Listen to the Podcast here: Guidance for Newbies
Summary: This podcast episode provides actionable, step-by-step advice for pediatricians who are considering launching their own direct primary care (DPC) practices, highlighting critical preparation strategies, pitfalls to avoid, and essential resources for a smooth transition.​
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 DPC Pediatricians. Phil and I today are excited to talk a little bit about just some advice for newbies. We recently had a wonderful direct pediatric care virtual summit, our first ever. We were so excited to help create it and to help curate the speakers. And we were delighted with the turnout.
A lot of you turned out and listened to our lineup of great speakers. We were amazed at how many people actually attended live. A lot of virtual conferences, people register and then sometimes they say, oh, I’ll just watch it later. And they don’t show up live.
We had, I think, what, 130 participants consistently on day one or more?
Every day over 100 for sure. Yep.
Yeah. So it was amazing. And it was, I think, just that community and being able to hear everyone interacting or watch everyone interacting on the chat and receive great questions. That was just such an awesome experience for us. And we’re glad that everyone that attended hopefully benefited from that.
So today we’re talking to those of you who maybe attended the summit or have discovered DPC through another means and are thinking, OK, I think this is for me. I’m ready to start. but what do I do? Like, where do I actually start, right? What are the first steps? So, Phil,
what would you say are some of those very first steps that someone should take if they’ve made the decision to go ahead and jump into the world of DPC?
I think it’s tricky because you have come to the conclusion that you’re going to do it. And then it’s like, I want to learn how to get into the pool without just like jumping in and burning all the bridges and those sorts of things. And so, I mean,
we’ve helped enough people just over our years in DPC to know kind of what the order of operations should be. And we were talking, we talked about this quite a bit because a lot of people are like, yeah, I want to do it. I have nowhere to start. Do I… Pick my name. Do I pick my hours?
What EMR? I’m like, whoa, whoa, whoa. Let’s slow things down just a little bit and let’s take things from a stepwise progression. I think the first thing that you need to do is envision what you want it to look like.
because if you don’t have a clear path of this is what in two years i want to be doing and what my schedule looks like and who i’m able to help and all of those sorts of things if at least you don’t have the big picture then it often just feels
like well i just want to jump in and then i’ll figure it all out and let myself be morphed into that i think if you can take and it’s hard because you want to jump in and you want to start like signing up for the things and getting your LLC started.
But I think if you do step back and say, two years from now, things are going swimmingly. What does that actually look like? And what’s my aim here? And if it’s just to get away from the corporate job, if it’s just to get away from seeing five patients per hour, that’s one thing, like those things will come.
But I think it really helps if you have at least a murky vision of what you’re hoping for.
Absolutely. I 100% agree. In fact, I was just looking at the startup guide, which you can find on dpcpediatrician.com. And those first steps, I wrote this over a year ago. First of all, learn about DPC, get inspiration from others. You’ve already done that if you attended the virtual summit, if you’re listening to this podcast,
if you’re exploring those DPC groups online. Second, if needed, save up for your GPC. So if you are in a financial position where you don’t have $20,000 for startup lying around, then you’re going to have to think about that financial runway. Like how are you going to get yourself to that position? Right.
And then the third and fourth are, first of all, develop a mindset for success. You have to start out believing that you can do this, believing that you can develop the skills and Grow your knowledge that you need in order to do this. Because if you start out already doubting yourself, of course,
all of us are going to have some doubts. But if you are severely doubting yourself, then you’re not really setting yourself up for success. And then the fourth one was really exactly what Phil just said. Refine your vision and build your brand. Because you can’t build a ladder or you can’t build a staircase to something if you
don’t know where that staircase is going. Right. So you have to really say, OK, do I want a home visit model of care? Do I want to focus on newborns and lactation? Do I want to focus on behavioral and mental health? Do I want to have a general DPC,
but somehow differentiate myself because of the concierge level of care that I provide? Right. Or my unique personality. Do I want to take an integrative functional or lifestyle medicine approach to care? Because that’s going to guide all of your decisions. It’s going to help you decide what you want to name your practice.
It’s going to help you decide where your location is going to be and how big of a location you need. It’s going to help you decide all of these other things that basically are down the list. But if you don’t have a clear vision of what you really want, it’s hard to make some of those decisions.
right i think that those are the big pictures and and it’s often good as you’re defining that to like get a good broad sense of what are the options available because when i went into it it was full spectrum primary care and i hadn’t
considered kind of any of those other avenues and i like and i’m glad that things turned out the way they did but i didn’t consider well what if i just did a home care or what if i did a virtual or what if i did adhd only or those sorts of things
And I think there’s a lot of different ways that you can distinguish yourself. And a lot of it comes down to who do I want to care for? How do I want to care for them? When and where do I want to care for them? conveniently and amazingly with DPC, very personalizable. Like I’m the primary breadwinner.
I want to do this as a side project gig. I want to homeschool my kids. I want to do this or that or the other things. There’s a lot of different ways that you can make it work for the context of your life and your values and your goals.
But if you just jump head first in without taking those things into consideration, it might turn out great, but it might turn out like, okay i didn’t really plan for and i have to kind of pivot now so getting those things lined up in the mindset and all that makes a huge difference and then i
think like actually okay i did the mindset work i’ve got the vision what’s the check boxes in numerical order because i love a good check box i think for me the one that i always when when people are like hey i want to start my dpc what do i do
i’m like well what does your contract say because a lot of physicians came from corporate, came from academia, came from a large private practice and they were, it was their first job and they were so excited that they put a contract out in front of them and they signed it and they filed it.
And that’s fine if you’re gonna stay there and be happy there to just have the contract on a shelf somewhere. But when you’re saying, okay, I’m going to make a pivot, I need to know what my contract says. And so I always try to tell people like very, very early on, get a copy of your contract.
Because if you don’t have one, which most people don’t because the digital age, it’s like, yeah, it’s somewhere, it’s online, it’s in a DocuSign email somewhere. You can say, hey, I’m updating my stuff for my will and our attorney needs copies of our contracts. Can you shoot me over a copy of my contract?
So that you have a copy of your contract before the red flags go up of, hey, he or she is leaving. Let’s see what the contract says. We can really stick it to them. You want to be in the driver’s seat of knowing what’s in your contract. So getting a copy of your signed contract is critical.
And you can work through either through yourself, just reading it, through chat gpt hey where am i where are my risks and exposures here or having an attorney look at it to say here’s what is going to happen when you put in your notice and here’s what’s going to happen on your last day and here’s what’s going
to happen like knowing those things gives you the peace of mind and also the map of what it’s going to look like when you leave. If you can take your patients with you, if you can take your nurse or your staff with you, if you can tell your patients where you’re going, if there’s a non-compete clause,
if there’s a radius or a time limit that you can’t practice within a certain boundary, like all those things are in your contract, whether or not, or you never thought you would leave and now you’re leaving. Figuring out all of those different things, then you can create your plays within those bounds.
And I think one of the things that gets passed around frequently is, well, there’s non-competes have been outlawed. Not really. I mean, in some states, you can’t have a non-compete clause, but there’s so many carve outs that just having seen a headline that says, yeah, non-competes aren’t a thing anymore. Yeah.
because IBM doesn’t want their computer programmers to be competing and blah, blah, blah, blah, blah. That doesn’t mean that just because you saw the headline that non-competes don’t apply in your state, that that means that it applies to you. And so get your contract and then talk with an attorney if you’re not 100% sure.
Absolutely. I didn’t personally have to deal with that. Thankfully, I was working in urgent care, which those contracts just tend to be more flexible because they, by nature of it, a lot of people are working urgent care as sort of a moonlighting gig or something like that.
And so I had already changed my contract from 80% FTE to PR. And so I knew that my PRN contract did not have any limitations on what I could do, which was great. But I’ve heard so many stories from colleagues in the DPC community of things getting really ugly. My colleague,
one of my colleagues that shares the building with me, she’s a family medicine DPC, and she left a private practice in the community that had something like 20 different partners. And she had been a partner for 15 years there. She really thought that that was going to be her long-term gig.
She kind of saw the writing on the wall, the financials of the practice were going down and down. And so she ended up making the hard, very difficult decision to leave. And without divulging too many details, things got ugly. Right. And and uglier than she would have anticipated.
And I think that I hear that story just so often. So if you have a contract with a practice and you’re going to be leaving and you should assume that it’s probably 90% likely that things are going to get somewhat ugly. Now, I hate being a pessimist. I don’t like being a pessimist, but you should protect yourself.
Just like Phil said, read the details, hire a lawyer to review it with you. Think about all the possibilities and be in that driver’s seat, like you just said, because you don’t want to assume, oh, but they’re my friends and they’re my colleagues and we’ve had a great relationship for…
20 years and they would never do something to hurt me. Well, you’d be surprised, right? I like to believe the best in humanity, but I’ve just heard too many stories that are the opposite of that.
And I think that’s the thing is you quickly realize, which is okay because you have thick skin and you realize that this is better for me and for my family and for my patients to move on, but not everyone’s gonna be happy that you’re leaving because it’s gonna make more work for them.
It’s gonna make less money for them. It’s going to make more difficulties for them no matter what when you leave and so like i i mean my former partners i would if one of them was going out of the country for a vacation hey can i give my
mom your phone number in case something happens with my kid of course we see him at the pool all those sorts of things really good relationship really close bonds two said goodbye to me on my last day that was it so they will not be super excited. I would not expect cakes and parties when you’re leaving.
Maybe you will have that experience. I’ve talked with one pediatrician over the past four years that had the, they were super excited for them and there was time and it was just worked out perfectly. And in part, it worked out perfectly because they already had another pediatrician that was
coming in that they could just fill right into that slot. And it’s like, yeah, go for it, go. By and large, it will not be the most pleasant experience leaving a partnership in particular. If you’re leaving a corporate job, like if you’re employed by a children’s hospital or something like that,
they’re just gonna scratch the name off the door and put a new name on the door. And you’ll realize how replaceable you always were in those circumstances. And that will suck, but you’ll move on from that really quickly as well. But I think making sure that how things could go
by knowing what’s in your contract will dictate a lot of those things. And it will also protect you because one of your partners or something like that may say, well, you can’t leave, or you can’t take your patients with you, or you can’t do this or that or the other thing, or how dare you?
And you can say, well, this is the contract guys. Like we all signed this. Your name is right here too, bub. This is what we all agreed to. And I know that hurts your feelings or makes your day, week, month, year worse that I’m leaving, but this is what,
we all signed up for when we, we wrote the contract that you gave me.
Yeah, I was just in California recently talking to an ex colleague in San Diego, and she left the community health center where we had worked together. And then she joined this really small private practice. And she joined that small private practice because she thought she saw potential in
herself maybe becoming a partner or even taking over ownership of the practice since the owner was aging and getting close to retirement. Well, it turns out that after a year of being there and enjoying it, the owner decided to retire and sell the practice to this large sort of, it’s called CPCMG. It’s this big sort of
pediatric clinic conglomerate in the San Diego area. And so she found herself being kind of like taken into this huge organization that had a lot more rules. And she had been working, I think, just a couple of days a month in a side gig.
And when they took over, they saw that and they said, you can’t do that anymore. we own you and i really hate that attitude of these larger organizations of like we own you or you can’t do anything so she’s been considering dpc and we were talking
about the possibilities and unfortunately her contract is just so strict that she can’t even begin opening even though she works part-time and ideally she could overlap the the contract and just the administration of that organization is too strict about that. So it’s just think about it. Look at your unique situation because there’s so many different possibilities and
you really want to know how you can make the transition safely and as seamlessly as possible with as little drama as possible as well.
For sure. And the nice thing is like you got that end date and the drama will end because they got to move on and they got to start seeing patients too after you. And so it is hard. Like that was a really hard period when I was leaving, but it ended and we all moved on.
And yeah, I was going to say something about Christmas cards. We don’t still send them all Christmas cards. So, but, but that’s okay.
So after you look at your contract, Phil, what would you say is the next step?
I mean, the next step is I like to just think about like, okay, I’m going to open this practice and start getting paid. So I like have to do the legal mumbo jumbo of getting paid. And so the next step then in my perspective, at least is to open an LLC.
And this is something that you can do on your own. This is something you can work with an attorney too. I mean, ChatGPT can give you a lot of the short and long of how to open an LLC and all the ins and outs of that. But in the big picture, you need a business entity.
that can get you the money that you take in so that you can actually like bill patients, get paid, have it show up in your bank account, buy groceries and those sorts of things. And so get your contract, open it LLC. Marina, help me think about what we need to know when it comes to like the name.
Do you have to name it after, like, do you have to pick the name first and foremost? Can you kind of have like a doing business as sort of thing? Like what would be your advice?
Yeah. I would say think at least somewhat carefully about what you want to name it because changing the name later becomes painful. Yeah. if you end up choosing a name in the beginning and later you want to operate as something else you can always use what’s called a doing business as name so if my
business was capella medical whatever um and i was like oh i don’t like that name after i opened i decided i wanted to do integrative and i didn’t know that in the beginning so now i want to do business as healing arts pediatrics i can do that right or what if
i were to actually decide i want to start seeing adults because i have this integrative medicine training and i learned a lot about adult medicine and now instead of just having a name that’s healing arts pediatrics and people think i only see kids i can change to doing business as healing arts medicine or something
So you can always use the doing business as option, but you also have to, in different accounts, you’re going to have to let your state know or let your financial institution know. They usually have a place where they ask the name of the business and then they ask for alternate names they’re doing business as.
So you can do that. Another thing would be to figure out if you can operate as an LLC in your state or if you have to operate as a P or a professional LLC in your state. States like California are more stringent. And so in California, if you are a physician, you have to have a PLLC.
You cannot have a regular LLC if you’re going to be practicing medicine. Right. Right. And maybe the fees are a little different under that category as well. So just make sure that you investigate the rules of your particular state before you register the LLC.
There are also a lot of companies out there on the internet that are happy to take your money and say, hey, we’ll register your business for you. right for the low low fee of 500 and if you actually like do a little bit of digging and you just go directly to your state website and business registration on
your state’s website it’s like 50 so don’t fall for those schemes companies that are happy to take your money to file paperwork and essentially you end up in putting the same information in that system as you would have had to input into your state system. So please don’t waste your money. You don’t have to waste your money.
It’s so easy to do it generally through your state’s business registration website.
Yeah, it’s something that seems hard. So why don’t I just pay somebody else to do it? And then that’s how they make their money is they do that for a lot of people where they’re basically just plugging in the information that you’ve given them and then charging you 10 times as much.
And I’ll also add that you have to register your LLC, but you also have to get what’s called a federal employee identification number. And that’s also really easy to do through some federal website. I don’t remember exactly what it is, but just Google FEIN registration. Super easy. Takes a couple of minutes.
You get your FEIN number and that becomes part of your like overall business registration.
And the reason that you need this so early in the process is so that you can buy stuff. Like if you’re going to open a business credit card, if you’re going to open a business checking account at your local bank or a national bank or something like that, like they’re going to need those documents.
And so you say, yep, I do have a business set up. Here’s from the state, not state attorney, whatever state office or whatever, like you get those documents that then you can say, yep, I’d like to open a business bank account. And those then allow you to start doing all the other steps that cost money to get
your EMR, to get your payment platform, to find your space. All of those things come from, okay, I have a business credit card that I can charge that on. I have a business banking account. I have an address. All of those sorts of things flow from that information. So I think those get your contract, open your LLC.
And then I think really it’s like, find the resources and create a timeline. So resources wise, the Facebook groups are really helpful. The DPC pediatrician content, the guide, the courses that are on a bunch of the different kind of very specific topics, whether it’s SEO or website or social media or bookkeeping or all those different things.
And then creating the timeline of like, here’s when I want to open. Okay, I need to work back. I’m going to open in six months. So I need to work back. And I need to let my office, my current practice know on this day that I’m leaving so that three months from
then I can be done and then open when I want to in the future thereafter. It’s kind of like crafting that timeline of the order of operations. And I still have the Monday board that I used when I left my old practice and it was broken down by months. Like, okay, I’m opening on January 1st.
So here’s what I need to do in December. Here’s what I need to do in November and October and August. Marina is looking at me like, I can’t believe Phil did plan that well. And had all those things planned out. Maybe in a past life, I was better at planning.
That might be a little bit of projection, but that’s okay.
But I did, I had, and maybe some of it was retrospectively too. Like, yeah, I did that in July. And now that it’s August, I can check the list of the things and write the things that I already did. But that helps you to then know, okay, here’s what I need to do each month to prepare.
Because you’ll also have your full-time job or whatever else you’re doing and your family and those sorts of things. So then you can kind of divide it up and be like, I don’t have to figure out an EMR for three more months still.
So I’m going to put that one down on the list and just kind of like passively absorb information about what EMRs people are using, knowing that that’s something that I’ll do in July rather than right now.
Absolutely. Yeah. And that’s where I’ll put another plug in for the startup guide. 27 steps. So the checklist is already beautifully laid out there for you. I might be revising it a little bit. There are one or two steps that I might be adding in there. But if you want a checklist, that’s a great way to start.
And that way you can really do what Phil said. You can give yourself kind of a timeline. Also give yourself a little bit of grace and flexibility because sometimes things take longer than you think they will. Like Sometimes getting the business license is a little bit more painful depending on
your city and when they meet and when they approve those licenses and all that stuff. So give yourself a little bit of flexibility. It’s okay if it doesn’t work out exactly as you plan. That is part of the adventure of entrepreneurship is that there are things that are
unanticipated and surprises and you have to be able to be flexible and kind of like just ride the waves of entrepreneurship sometimes. So,
well, and I think the very last point to going back to the contract that we talked about earlier is when you have your timeline, then you’ll know. what could happen if when you announce your departure time, they try and pull a fast one and say, actually, we just want to let you go today or something like that.
Like you’ll know then, okay, my timeline has to change or no, they can’t just actually fire me without cause because I said, I’m going to resign. Those are all things that when you have your contract, it helps you to be able to make that timeline and make it a realistic timeline with
enough room and wiggle for pivoting as possible. things come up and things take longer, things don’t take long or the timeline changes.
Absolutely.
This has been another fantastic episode in my opinion, because I think it really laid out for us exactly what you need to do. If you’re saying, okay, I’m going to do it. I don’t know where to start, but I’m going to do it. Start here, get the DPC pediatrician startup guide, join the groups.
Everybody will be so excited to help you along on this awesome journey.
