Link to podcast: 030 Enrollment Fees
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. Welcome, everyone. Today, Phil and I are going to chat about this question that comes up frequently in a lot of circles in DPC, and that is the question of should I charge an enrollment fee? Now, I will say that when I was first starting at my practice and deciding whether to charge an enrollment fee,
I definitely kind of fell back on a lot of my own experiences. So I’ve signed up for a gym membership or some other sort of membership. And there’s always this pesky enrollment fee. And to me, it never really made sense. And it was just kind of an annoyance.
And so I didn’t really love the concept of enrollment fees because it just felt like a way of squeezing more money out of someone. Now, having been in practice now for three plus years, I have a little bit of a different perspective on it. Because when we start seeing patients,
there’s a lot of investment that goes into the relationship up front, right? Sometimes I have to review old medical records and request them. Sometimes I have to just spend an hour and a half with the family that very first visit, getting to know them, getting to know their needs and then communicating follow-up plans and all that stuff.
And on a couple of occasions, I’ve had families who join and then they just continue. They get what they want out of me and then, and they have a great experience, but then two months later they leave. And so if I’m only charging a hundred dollars a month or 150 a month,
for that membership, and I poured four or five hours into that family, I’m losing money. Now I have a different perspective because that enrollment fee is a little bit of a protection, a little bit of a buffer to help protect against that circumstance.
Now, I won’t say that that’s a common circumstance to have, but the enrollment fee helps. And I don’t think gyms go through the same thing, right? When I sign up for a gym, nobody is spending like two hours getting to know me. They’re just like, okay, here’s your card. You can access the gym.
So I’m curious, Phil, what’s your perspective now that you’ve been in practice for a while?
Well, I was going to ask you, what do you charge for your enrollment fee?
Yeah, I don’t charge too much. I charge $100 and I think it’s per family. So I try to keep it really reasonable, but it’s just kind of like an extra amount that makes the family really think, am I ready to commit? If that makes sense.
For sure. And I think that one of the things that it does too is it reminds them of, okay, this is different than a typical practice. Like we are paying for membership. Because otherwise they might schedule their first appointment and they come in and you do all this work and they’re like, wait, this is every month?
Like I thought this was just a one-time bill. Because despite the fact that you tell them over and over and over again how it works and they’ve read the website and Did you read the website? Yes, I read the website. Did you read the part about the membership? Yes, I read the part about the membership.
Like sometimes it still doesn’t click. And more than you would expect, it doesn’t click. And so having that as kind of a, okay, wait, I have to pay this, just makes it more clear to people that this is how the practice works. And so I think from that perspective, it does really help
What we’ve done, it’s a hundred bucks per family for the enrollment fee. One of the things that we’ll do is waive it for some people. And sometimes that’s an incentive enough. If we’ve met with them and they understand, then we’ll say, we’ll just waive the enrollment fee and then you can just join.
We do that a lot for babies. Like they come in for their meet and greet. They’ve made the decision. We want them to enroll. They say, yeah, we’ll enroll. And we’ll say, perfect. Just use this code so that you can skip your enrollment fee, especially because they’re a baby. Like there’s, they’re not even born yet.
There’s nothing special to do with them to prepare for their, for their arrival per se, leave that enrollment fee. But I think it is a useful strategy for the reasons that you said, and to kind of protect yourself from putting a lot of effort in and then having somebody turn and cancel straight away.
Yeah, definitely. Now it’s also something that you get to decide for yourself, right? Just like everything we say is your practice. You get to decide You can make it a $200 enrollment fee. You can make it a $100 per child enrollment fee if they’re like enrolling them at different times.
So I have families where they’ll just kind of enroll their complicated child right first. And then maybe later they’ll enroll others. And so that’s kind of subjective for me. It’s like if it’s been a year, maybe I’ll charge enrollment fee. But most of the time I know the family, I kind of know the needs.
I can kind of gauge how much time the other children are going to take. based on, based on the family’s overall needs. But I think it’s just, it’s a little bit of a buffer and a little bit of a way of ensuring that families are really committed and know what they’re getting, getting into before they’re, they join.
Like you, I get a lot of families that are like, did you read the website? Did you really read the website? And it’s just like, I think people just skim. Yeah.
You’re a human. You read the website.
Yeah. Yeah. I learned early on, I have to be really clear about that because I had a family who reached out to me and they said, oh, I found you on social media and I checked your website and I really like everything that you say and what you’re about.
And we scheduled their two-year-old for a physical and they show up and- they’re signing the agreement and they’re like, wait a minute, we didn’t know. And I felt terrible having to turn them away because they just hadn’t. And so now I have to really crystal clear, like, okay,
it’s going to be this much before I schedule that appointment.
We actually did. We actually, on our enrollment page, we have, like, we use Hint for our enrollments, but we put a page before that where it confirms with them that they understand what they’re signing up for. And yes, I get it. And they have to click a checkbox that says, yes,
I get it before they actually go to the registration page, just to avoid that exact thing where people sign up. They think they’re just putting their credit card on file or something like that. They don’t realize despite the numerous times that it’s on the website and that you’ve said it.
I do think an enrollment fee is helpful to just bring that topic home. Some don’t charge an enrollment fee. And I think that especially if you’re just starting out and you want to minimize friction, don’t charge an enrollment fee. If you want to test and see how that works and see how many times that you have
this challenge to deal with versus how many people get it and they’re happy that there’s an enrollment fee and they just pay their monthly fee. then that’s a nice thing too. Like you said, you get to decide and you can also test and then you can change your mind too. If you say this isn’t really well,
we’re getting lots of false starts with the signups and those sorts of things. Or you could say, well, no, it’s working really well and it’s helping families to get in the door. There’s not an enrollment fee. We just use it. We just start their monthly fees right away. Great.
Like you can do it either way that you like and you can always adjust as you go. And sometimes you might say next month we’re starting an enrollment fee. So if you’re on the fence and you want to get it now and save your a hundred dollars so you can go out on a date night,
get a babysitter, sign up now. Don’t wait. You can use it as kind of matter to, to push people to actually jump off the fence and sign up.
Yeah. I think it also depends on the community that you’re in. Right. Especially the family medicine, DPC doc world. I think there are more people that argue against it because maybe they’re in like semi-rural communities or rural communities where people really are they’re not the average wages or the average income in the area is not very high.
And so an enrollment fee can be perceived as just an extra barrier to getting medical care. So, and that’s a completely valid argument, right? So you have to kind of figure out what area you’re in, like in order to figure out your pricing, in order to figure out what kind of pricing model,
including enrollment fees and tiered pricing is going to work for your community. We had a pediatrician at the Mastermind a few weeks ago that mentioned that she’s in a part of Appalachia where the average income is much lower than many cities. And so she had to lower her prices in general in order to attract patients and make
her practice successful. So there is price sensitivity that is different in every community. And please don’t just charge an enrollment fee because Phil or I are doing it or because somebody else is doing it. Test your market and it’s okay to change your policy and see what works for you.
Yeah. And I think that’s the beauty of Pediatric UTC. If you’ve listened to enough of these episodes, you get to choose. And so you get to make the choice and then you get to decide if you’re going to stick with that choice, if it’s working for you,
if there’s something that you’ve figured out that doesn’t quite work so well, then you just adjust and keep going.
Yeah. One other quick thought is also, if you don’t want to have an enrollment fee, you could also play with the idea of having a minimum membership commitment. So lots of families will ask me, do you have a minimum commitment? And I don’t. But I do say, hey,
but I also appreciate it if you stay around at least six months because there’s a lot of investment that goes into your family in the beginning. And most people just kind of agree to that without a contractual obligation. But you can play around with that. You can say, yes,
I want to have a minimum six-month commitment or three-month commitment or whatever you want to do, right, as an alternative to an enrollment fee. And that can give you some of that protection. Yeah.
Yeah, that does help with the protection too. And then you just make sure if you do that, that you spell out in your agreement, like what that looks like if they decide to leave two months or six months commitment or something like that. We also don’t have like a minimum fee or a minimum enrollment period,
which a lot of people, more surprising than I was expecting, ask about like, what’s the minimum commitment? I think because everyone’s been burned. by the gym membership that they signed up yes motivation and then they decided oh this isn’t for me i want to cancel and it’s like no you still have 18 months locked
in here you can pay that’s happened to us too and so people are really hesitant to sign on for commitments so i think you pick one of those two if you’re going to pick something you pick the enrollment fee or you pick the minimum monthly membership duration and then move forward with that
So yeah, test your market, find out what works for you and what you feel good about, right? If you just really don’t feel good about charging enrollment fees, don’t. If you want to kind of protect yourself and you’re okay with it, do. Yeah, excellent. Well, thanks everyone for listening. Until next time.
