has a different circumstance in life or values things differently, that it might be a really good fit for them. So I would look at a meet and greet that doesn’t join as an opportunity to practice and to reach others that might be you know, connected to that, that family that didn’t join.
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And so I think that’s a really important thing is to not be so set on every single meet and greet or interaction that you have being right for your practice. Because like you said, if, If they’re on the fence and you’re really trying to convince them and you’re
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putting all this effort to try and convince them and they’re of the money mindset that this really doesn’t make sense, then what’s going to happen is they’re going to be in the terms and conditions. Every single time they have a question and every single time that something is like
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a little bit of a boundary issue and they’re going to say, well, you said this and you said this and you said this when we joined. You said that we had unlimited access. Well, yeah, I said that you had unlimited access,
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but that didn’t mean at two in the morning I’m going to come over to your house and take care of your child. Like, Well, it doesn’t say that in the terms of conditions. Like those are the people that you don’t want in your practice anyways.
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You want people that say this is a really good fit for me and this makes total sense for me. And as you find those people, they’ll share with their friends. They’ll share with their coworkers. They’ll share with people that are like them that are good fits and value the same thing.
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And that will be what grows your practice.
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Yeah, absolutely.
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I think one thing too that you had said was there are certain different types of people. I feel like millennials and Gen Z, which are the ones that are having young kids, which I think is like the prime place for pediatric DPC is for those families with young kids that are infrequently, value their time a lot more.
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than previous generations and are willing to pay for convenience and i mean the pandemic illustrated that with uber and doordash and grubhub and all those different things i’ll pay double for my chicken sandwich if i don’t have to leave my house to go get it I don’t mind. Like I will exchange my money for my convenience.
14:04
And millennials and Gen Z are definitely of that mindset of if it’s more convenient for me, I’m willing to spend the money, which means that the future of DPC should look really bright as those people with those money mindsets continue to have and start families.
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Yeah, definitely. I agree with everything you said. My last thoughts would be to reiterate that it’s okay if you feel uncomfortable asking for money, even after having done this for three years, I still feel a little uncomfortable asking for money. And I don’t expect that to ever completely go away. And that’s okay.
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But I know that the more I practice, the more comfortable I get. And it’s just a matter of doing it right. And if you have that mentality, if you really are afraid starting out, just tell yourself, look, for every
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10 things that I do or 10 people that I talk to, I only expect one of them to join. If you start out with that mentality, it’s much easier from an emotional perspective to face rejection because rejection can be hard and it can feel like rejection when people say, oh, you don’t accept insurance. That’s crazy.
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Like, how can you call yourself a doctor and not accept insurance? People say all sorts of crazy things, right? If you go into it expecting it, then it’s much easier to swallow as opposed to going in and expecting that every person is going to love what you have to offer and say, here’s my credit card.
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So those are just some tips. Practice and set your expectations low just for your own mental health.
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Yeah, I think that makes a huge, huge difference. Everything you said there is just practicing and being okay with the discomfort that comes from that and figuring out how to speak in a way that makes you feel good and show off what a cool model that you’ve created and how it’s not for everybody.
15:51
It is just brilliant and makes it so much easier to have those conversations with low expectations.
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Yeah. Well, those are our tips for getting comfortable asking for money. Um, if you ever have more questions related to money that you would like us to do a podcast about, please reach out and thanks for listening.
