Listen to the Podcast Here: What Equipment do I need to start?
Summary: In this episode of DPC Pediatricians, Dr. Phil Boucher and Dr. Marina Capella dive into a fundamental question for anyone starting a Direct Primary Care (DPC) pediatric practice: What equipment do you really need at the beginning?
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 to another episode of the DPC pediatricians podcast. Recently, we got a great question from one of our listeners who said, Hey, I’ve been listening to all of your episodes. Thank you so much, by the way, for doing that. We’re glad you’re listening. And they said,
I’d really like to hear an episode on the topic of what equipment do I need when I’m just starting out? And that’s a really common question. So I’m glad you brought that one up. And we’re going to chat a little bit about that today. So Phil, start us out.
What’s kind of the first category of things that you need when you’re starting out?
Right. I don’t mean to throw us under the bus, but I think that as we go through this and talk through these things, a really good resource for you to use as a, okay, what else do I need? What am I not thinking of? Is, well, one, the DPC Facebook group, the pediatricians who do DPC.
Two is the… pediatrician startup guide at dpcpediatrician.com three is our upcoming virtual summit. So if you haven’t registered for that yet, you should definitely register for that because not only are we talking with people that are growing their practice and training practice or have already started, but or are DPC curious, we have talks specifically on that.
So go to nutrition.com summit to register for that. And then lastly, I don’t know if you’ve heard of this, but ChatGPT is a lovely resource to answer all of these questions. So as we talk through this, think about the different resources that you have so that you don’t have to reinvent the wheel and start from scratch.
ChatGPT didn’t exist when I was starting. And so we had to think through those things. And I think for me, one of the things that I did was I overbought, and I know that you didn’t too, Marina, was that like you think about what it’s like to be a pediatrician in a fee-for-service practice.
And you think you have to replicate that in your direct primary care practice, meaning you have to have every single touch point and piece of equipment and thing, when in reality, you probably need a lot less than you realize.
And so when I kind of think through what is the bare minimum setup where I can open the doors? Well, obviously in pediatrics, a lot of it is your thoughts and your brain. And that sounds so dumb, but that is true. Like a lot of when we’re seeing patients, is not complicated diagnostic tools or expensive equipment.
It’s our stethoscope and mostly what’s between our stethoscope ears that really is going to do a lot of the work when it comes to being a pediatrician and the way that we practice and the things that we do. So you need those clinical essentials like the stethoscope, the otoscope, a scale, blood pressure cuffs,
those very basics of like, how can I take vitals and how can I see a patient? And then the exam room, which a lot of people start with a in-home visits or virtual forward practice. And so we don’t need to have a super fancy exam room with tons of bells and whistles. When I first opened,
my very first patients were, I saw them the very first day that I was open and our furniture hadn’t even come in yet. Like it got delayed in transit because we opened in the winter and there was delays. And so I saw them in a completely empty exam room and the grandma brought the baby
in in the stroller and just held the baby. And then I held the baby up and I looked in their ears. Like you can get by with a lot less than you think when it comes to starting your practice. So I think of like the clinical essentials, the physical essentials that you need,
and then the like tech and administrative essentials. So if we’re kind of talking exam room and the the clinical essentials those are the things that i think of first and foremost marina share some more of your like basic supplies that you’re going onto a website and clicking and adding to cart and ordering so that you have
yeah when you first open
I mean, like you said, the most essential stuff is like if you think of just a really basic exam room, right? What do you need in that exam room to do your job, to carry out the patient visit, to check vitals, right? So I didn’t have anything to check pulse oximetry in babies.
And so I was able to find for a few hundred dollars through Henry Shine, a pretty good device to do pulse oximetry that had an attachment for pediatrics. And also for adults, I will say that they’re really nice ones like Massimo makes really expensive, really nice ones.
But I did not have the budget to like go all the way out. Right. Eventually, might I? Yeah, sure. But in the beginning, just go with something that’s more cost effective that will do the job. There’s also one on Amazon that I’ve bought multiple versions of like home visits and stuff. And it has a pediatric heel attachment.
It’s about one hundred dollars. So you can find options that work pretty darn well. out there. So the stuff you need in your exam room, you have to have a way to measure height and you have to have a scale, right? Including a baby scale and a children adult scale.
You have to have the otoscope, the ophthalmoscope, the stethoscope, right? I actually had mine still. How in med school, they pressure you to like buy your like spigmo manometer and your otoscope. I still have those.
You got the direct op or the indirect ophthalmoscope, like $500.
Exactly. The ones that you hardly even used in med school, right? They were just like sitting in a bag in my closet. So I just was able to use those when I was first, first starting out. And then after a while I bought more because I had more than one exam room. So, yeah, think the basics.
Like, what do you need? You need a basic table. You don’t have to get one of those really fancy exam tables that cost $10,000. There are some that cost like $500 online that you can assemble kind of IKEA style, right? And for kids and for teens, they’re going to do the job just fine.
I’d say another category that I thought a lot about was like furnishings because I was leasing a new space and I had to make my space look welcoming to both kids and teens and parents, right? Phil, I think you moved into a beautiful space. How did you think about furnishing your office.
So I was like you and we put the furniture together ourselves. Like when we first opened the furniture arrived and my kids and I were with the Allen wrenches, like screwing all the little things in to assemble all of the furniture and we didn’t go big.
And when we moved into our new space, we just brought that furniture with us as well. Yeah. I will say that my own actual office, not my exam rooms, my office itself is very sparsely decorated, mostly because I don’t like spending money on those sorts of things. So I have a nice big room with nothing over there.
And my staff is like, why don’t you get a table or something? And I just have never taken the time to actually do that. But I think that you can certainly make do and realize, okay, I’m not seeing 30 patients a day. I can get by with a lot less.
I can figure it out when it comes to pulse oximeters. Like, I mean, at a children’s hospital run clinic, every baby that comes in that has a cough gets a pulse ox. Do you really need that? If this baby just has a little bit of sniffles,
are you going to be really checking a pulse ox on every single kid with a runny nose and a cough? No. No. You’re gonna do what you need to do. And so that means that you don’t have to have the fanciest version of everything in order to provide exceedingly good care for kids and to provide safe evidence-based
care, all those sorts of things. So I always try and say like, what is the minimum that we need? And what can we do in a pinch if we’re not sure, rather than feeling like you have to have every contingency planned. A specific example that happened a few months into my practice, mom texts,
kid just rubbed his eye. It’s all red. I think he scratched his cornea. Okay. Come on over. We can help. Well, crap, I actually don’t have a black light. I have fluorescein because I remembered to order that, but I don’t have a black light. Well, between when I said, come on over and when the patient arrived,
ran to the hardware store and bought a black light. Like you don’t have to have everything that you planned for. What’s the worst thing that could happen? Well, I don’t have one, but I’ll run to the hardware store and then I’ll meet you back at the office. Exact same, same sort of thing with a hair tourniquet.
I had to stop at the store and get some Nair for a hair tourniquet before having them come over. You have the time. to pivot and figure it out on the fly rather than having to have every single thing already in stock before day one.
Definitely. Yeah. I came from, well, I had done a couple of years in general pediatrics world and we had all the circumcision supplies and all the good GenPed stuff. And then I had worked in pediatric urgent care for a few years and we had all the procedural bells and whistles.
So I think I really fell prey to the temptation to like, oh, I need like these sutures and those sutures and like let gel and like, and i mean honestly i didn’t use anything for like the first six months now it is rolling the dice a little bit right but what’s the worst case scenario if you have
to send one patient in your first year or six months to urgent care right and then in your second year then you have the money to then stock those supplies right it’s totally okay like i think we i made a bigger deal of it in my head
then i should have because i was like well what if and what are they going to think of my practice if i don’t have those things then it’s fine we overthink it way more
than the parents do so well and i think we exceed so many of their expectations but we feel like well we could have taken if i had had vicryl i could have done layered suture closure of their forehead laceration sure but nobody’s expecting you to do that and they might be best served in the er
for their layered closure unless you do a lot of them on a regular basis and so you probably don’t need a vicryl in four different sizes to open your practice yeah
moving on to like another category of stuff so so we’ve talked about kind of the basic exam room equipment you got to have also your furnishings to whatever level you want i would say be budget friendly in the beginning you can always add things to your wish list for
later but you don’t you can save money and stress for yourself in the beginning by doing just what’s necessary the other category would be like office office supplies so i needed to have like a printer and just some like yeah the wi-fi the router like that kind of stuff office chair like
i think i got a new laptop for myself because it was time for a new a new laptop so yeah some of that stuff think about like basic office equipment that you might need like i still have people fill out paper agreements when they come and so i needed
a stock of paper and things like that right and then another category would be lab stuff so lab stuff can really vary from like minimal supplies you’re talking you’re like strep tests and your urine dips to all the way to you have you draw blood in
your office and then you need to have like all of the stuff to be able to do phlebotomy and spin the tubes and send them off. So how did you start out in that department, Phil?
We started off and have mostly maintained just a very simple flow of the very basics when it comes to what can we diagnose in the office versus what do we need to send out? And so that looked like strep. I mean, strep’s number one, obviously.
Like that’s the number one point of care test that you’re going to be doing. So figuring something out like that with the rapid strep tests that are super cheap that you can buy with your Amazon business or through McKesson or Henry Schein or wherever.
like that and having those and then flu tests same sort of thing if you if you like to do flu and urines i mean those are the three big ones that you’re going to do on the regular in your office so having some plan in place for what you’re going to do
for those outside of that i think you can just get more sophisticated and more sophisticated over time maybe you have a id now machine or binax now or something like that those you do not need when you first start out, as long as you have a plan for four-year-old comes in with a sore throat and a fever.
I do a rapid strep. It’s positive. I do a rapid strep. It’s negative. And I want to do a backup culture. How am I going to do that? I’m going to send the backup culture to the lab, figure that out. But those are things that you can grow into over time from a test standpoint. And then, yeah,
I think as you work through, you’re going to, and sometimes what I’ll have people do is just kind of like, imagine that you have a patient coming in tomorrow. Well, you’re going to have to document their visits. You’re going to need an EMR. You’re going to have to prescribe a medication for them.
So you’re going to have to have your EMR set up with your pharmacy and those sorts of things. And then you’re going to have to see them in the office and you’re going to have to have an otoscope and you’re going to have to have all the different things like that.
Just work through what it looks like from start to finish. Do that for a few different patients and you’ll probably see and think through some of the different physical equipment that you need in order to see them and then go from there because the most important thing to do is to get your practice open and to be
accepting new patients and whatever you can do to get to that point as quickly as possible is going to be in your best interest and then from there we can add on and fill in the gaps and figure out what we need as we go and as we grow
Yeah, definitely. And actually, as you said that, I thought one thing I didn’t think about at first and then when I was seeing the patient, I thought about it was like the your PHQ-9, your like your anxiety screens, your postpartum depression screens, your lead.
Like I printed out a couple of those and then also like the ages and stages questionnaires. I printed those out and I just had them. in like a little cabinet in the office when I started with an easy access for those visits. So that’s something really cheap. You just got to print stuff out.
That’s something to think about to stock in your room as well. Now, when we start thinking about like lab stuff, if you are going to do any sending out of tests, you do need to establish a relationship with a lab company like LabCorp or Quest.
I highlight one of the questions that’s most common in the Facebook groups is like, wait a minute, I reached out to LabCorp and the price list they gave me is like way higher than what some of you doctors are quoting.
so in order to get the really good pricing on labs you have to go through a what is it called a group purchasing organization or something like that yeah exactly so peds pal is one that people use for vaccines i went through one called hps healthcare procurement solutions
And I get really, really good rates on my LabCorp labs. And so make sure you’re going through a GPO if you’re trying to get those labs. And then once I had a rep through LabCorp, they sent me a centrifuge. I didn’t have to buy a centrifuge. They give you access to an online system where you can order
like all of your needles and all of your tubes and all of the supplies, even you can order band-aids and alcohol swabs and things like that. So don’t waste money on that. I didn’t realize in the beginning. So I ordered like urine cups and things like that.
And I didn’t need to.
Yeah, exactly.
So we had the exact same thing. We, we ordered some and they brought us an entire trash bag full of urine cups. I was like, We’re not going to run that many urines before I retire, but thank you for this huge bag of urines.
Right, exactly. And yeah, so you can get a lot of that stuff through your lab of choice. Some other things to think about, like if you’re going to do in Utah, we have like a two-step newborn screen program. So the first one is done in the hospital or by the midwife.
And then the second one is done at two weeks. so i had to have like the lancets and things like that for the heel stick and the heel warmers and like co-band and stuff to wrap the foot basic wound care stuff as well thinking of co-band your band-aids and all that stuff and then also like i
thought it was really worth investing in a hemocube machine because it’s only about i don’t know it’s like In the range of $500 to $1,000, I can’t remember exactly, but it allows you to do that hemoglobin screening at nine months and then in other kids who are high risk.
And since that’s part of kind of like the well child care, I felt that that was worth it to have. But there are more expensive things like your lead care test kits and your photo optic vision screeners and your hearing screeners. Those are really big ticket items. Like lead care is $2,500.
The Welch Allen photo optic vision screener is like seven or $8,000. Our hearing screener was four or 5,000. So those were things that we bought later on. And I was sharing my office with another pediatrician. So we were able to kind of share that equipment between the two of us. How about you?
Did you splurge on any of those things or did you already have some of them?
Let me go back to the lab for a second, because I think one thing worth zooming in on when it comes to pediatrics and direct primary care is in adult family practice, like getting a discount on labs is a big deal for people and a big sticking point when it comes to, Oh,
you can get a CBC for $11 instead of going for 47 for the hospital. I always argue and think that in general, Parents aren’t expecting one to get labs very often. Like it’s not like we’re doing a chemistry every three months because we’re on semi-anti-hypertensive that we need to check our calcium level or something along those lines.
And so I wouldn’t let that be a hang up for you in starting your practice. If you haven’t negotiated a lower rate with the labs, parents are already expecting that if they need labs, they’re probably going to use their insurance and pay out of pocket for them if they have insurance. And so for us, that’s never,
we’ve never offered like a reduced price for labs or anything along those lines. We will draw the lab, whether it’s a urine or sometimes a blood or something along those lines and have a, the lab will send a courier to pick it up at no charge to us or to the patient.
They just want to do the lab tests and then they just bill the patient’s insurance. So we stay out of the whole lab ordering discounts game and never get any pushback or have never had patients say I was expecting to get a cheaper rate. Cause we don’t do that much lab in general.
And so I think that’s something where if you’re thinking to yourself, like, I don’t know how to do that. I don’t want to negotiate. Don’t feel like that has to be solved for you to open your practice. And you can always just send patients to a local lab.
If you don’t want to get into the phlebotomy and things along those lines, we sent, we will sometimes draw a house. There’s a children’s hospital satellite clinic that will draw for us. We just send an order. There’s three different local labs between LabCorp and what’s the other big ones, the other big labs that you think of.
And then there’s a local lab too. We have a ton of options in town for getting labs drawn and ordered and all those sorts of things. So I would encourage people that are wanting to start lean and keep it simple to consider just not offering all of that outside of the point of care stuff and just
being the resource of, I have an account with LabCorp, I’ll send the lab over. It’s down the street. Here’s a map of how to get there. They’ll send me the results and I’ll check back with you. And parents are happy and understand that.
Yeah, definitely.
I would say that.
I had the same thing. I remember the first time I wanted to try to do it. And so I tried drawing blood in two kids. Well, I had success in some kids that were older. But the first time I tried on a four-year-old, it was a disaster. And he was really fighting it.
So luckily, I had a lab court right across the street. And so for the first year before I hired my medical assistant, maybe a year and a half, i just sent people across the street because it was so easy and you just print kind
of the lab requisition form with what you want and you send them over there and it’s so easy you don’t have to package anything you don’t have to call the lab you don’t have to spin it because that you have to think about the amount of time that
that actually adds on to you if you have no assistant or no medical no ma that like it can take a long time and you’re not getting paid adequately for that extra time that you’re spending
And you’re a holder and it makes a huge mess and it can be traumatic and all those sorts of things too. So I think there’s plenty of good reasons to not do that unless you feel really comfortable and want to do that. My nurse practitioner loves drawing blood. She was a phlebotomist in a past life.
She’ll do it just for the fun of it. And I am not that way. I’m good from residency at doing arterial sticks. So I’m always like, can I just do a quick art stick? Like, that’s probably gonna hurt, but I’m better at that.
No, stay away from my child.
I know, I don’t actually do that, but I’m always like, there’s just this popping artery right here. I’ll just take a little out of that. And so, yeah, I think that that, okay. And then the other thing you asked about was some of the more expensive things like the vision screener,
the lead and all those sorts of things. I think, again, those are things that, especially with the hemoglobin and the lead, it’s nice to have that in-house. We have that in-house, but before we had it in-house, we just sent them to the lab or we drew it and sent it to the lab and they, they build them.
So before we had that in house now in Nebraska, we have a lead screening program where we basically just get these little cards that we put the drops on and then we send it to them, the, the lab. Um, and they do that there and we do a human, human house. We do have a photo vision screener.
You can often get good, cheaper versions of those. If you just ask around about what’s available, you can look on eBay. There’s lots of options for that and to minimize the cost of the vision screening. And sometimes if you want, you can work with a local optometrist to do vision screenings.
Like we have a local optometry office that will see kids at no charge as part of their program to get more people into their office. They’re a new office. They’ll see them at no charge. So that’s another opportunity for you to work with somebody in the community, get that covered without having to do it yourself.
And so I think there’s lots of opportunities like that too.
Yeah. When it comes to those expensive things, what I would advise based on my experience where I did not do this and I wasted too much money in the beginning is if there’s something that you really want, but you don’t absolutely need, don’t buy it and put it on your wish list and say, okay,
when I reach a certain financial goal, I will get that. Right. So create a wishlist with certain financial metrics that it’s like, okay, when I get to this point, then I can add this or with the black light example, or like the Nair example,
there are those little things you don’t have to worry about until you need them. Cause you can just run to the store and get them.
Yep.
I wish I had done that.
And the thing to think about too is like the vision screener. Well, I don’t have any patients coming in next week that are two or two and a half or three, whenever I want to do that. So I’m going to wait.
And if they get to two and a half and I’m like, I don’t have a vision screener. Well, I can still use my regular direct ophthalmoscope. And then I can say, by the time this patient is three, I’m going to have purchased a vision screener so I can do the full vision screen or something along those lines.
Like these things feel like an emergency. but they’re the least emergency thing ever, especially because we have other tools that we can use before we get that. And so I think that just hopefully taking a lot of the pressure off of how rapidly do I actually need this?
Absolutely. Yep. Well, hopefully that answered your question of what supplies do I need in the beginning. The pediatricians who do DPC Facebook group, I believe in their shared files, has a document that someone had put together with a basic supply list. The DPC Pediatrician Academy also has some supply lists and will probably be
putting that into a cheaper course that you can purchase. purchase as well to get access to that supply list. That way you can kind of look at all the possibilities and then figure out, okay, what do I need for my office at this time? All right.
So there are a few resources for you and thank you for the question. Thanks for listening until next time, everyone.
And don’t forget. to come to the Direct Pediatric Care Virtual Summit this September. You can register now at dpcpediatrician.com slash summit and come and learn everything from DPC curious to launching, to growing, to a mature practice, to a specialized specific area of interest,
we’ve got you covered and we’ll be talking through all of the steps that you need, connecting you with those people that can help you to get your practice started and to get growing. So register today at dpcpediatrician.com slash summit.
Okay. Now, thanks for listening until next time.
