In this episode of “DPC Pediatrician,” Dr. Phil Boucher and Dr. Marina Capella discuss a unique aspect of pricing in pediatric Direct Primary Care (DPC): the family maximum charge. This episode dives into whether implementing a family maximum fee makes sense for your practice. They share their experiences with large families in their practices and explore the advantages and potential challenges of setting a cap on how much a family pays, no matter how many children they have. If you’re wondering whether a family maximum is right for your DPC practice, this conversation is a must-listen!
Link to Podcast: The Family Maximum Charge in Pediatric Direct Primary Care: Is It Worth It?
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr. Marina Capella, two DPC pediatricians who are on a mission to share our love of direct primary care with you. Hey, everyone. Welcome to another episode of DPC Pediatricians. Today, we are talking about a very niche specific topic in the realm of pediatric DPC,
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which is the family maximum charge. Now, I specifically didn’t want to know what Marina’s stance was on this when we were starting. I said, let’s just talk through it as if we don’t know each other’s positions because I don’t know her position. I don’t want to know that she knows mine. But when it comes to families,
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typically in pediatrics, spend is a little bit higher than in family practice when it comes to the cost. I mean, we’re doing vaccines. There’s lots more visits. There’s lots more illnesses, especially in the first years of life. In my practice, we have a tiered pricing model where the first year is the most expensive and then it gradually
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tears down as they get closer and closer to school age because we know that the, you know, a six week old has a lot more health care needs than a six year old and we’ll see them a lot more on a regular basis. But then as you start having these growing families,
1:10
it can quickly get really expensive from the family perspective. If you have a three-year-old and a one-year-old and a five-year-old in the mix, you quickly find, okay, this is actually becoming quite expensive for families. And so what we’ve done in our practice is we’ve set and maintained a family maximum of $300 per
1:32
We’ve adjusted our prices upwards over time, over our three years in pediatric TPC, but we’ve never moved the family maximum. And I don’t know if we ever will. I personally think that those big families are great to have around. One, I mean, I have a big family. We have six kids ourselves.
1:51
But they they’re usually not the high utilizers because they have multiple kids. They’ve got, you know, three, four, five, six, seven, eight kids. They are busy and they’ve gone through all of the running noses and coughs and rashes and things like that. Their bar for reaching out is usually a lot higher. And so.
2:11
If I could have a practice full of families with seven or eight kids, I don’t think the phone would ring very often, to be honest with you. And so I want to attract them to my practice, which is specifically why we set that cap. Because if it’s eight kids and you’re talking $100 per kid,
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there’s very few people that are going to be able to pay $800 a month for their pediatric care or $500 a month for their pediatric care or something along those lines. And so I want to incentivize them to sign up knowing that And occasionally if they all get strep throat, it’s going to be a busier month,
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but actually it’s going to be a rather easy month because at least for me, if they have strep throat and one of them has strep throat and there’s five kids and they all have fevers and sore throats, then they’re all probably going to have strep throat is not going to be all that much work.
2:55
So that’s kind of my take on it. Like bigger families, more than welcome. They’re going to have much less utilization. They’re going to happily know that we’ll be able to take care of them when they need us. We’ll do the triple visits to make their lives easier for sick visits and for checkups.
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And they’re relatively harmless when it comes to the needs that they have. I don’t know what your take on it is.
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Uh, well, I guess I don’t have to say anything cause I pretty much agree.
3:22
You probably do have a lot of big families too.
3:25
We have a fair number of large families. I think you have to be careful when it comes to like, so for me being integrative pediatrics, I offer a little bit more than the standard pediatric care. So I offer some extras like myofascial release therapy and, and, and some hypnosis and some other stuff. So the, the only one,
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you know, time I have to be careful as if a family is specifically interested in utilizing those services. And then I have to sort of have in my contract that there’s a cap under the normal membership fee of a certain number of hours per year of membership. So that kind of helps to protect me.
4:04
But also even with that said, A family of eight, like they barely have time. Those parents barely have time to go to the bathroom. Let’s be honest. They have multiple kids in sports. They’re like ferrying them back and forth to those things, those activities.
4:19
They just have so much on their plate that they really have difficulty getting to the clinic. Right. And they’re only really going to do it if they really, really need it. So I think it is a pretty safe bet. It’s pretty safe to have a family maximum. Of course, play it by ear. If there’s a unique situation,
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multiple children with complex medical needs, maybe you need to come up with a custom price. But I would say by and large, it’s pretty safe to have a reasonable family max so that the family isn’t completely deterred from ever using their services or joining because it would be way too expensive.
4:57
I think a lot of larger families are also a little bit more careful with how they’re spending their money because, of course, having a lot of kids is really expensive. And so you have to make it at least reasonable or doable for them. I have a family, I think the biggest family,
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I don’t have a lot of big families, but biggest one has like five kids and the mom, like literally we have difficulty scheduling appointments when she needs them because she says, well, she has volleyball this day and this day and this other day I have something else.
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And it’s really hard just to find a time that works around her kids’ schedules. So I have to be a little more flexible with those families, but I’m able to do so. And usually we’re able to come up with something that works.
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I mean, I think one thing in pediatrics is usually the natural history of whatever we’re going through. A lot of it will work out on its own. I mean, I think the more that we practice, the more we’re like, let’s just give it some time.
5:48
And with these big families, by the time they get around to, did you text them? Did you call them? Did you set up an appointment? Like a lot of those things have already, the natural history has already played out and they’re not sick anymore and they didn’t actually need anything to begin with.
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So I think that that helps too. But yes, if they have a lot of complex special needs, if they have a lot of specific conditions, if you’re doing some very specific things, then sometimes you have to get a little bit more specific.
6:14
Or you look at it through the big picture of I have super underutilizers, I have super overutilizers. And it will all even out at the end of the day when it comes to how much any one family is costing me in terms of my time and expertise. But somewhere in there is the right amount.
6:33
But I do think that, like you said, cost-conscious families, which most families are cost-conscious, especially as they have more and more kids, they’re going to look at those numbers and say, well, we don’t even use them that much. How are we paying $500 a month for pediatric care when we hardly ever need to go in,
6:49
especially because once they get their set of kids, their cohort of six, five, four, six, eight kids, they’re going to have older kids as well that are not going to be high utilizers too. So I think there is a sweet spot where if the price is too high, you’re just not going to have any of those families.
7:05
Yeah, exactly. And I would say exactly what you said earlier. Once a family is on their like third, fourth, fifth kid, like they don’t sweat the small stuff. They’re like, oh, we’ve seen that before. That’s nothing. It’ll pass on its own. We don’t have to worry about it.
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So I would say usually those are the lower utilization families like you said.
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So I think the bottom line here is consider, strongly consider a family max so that you can attract those big underutilizing families. And then the nice thing is too, is your mileage may vary. You might find that you attract really high utilizer families that you love, or you might say,
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this is a little bit too much for me and I need to set my prices to adjust to what the market will be.
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All right. Thank you for listening until next time.
