Listen to the podcast here: Can DPC Physicians Burnout?
Summary: In this episode, Phil and Marina discuss how Direct Primary Care (DPC) physicians can still experience burnout, though from different causes than in traditional fee‑for‑service systems. Instead of systemic pressures, burnout in DPC often stems from overcommitment, poor boundaries, and underpricing. They emphasize the need for clear expectations with patients, realistic pricing, and structured time management to sustain balance and prevent exhaustion. Ultimately, they encourage DPC doctors to take ownership of practice design so that their systems truly support well‑being and longevity in medicine.
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. We’re happy to be here with you today and we are going to address this very important question of Do DPC physicians burn out? Now, I don’t know about you, but in my past work life, I definitely experienced some burnout.
And that’s part of what really drove me down the path to discovering DPC as a practice model and eventually opening up my own practice and creating a work life that I now really love. However, If you browse DPC Facebook groups, you may encounter some conversations among physicians that talk about this issue of burnout, about boundaries, about, hey, I thought this was going to be so wonderful and so great, but it’s turning out that there are actually problems and issues with boundaries with patients, and I’m starting to burn out, and what do I do, right?
Just the other day, I saw a post by a physician who was… sort of bemoaning her work life and saying, can I just close my practice? And that was really disheartening to see because a lot of us in the DPC community are really passionate about this DPC model and how it can bring better work life integration for physicians and it can provide better care for patients.
And so when I see posts like that, it’s a little sad. And it makes me wonder what happened, right? Is it that just medicine is not really a right fit for that person? Or is it that they created something that they thought was going to automatically be better, but they didn’t really put the systems in place to make sure to guarantee that it would be better than what they lived in before? So I’m curious, Phil, about your thoughts. Do you think BPC physicians can burn out?
Absolutely. I think it’s a different, like same symptoms, different underlying etiology typically, because I think for fee for service, employed by a big group, employed by a hospital system in academia, a lot of the burnout comes from lack of control. And that then manifests as crazy schedules, short visits,
really high expectations in terms of volume and all those sorts of things. And that leads to burnout just because you can’t just keep pushing the pedal so hard for so long and expect the wheels not to come off, whether it’s the physician themselves, the clinical care that they’re providing,
the ability to keep up with all the other things. And then like you talked about with work-life integration and having all the different pieces, like at some point you’re, then you’re gonna have to be charting at 11 o’clock at night. And that’s not sustainable for most people for very long.
I think on the flip side, in DPC, it often comes from Well, I made this promise that I would be there for my patients. And so if they’re texting me at eight o’clock at night, then I need to respond. I feel an obligation to respond to them. Or if it’s my kid’s birthday party on a Saturday afternoon,
but somebody needs stitches, I feel beholden to do that. Or not even do that, but kind of just have the cloud hanging over our heads of this moment, this date night, this movie theater outing could be really put to the side if a patient needs something.
And so I think they look similar in the different things that we talk about. And everybody, I feel like, is much more in the know on what burnout typically looks like, or you can kind of see it from a mile away. Because we have had a lot more emphasis on physician wellness in the past decade.
But then you get to the same point. It’s like, well, maybe I should just go back and work for somebody else because this is too hard for me to do it all on my own. I guess I’d be curious your thoughts, Marina, on what sort of practices,
like what sort of things that people do that leads them more quickly to the burnout stage in DPC that you see?
Yeah. Two things come to mind. First is being so desperate to attract patients that you really over commit yourself. You want to make them happy. And so you make yourself available 24 seven and you answer their text messages within five minutes and you create this expectation that becomes unreasonable and unrealistic over a certain amount of time. Right.
Because maybe it’s realistic when you have a panel of 20 and 30 patients. But once you scale to 100, 200, 300 patients, you can no longer meet that expectation, but you have people who were trained to expect something from you and then can be disappointed when you are no longer able to fulfill those expectations. So first… You have to be really careful in the beginning. I know I was in that space where I was desperate for patience.
I was willing to give discounts. I was willing to come in on my days off because I was so desperate to make this model work. And that’s normal. I think it’s normal for us to feel that because there’s a lot of fear involved in even opening our practice. And then suddenly we are our own marketers.
We are the one in front of everything. Right. And we have to make it work. But and obviously you do have to work hard in the beginning to attract the right people. But I would just be really cautious, really thoughtful, really intentional about expectations that you set up in the beginning.
So now that I’m more established and I’m not in that place where I’m desperate for people, I’m very intentional about the conversations I have and onboarding. Hey, I’m not available during the night. I need sleep like everybody else. And so if something is in the middle of the night, yeah, you can do X, Y, and Z,
but I probably won’t wake up to your message. Also, I say, I like to go to conferences and I take a few vacations a year. So during those times, I will most of the time have a pediatrician covering for me for urgent issues. But there may be once or twice a year when I’m not available,
you’ll get an automated text message that says I’m not available. Please go to your nearest urgent care. Right. And then also kind of reasonable expectations about how I will reply. So if it’s a non-urgent question, you can send me a text message and I’ll get back to you within a few hours. Right.
If it’s something urgent, call me. And if I’m in with the patient, I can’t answer right away. Leave me a message. So that way, as soon as I have a break, I will see your message and I will know that it’s something urgent and get back to you. Right. And I’ll do my best,
but I can’t guarantee I’ll always be able to drop everything and see you right away. I’m. human like you right this this this core theme is coming across that we are human right and we need to acknowledge that within the culture of medicine i think it’s
really easy to fall into this trap of thinking that we’re somehow supposed to be super human and we’re not right so yeah so that first thing has to do with expectations and i would say the second one that leads to burnout is well let me
let me Double click on what you said there. I hate that term. Go ahead. It’s a good one. I think you’re absolutely right. And I think that we have this expectation that we want to avoid rejection, especially because we’re doing something different and we’re doing something new and people haven’t heard of it before that like,
I got to make sure that they don’t say no. And so, oh yeah, I guess I could do that. Or, oh yeah, yeah, that’ll work. Or, okay, fine. I’ll do that. And that just continues to grind on you when you keep doing that and then set those expectations. And on the flip side,
if you are upfront with your patients that you are also a human being like them that needs sleep and that needs to recharge, they’re gonna be like, yeah, that makes sense. Like we didn’t expect you. to drop everything for us. And if they say, well, we wanted a pediatrician that would drop everything for us,
that has a helicopter standing by and can fly over to our kid’s house and give them some ibuprofen. If they have a fever, you say, well, I’m sure that service exists, but it is not for me. And so you need to find somebody else. And I think that we’re afraid that if we say no,
that we’ll be rejected by too many people and we’ll fail. When in reality, if we just share information here’s where we’re at, people will be like, oh yeah, they’re a human too. I mean, I pay for a Netflix subscription, but that doesn’t mean that I can just like demand any video or movie that I want.
I know that like, yes, I have a subscription. Yes, there’s a lot of options here, but that doesn’t mean that I just get everything. Or we go to a pool in the summer And it’s a membership pool that you pay a couple hundred bucks for the summer.
But that doesn’t mean that I can just go in at two in the morning because I paid for a membership. Like there’s still boundaries and rules. I can’t bring glass bottles or my nachos into the pool. I have to respect the rules despite the fact that I’m paying for it.
And I think that is so different than people are accustomed to that they feel like if somebody is paying any amount of money, they deserve 100%. They deserve everything that they could ever want. And I think when we can reset those boundaries to just like the normal boundaries that people should expect from a fellow human,
then people are like, oh yeah, that makes sense. And no, it wasn’t a big deal that you weren’t open. And I wasn’t expecting you to respond to my parenting question at two in the morning, just cause I was up. I want you to get your rest too,
so that you can be a good human for all of the people that you take care of and all those sorts of things. Okay, so I think that one of the things that often happens is we feel like they’re paying a monthly membership fee. It’s totally different. I don’t want them to reject it.
So I need to do whatever I can to make sure that they are taken care of and all of their needs are met. And if they have the wrong idea about what those… restrictions are, then that’s going to cause a lot of strife. And they’re going to say, well,
I thought you said that we could come in at seven o’clock at night. Or I thought you said that one time there was a patient that had croup that you went over to their house and you gave them steroid. And now my kid has a croup and you’re not coming over to my house with a steroid at
10 o’clock at night. Like, what’s the deal here? And so if we set regular expectations and reinforce those expectations on a consistent basis with the way that we practice and the way that we communicate, people are very happy to live within those boundaries and expectations. I have a Netflix subscription,
but that doesn’t mean that I have access to every movie that ever existed just because I pay a membership fee. I have the ones that Netflix has available, but if they don’t have it, then I got to go find a different way to get the movie that I want to watch. We go to a summer pool,
like we pay a couple hundred bucks for a pool membership for the summer. And yes, I’m paying for a membership. That doesn’t mean I can go in at two in the morning and go swimming like the pool is closed. The sign is up and it says the pool is ours.
I can’t bring glass bottles and nachos into the pool just because I’m paying. a membership. And I respect those rules. I was like, oh yeah, despite the fact that I’m paying for something, like there are still limitations that are put on that. And I think that when we explain here’s how it works and have very clear boundaries,
parents happily live within those boundaries. And then when we’re able to go above and beyond, they just think, wow, this is the most amazing thing ever because we’ve set those expectations to a reasonable place that it’s easy to go above and beyond. I had a mom, what did she need? Some Zofran or something.
And I was leaving for the day and she couldn’t get, the pharmacy was closed. And I knew that they lived over in an area of town where I was going to be dropping my son off at guitar practice. And I was like, hey, there’s a coffee shop around the corner from the guitar studio.
I’m going to be sitting there at 630. Just stop by and I’ll pass you some Zofrian or some Decadron. I don’t remember specifically what it was. And it was like, that was very much in my bounds because it wasn’t an inconvenience to me other than slipping it into my bag and then handing it off to the parent.
And it made a huge difference for them. Whereas if I said, oh yeah, one time we had a kid with croup and I went over to their house at 11 o’clock at night and I gave them some dexamethasone and I took them out in the cold, then parents are going to expect those things.
And then when you don’t deliver, they’re going to be like, I got shortchanged because somebody else got more than me. And so I think that that can be a big source of burnout is when we feel like because somebody is paying, they get whatever they want and deserve to be completely satisfied and honored with
whatever requests they make.
Absolutely. Yeah. I share my office with a family medicine doctor named Dr. Jackson. She’s amazing. She just opened her DPC earlier this year in 2025. And one of the things I admire about her is she’s very good at setting and respecting boundaries.
So she was telling me that the other day she had a meet and greet with a potential new patient. And she was explaining her model saying, hey, I’m in the office three days a week, but accessible via email or phone call five days a week between the hours of nine and five. She has four kids,
so she has to be very careful with setting those boundaries and respecting them. And the patient said something when she explained that the time that she’s available is, The patient said something snarky like, well, yeah, because I always get sick between the hours of nine and five, Monday through Friday, right? And Dr.
Jackson was really gracious about it and said, I understand that, but I also have a family. I have kids. I have a lot that I have to balance. And in order to be able to be my best for you, I have to also take care of myself.
And I love how she’s just so confident and comfortable saying that to other people, because I think not all of us are. Sometimes we second guess ourselves. And again, there’s this desire to please everybody. And we can sacrifice our whole life and our health if we… always, always, always, always are giving.
And I know that I’ve learned that lesson for myself in some ways and continue to learn that lesson in my life that I’m a very, very good giver and I’m not always great at expecting the same in return or having balance in that sense. And so we have to just be very intentional, very thoughtful,
very careful about how we set up those systems for ourselves because it’s very easy, slippery slide into burnout again.
Now,
however, unlike in our previous work life where we could blame our burnout on a system or we could blame our burnout on a boss or we could blame our burnout on the schedulers or the MAs or whatever it was, right? We will only have ourselves to blame if we develop systems that don’t truly work for us.
And that’s difficult because we’ve never… been allowed to have this level of responsibility over our work lives in the past, right? We were always scheduled by someone else. We were always, we had to ask for vacation from someone else. We had to basically abide by all of these rules and restrictions.
And now we are the ones in charge of all of that.
Right. It’s really easy. Like, I feel like in the olden days, like you just went where somebody told you to go and you went to that room and then you went to that room and to that room. And now When you have time, it’s like, well, what do I do with all of this time?
And how can I use it efficiently so that I’m able to see the patients, but also not burn out because I’m like way deep in doing a lot more. And I think one thing that really helps, at least for you and I, is the hindsight of like, okay, it’s worked out okay.
Like our patients like us, they’re paying every month. They’re not all canceling their memberships. And so then it makes it easy to be like, yeah, they’re not a good fit for us rather than I’m going to change my… of offerings or my availability so that i will fit in their lives it’s like they’re
just not the right fit for our practice but i’m trying to think back people leave for all sorts of reasons they got new insurance their job changed they moved those sorts of things i can’t think of anybody in four years that has left because we weren’t available enough for them
And I think I would remember that because it would stand out to me because I’d be like, what the heck? That doesn’t jive with what I think of when they come to that. And I can’t think of anyone that has ever said that or complained about that. So that tells me we’re meeting their expectations.
And sometimes we’re able to go a little bit above and beyond their expectations and really make their day. But most of the time we’re meeting their expectations. And we’re very rarely, if ever, not meeting their expectations, which is totally different than regular old healthcare. Like most of the time in regular healthcare, your expectations are not being met.
It’s taking longer. There’s more Red tape, it’s delayed. And so if we can just like meet people’s expectations, then they’re going to feel really taken care of. So I think that we often will set a really high bar for ourselves and that will
lead to burnout when we feel like we have to keep giving and giving and giving to make sure that patients are just completely happy and taken care of.
Absolutely. Yeah. Now you talked earlier, Phil, about kind of this analogy with like Netflix or with like the pool summer subscription, right? And how just because you’re paying something, it doesn’t mean that you are entitled to everything. So my second point about the big contributor to burnout in DPC would be not pricing appropriately. So it’s really easy.
Again, in the beginning, you want to attract patients. You want to make your price as reasonable as possible in order to attract those patients. then I see some people falling into the trap of undercharging relative to what they are offering, right?
And so I learned this a little bit the hard way and I had to adjust my prices over time that in the beginning I was underpricing my services and also in my contract had quote unquote, unlimited visits. And I started to realize, especially as an integrative pediatrician who does a lot of different modalities,
that it was really easy for parents to come to expect for only $75 a month that I was charging for older kids in the beginning. Right. These families that were like, oh, yeah, you can do like two sessions a month of hypnosis, right? Starting to do the math.
And I thought, no, this is not going to work for me. So I eventually increased my prices and I also changed my contract so that my essentials membership plan is including well child exams and up to six sick visits per month. I mean, sorry, per year. So that way it’s a reasonable expectation of time.
And if they feel like they have needs beyond that, then I have what’s called a premium membership where we talk about the needs and then come up with a custom monthly fee that will truly help fulfill those needs in a way that I’m not being exploited.
And they’re getting what they need, but for a reasonable rate for my time. And this can be challenging because I think Everyone lives in a slightly different area. The socioeconomics of different areas in the country are going to vary. And so, I mean, as much as I would say,
I’d love to charge a thousand dollars per hour because I feel like that’s what I’m worth. Right. The economics won’t always work out. So you have to balance the reality of the economics with also your needs and realistic expectations about what you can provide for a certain cost. Right. So again, be really intentional, be really thoughtful,
do the math, realize that some people are going to be over-utilizers, some are going to be under-utilizers. But ask yourself, at what point, where is that threshold at which I would start to get resentful if people were expecting more than this or demanding more than this from me at this price point, right? And help that guide yourself.
your pricing decisions and your contract decisions and all of that, because resentfulness is one of the things that’s going to lead you further and further down into burnout, right? If you feel like you’re not getting back what you’re putting in, there’s going to be that imbalance and that’s going to contribute to burnout.
For sure. And I think shifting gears a little bit when it comes to another thing with burnout is when we have all of the control and we’re not able to manage our schedule effectively, then things just kind of spill everywhere. And we’re constantly feeling like we’re putting out fires. That’s something that I hear. I would love,
we should just do a poll in the, one of the Facebook groups about ADHD and DPC, because I feel like a lot of direct primary care doctors might have just a touch of ADHD And when you have, when you’re working and you’re having to see 40 plus patients per day, like there’s motivation there, there’s a deadline,
there’s a timeline, those sorts of things. When you are in charge and you have long visits with patients and nobody is checking you or looking over your shoulder, like, why aren’t they getting the things done? If you don’t have those internal motivation and accountability issues,
It can just get really messy because you’re doing everything at the last minute and it just feels like a whirlwind every day. And I’ve heard this from other physicians that just feel like they have all this time, but they’re never getting anything done.
And I don’t know if that resonates with you or with a lot of our listeners. But I find that having that external accountability of working in a big system and somebody checking all of your stuff actually does help from the standpoint of like, I got to get things done. I got to get things done.
And now DPC feels like a luxury because I’ve got all this time But I also need to use my time wisely. And if I don’t, then I’m still going to be charting in the evenings or I’m going to be spending a Saturday morning catching up on charts or patients are going to spill over or
there’s going to be lots of misdone things and undone things that I just haven’t taken care of because I don’t have those internal or external accountability systems lined up. And I feel like that contributes to burnout in direct primary care when you have control.
Absolutely. Yeah. I actually would not be surprised if your hypothesis was true, Phil, because I think that especially physicians with a little bit of neurodivergence can, and it can be anything from just a tiny bit to more moderate or severe, but they can get more frustrated with the systems and the time limitations and the
expectations to do so much and so little time, right? Although that can happen to anyone as well. And I’m sure, Phil, you’re not speaking at all from experience here, right?
Theoretical things that chat GPT tells me. It’s all theoretical.
Yeah, that’s right.
I’ve seen your emails, Phil. Yeah.
But yeah, those are all great points. And I really loved Dr. Rosanna Lastra, who has a DPC practice pediatrics in Florida, I believe. She gave a great session during our summit in September, our virtual summit, about how she uses this really cool system of time blocking.
And that kind of inspired me because she’s very intentional about how she creates her schedule. and realizes that yes i need time to see patients but i also need time to do all of the business administrative duties and also reply to patient messages and reply to
emails and work on all the back end stuff and delegate stuff to my employee and all of that stuff and so she’s very intentional about her schedule while also saving plenty of time for her family she has kids and she has a husband and she has
other she likes to work out so she demonstrated in that session how she does her time blocking and i thought it was a really brilliant way of helping to ensure that balance that all of us need in our practices and after i listened to her session i actually became more intentional about my own schedule.
And I started adding admin time blocks in my schedule because I just realized I was, I was starting to take work home and I wasn’t loving that. So I’ve gotten more, more realistic about how much time I need to block off in my schedule in order to really accomplish those things.
I’ve done the exact same thing. It’s the time blocking. So I do find that really helpful too. And what I think DPC pediatricians and physicians in general worry about is if I block time, a patient will need me during that block and then it will either go by the wayside,
they’ll feel untaken care of or it just won’t stick. And my solution to that that has worked really well for the past four years is makes self scheduling so easy that parents just do it. And when it comes to self scheduling, like 95% of our visits in our practice of 700 plus patients are self scheduled.
And when somebody says that their kid is sick, I say, oh, we should see them today. Here’s the link to book an appointment. Let me know if you can’t find a time that works and they find a time. They find a time that works. Even if there’s like their dream time is not available,
they’ll find a time an hour later or before, or they’ll text and say, I got a meeting. Those times don’t work. Do you have anything else? Then we can do the like scheduling back and forth. But that allows me to time block so much easier because I have my availability and
I have the times that I’m not available. and parents get to find a time that works for them and they actively choose that time and then they’re committed to that time and so that seems like a little thing but it actually allows that time blocking to happen which then prevents things from
stacking up into the evenings or the weekends or the last minute deadlines although i’m really good at last minute deadlines marina will tell you And so if you are able to set up self scheduling and block that time, like she had talked about in her talk,
then it can be really beneficial to getting the stuff that you need to done in a timely manner without getting behind and waiting till the very last minute.
Yeah, absolutely. I love the sending the self-scheduling links too. I use Atlas. I wish their system was a little more robust and allowed more of that without me having to send the link. Families who have been in the practice a while, they know how to get to the link.
But yeah, I haven’t found a perfect system for that. But still, that saves me a lot more time of saying, oh yeah, that sounds like something that should be seen. A mom emailed me this morning that her teen daughter has been having lower back pain when she stands for a long time.
She was asking, do you think that’s something that should be seen? And then it was super easy to say, yes, I’d love to see her. Here’s the link, right? Totally. And saves a lot of time. So yes, I would agree. Find those little automations and options that make your life easier, right?
And then I want to say one last thing. Okay, one last thing about what contributes to burnout, in my opinion, is not… planning to enlist help. Now help can come in a variety of forms, right? Within the DPC world, of course, there’s a whole spectrum from people who want micro practices with only 100
patients to people who want to maybe have one or two employees and like a supportive staff. And maybe reach five or 600 patients, right? And it’s not my job to judge like which one is right or the other. I think one of the beauties of DPC is that you get to choose where in that spectrum
is right for you and is aligned with your goals for your life and your work and your professional ambition and satisfaction. Right. Whether you’re in a micro practice or you’re in a bigger, more robust practice, you have to think ahead of time of like, how am I going to…
Am I going to do everything myself from taking all of the phone calls and faxing all of the things and scanning in all the papers? Do I enjoy doing that? Or is it more realistic that I might be okay doing that in the beginning just to save money, but after a while,
that’s not how I want to be spending my time, right?
And just having a plan of like, when am I going to… jettison these things that I’m doing, like I’m holding onto them for now. I think of it like the rocket ship blasting into orbit. We need the big rocket boosters to get the initial momentum to escape Earth’s gravity,
but then we’re going to jettison those things as we go. And maybe answering the phones and filing your own faxes is something that we jettison so that we can keep moving upwards.
Exactly, exactly. And some people are truly going to stay small and they’re not going to mind doing some of that because if you keep your panel small, there’s not going to be that much work to do. But other people are going to hate it. I started to hate it after a while. I hated documenting vaccines.
I hated faxing. I hated dealing with all of the phone calls. And so I hired help. Now, I have in-person help. But there are lots of options. You can hire a VA for even five or 10 hours a week or less sometimes. Right. You can buy these packages through these virtual assistant companies. Right.
Or you can find someone like a mom who just needs a couple hours a week of flexible work in your practice or in your neighborhood. And she’s still taking care of young kids and wants something that’s just a few hours and flexible, but is willing to help you out with fielding emails or
doing your newsletter or all of those little things that maybe you don’t have the time to do or you don’t want to do. My point, though, is if you don’t plan to ask for help and you don’t structure your finances in such a way that you have the flexibility and the capacity to enlist that help,
to pay for that help, then you’re going to find yourself more resentful, more burned out because you’re not getting the support that you need. And all of us need support. The theme apparently of this podcast is we are all human. We all need support. Yeah. And if you don’t face that fact, if you don’t acknowledge it,
you’re headed for some degree of disappointment.
Amen. That’s so true. I think that makes complete sense. And I hope that people will take this and be like, okay. I’m getting started in my DPC, my DPC is growing, or I’m getting to that burnout stage. And here’s a nugget that I can take from this conversation today to help to relieve
that will be the wellness committee that you don’t have because you’re in practice and will help you to feel like, okay, here’s some things I can do to protect and prolong my career and my ability to care and serve for patients.
Yeah, absolutely. So I guess the answer to the question posed today, can DPC physicians burn out is yes. But there are lots of things that you can do to prevent that, to not just create the same dysfunctions that existed in your past work life, in your new work life.
But it takes effort and intentionality and thought and respecting boundaries on your part. And we fully believe that you are capable of doing that.
Totally.
And I wanted to mention also, if any of you feel like you need a little more support in your own practices or you have questions that you’d like to explore, Phil and I are available for one-on-one consulting. You can visit the website dpcpediatrician.com. slash consulting and find all the details about our offers.
You can book as little as half an hour to longer sessions, 90 minutes with us. If you have questions about either starting up your practice, about growing intentionally, about scaling, about automation, spill is great with that. about the mindset i love talking to people about kind of mindset work it’s like
what is it in your external world that needs adjustment but also what is it in your internal world that needs adjustment so that you can live a happier more fulfilled dpc life so thanks for listening until next time.
