In this conversation, two DPC pediatricians, Dr. Phil Boucher and Dr. Marina Capella, discuss the benefits and challenges of offering one-time visits alongside membership-based services.
Link to podcast: Should I Take One-Time Visits in my DPC Practice?
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr.
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Marina Capella,
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two DPC pediatricians who are on a mission to share our love of direct primary care
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with you. Welcome everyone to another episode of DPC Pediatricians. Today, Phil and I are going to have a conversation about one-time visits. Now we’ve seen this topic come up many times over the last couple of years in the Pediatricians Who Do DPC Facebook group.
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It’s a little bit of a debate as to whether you should or you should not. offer one-time visits. And by one-time visits, we mean that instead of a family being required to enroll in a membership in order to see you, you have a separate option where a family who just wants to try it out or wants to
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see you for an urgent thing or wants to see you for just a consult and get a second opinion is they have the opportunity to pay a flat fee in order to do that. So I’m curious, Phil, when you were starting out, especially how did you decide whether to offer one-time visits or not?
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When I was starting out, I decided, okay, this is a different enough concept that I don’t know that everybody’s going to just jump off the fence and they’re maybe just want to take things for a test drive. And I want to encourage that because I want to grow my practice.
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And what that looks like is meeting people where they are, which maybe they just are sick and need in to get their kids’ ears checked or Or they just want a second opinion about their kid’s growth or ADHD or something along those lines before they decide to commit. Which, frankly, if it were me,
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I would probably want to kind of like see if it really works and fits before jumping in. And so that made it clear to me that I should offer one-time visits. What we do is provide great care and check in the next day. And then what typically happens is they’ll have another episode where they need to
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get in for their ears checked. And they had such a great time last time that they’re like, yeah, can we come back? And we’re like, Yeah. But did you know that like we have a membership fee where you can get this on the regular basis and then you don’t have to come in for all the silly stuff.
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You can just text us when you have questions or concerns and that converts them into members or the third time that they’ve done it, they can never get through with the regular office. They know they can go on our website and book a one-time visit and they’re doing the math and they’re saying, well,
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I know their membership fees are this. I should just join instead of continuing to do this. And frankly, we’ve had a lot of patients that have signed up that way. And it’s really good to grow our practices through one-time visits. So it’s something that we started on day one with and we continue to this day
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because it keeps bringing in new patients. And also it just brings in more revenue. Like it’s nice. I think in the family practice realm, they have a lot of complex patients and I do not fault them for not wanting to deal with all of the polypharmacy and things like that when it comes to their patients
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and just having somebody walk off the street that could be having a heart attack. Like I think that pediatrics lends itself to, okay, this is not super complex or if they are super complex, we can figure out what’s going on with them right now and then work through their congenital heart disease, tracheostomy.
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Like those are much more for few and far between than in the adult world. And so for most pediatrician visits, like we can figure those things out on the fly or get the corresponding information that we need. And it’s not such a big deal. Whereas in the adult world, you don’t know who’s coming in.
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And they might need to go to the ER or be having a pulmonary embolism or all the adult things that I think you must walk in all the time that you don’t want to have to deal with. And so I can understand why family practice don’t want to do that.
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But I do think it’s a really good model for growing your practice, especially in the early stages to do some sort of one-time visits.
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Yeah. Now you alluded to the fact that, you know, sometimes families will do the math in their head and say, oh, you know, why am I paying these like one time visit fees? It might be better to do the membership. So how do you determine ideal pricing or how did you determine ideal pricing for
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those one time visits versus your membership? Because some people make the point that you shouldn’t compete with yourself.
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Right. I. think that the vast majority of parents have an upper limit of what they’re gonna spend to get their kids ears checked. And there’s urgent cares all over. And so I feel like I’m competing more with urgent care or the regular doctor than with myself. Now, if they keep doing it, then we’ll say,
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we don’t really do this kind of like all the sick visits. It’s just not our model. And so we will say like, okay, you’re using us like your primary care. You should probably either become members from a cost standpoint or go back
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to your primary care but by and large i don’t find that the math works to their benefit to just keep coming in for one-time visits so essentially like numbers wise if you’re talking about a seven-month-old that needs to have their ears checked a one-time visit is 147 a monthly membership fee for a seven-month-old in our
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practice is 175 Sometimes they’ll do a one-time visit and then they’ll have a bunch of other questions. And then we talk them into like, hey, did you know that if you have questions about your baby’s sleep or foods or those sorts of things, like our membership fee covers a sick visit every month and you get unlimited
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access to us for all your questions and concerns. And that’s enough to do that. It’s not more, like it would make more sense if somebody said, I just want to get their ears checked every so often. I don’t wanna come in for checkups and those sorts of things.
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So I’m gonna use you guys for the cheaper one-time visits. That would work, but it wouldn’t fit with our model. And I think they would find themselves wanting for more, or we would find ourselves saying this isn’t really working the way that we were hoping. And then we just talk that through with them.
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So I don’t think that I’m competing with myself by offering a lower price for infants per se. And I think it all probably comes out in the wash at the end of the day. What about you? What is your, do you do one-time visits and what does that look like for you?
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Yeah, I definitely offer one-time visits. And it was definitely kind of like you in the beginning. I thought, hey, I need to get people through the door. This is a new model and the first pediatric DPC in Salt Lake County and Utah County. So I need to do this.
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There were a few family medicine physicians, but PEDS was new. So I definitely thought anything that can get them through the door to get to know me, to get to know, wow, this is a different level of service. This is not like my typical pediatrician’s office. I was in favor of that.
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And I definitely still have a pretty good volume of people who opt for the one-time visit. I call it on my website, try it out visits. That way it’s kind of like, okay, I mean, I personally, maybe I’m projecting my own tendencies onto my community, but I tend to be hesitant when,
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whether it’s a gym membership or financial services membership is asking me to just commit all in from the beginning before I actually know what I’m committing to. And so technically I have it in my contract that it’s up to two try it out visits, but until I’m completely full, I have not enforced that rule.
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And I tell families that I say, you can keep using this, but if I ever get full, then I reserve the right to only see people who are members, right? And they’re they’re fine with that. I do charge a higher rate, though. So my one time visits because I’m integrative and I tend to attract more complex
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patients that are like, my kid has a lifetime of eczema and allergies and FODMAPs diet needs and all these things. Right. They are one hour. And so I charge three hundred dollars. And sometimes I feel like I should go up higher, honestly, because they come with so much stuff.
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And then usually I have to draw labs and I have to email the parent afterwards about labs and all those things. But that I try to price it so that it’s not competing with my membership. So it’s a little more painful, just like you said,
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why would I keep paying this higher fee when I can join a membership and overall pay less? And I have had some conversions, some families that after two or three visits say, hey, I finally am ready to come over and commit. There was one family that took two years.
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I saw them for a one-time visit in the very beginning, like my first few months of opening. And then two years later, they came back and said, hey, we want to join. For some people, it takes a long time to really process that. And for some of them, it’s never going to be right.
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I have some families that say, you know, my kid really is super healthy. We manage a lot of stuff at home. We have our own cadre of treatments that we use and we’re comfortable with and that work 99% of the time. So we really just want a physical once a year to feel like, you know,
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our kid is getting some sort of check in and check up and making sure we’re not missing anything. And for those, I feel like the one-time visit is perfect. I have not gotten rid of it yet three years into practice. If I’m ever completely full and saturated and can’t add another physician or something like that,
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I might get rid of it. But I like it as an introduction to my practice.
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Yeah, I think it’s a lot of what works best for any individual, like what they’re hoping for. If you’re trying to grow faster, if you want to bring in more revenue, then it probably makes sense to offer some version of one-time visits for some. If you’re cool with, I just want people to understand the model,
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and I don’t care how long it takes to get there, and I want to just cultivate my specific people, then it probably doesn’t make sense to do one-time visits because then you’re going to get distracted by those and have those play a role in your overall ability to serve your patients.
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And so I think a lot of it comes down to your growth speed that you want to achieve and the types of patients that you’re trying to attract. I should caveat ours is that we, like the 147 is for the sick visits. Like my kid might have an ear infection or they’re coughing or they’re having
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painful urination or something along those lines. We have other one-time visits that we do for different things that are different rates as well that we don’t require a membership for. I mean, ear piercing is a big one. We love ear piercing and it’s a big part of our practice is piercing ears.
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It’s fun.
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We don’t require them to be members to get their ears pierced, and we don’t include it for members because it’s something that is just an aesthetic thing that is a special thing that some people want, some people don’t want. So that’s a one-time visit. We do ADHD evaluation as a one-time visit to get them started,
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and then we convert them into a mental health membership or a regular membership. If they want that, if we decide that that’s the right route, but a lot of people just kind of want an extra set of ears and brain to go through, does my child have ADHD? What should we do about it? And I think we,
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like you, are able to take a more holistic approach than just like, yep, their Vanderbilts are positive. Here’s your focal end sort of thing. And I think families really relate to that and like that. We do autism evaluations that are a one-time visit.
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Those are some of the big like one-time visit things outside of just the typical cough, cold, ear infection sort of one-time visit stuff.
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Yeah.
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One other thing that we do is flu vaccines and vaccines in general. I would call it a community service because we don’t charge for them, but if people want to come and do a family flu shot, we do that for anyone as well. And there’s no fee. I mean, we get the reimbursement from VaxCare for those,
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but that actually has been a really good way to get our name out in the community. People love, especially the people that like are interested in direct primary care. They like the fact that you can get your whole family’s flu vaccines done at once. And so they come in, they get those done.
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We actually have a fair number that convert just from their experience of having their kids flu shots done. They’re like, oh, this office is nice. It was so quick to get in and out. Like there was no one in the waiting room. What the heck?
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This is the opposite of my previous experience where we waited, waited, waited to get the shots. It was a nightmare. And then dad had to go to CVS and mom had to go to Walmart to get their flu vaccines. Like it was just the easy button.
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And so there’s lots of opportunities like that where you’re outside of the membership, but you are providing value and showing how you do things differently.
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Absolutely. Yeah. I will say that there are some DPC pediatricians for whom one-time visits might not be a good idea. So if you have a really small micro practice and you do home visits, for example, I think that’s harder because you’re committing the time to travel to the patient’s home and do the visit and come back.
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So if you are going to do it, you would have to price it significantly higher to make it worth your time. And then it’s just less predictable when you have a home visit based practice. You really have to time your schedule around your travel and making sure you have
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the supplies you need and doing those visits at different homes throughout your city. And so with that, it becomes more complicated. And I don’t fault pediatricians who don’t want to offer one time visits with that model. That makes sense. So it really is up to you.
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I think Phil and I are two examples of people for whom it’s worked well and we like it. But that’s not to say that you have to do it. I think it’s just we’ve presented some of the reasons why you would want to consider it.
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But it really depends on the exact type of practice that you are creating and your vision for your practice. And also it depends on how successful you are from the start. Sometimes we have to do things just to get our business going and off the ground. And so maybe you don’t want to do it,
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but it’s a good thing to offer it in the beginning until you get full and you’re making money. And then you can say, okay, I’ve had enough of that. Now I want to focus on my committed families.
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Yep. I think that’s the perfect approach. And I don’t know if we’ll always offer it. I like offering it now. We’ll see how the years unfold. If it’s something that it doesn’t make sense for us anymore, then we can just push people to the membership and we’ll attract those that want the membership and don’t.
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Right now it’s working for us in terms of our schedule and availability to do it, but that doesn’t mean it has to be a forever decision. And I think that’s been the theme of this whole conversation. podcast journey that we’ve been on is like nothing that you decide has to be the way that everyone else does it.
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And also nothing that you decide has to be set in stone for the forever. Like you can change things. And I think that’s one of the real beauties of direct primary care is like what’s working now is working, but it doesn’t mean that that’s going to be what you’re going to be doing in three years from now.
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You could be doing something radically different. Whereas our colleagues that are in hospital owned fee for service practices know that in three years they’re going to be doing essentially the same thing, if not faster and harder and less fun. So I think that’s one of the really cool things about pediatric DPC is you get to
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have different things and things get to change and you get to pivot as you like.
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A hundred percent. That’s one of the things I love about it. All right. Well, thanks for listening, everyone. And remember you get to decide for yourself whether to offer one-time visits or not.
