Listen to the podcast here: Can Pediatric DPC work in rural areas?
Episode Summary: This episode explores whether direct primary care pediatrics can work in rural communities and concludes that it is feasible but requires tailoring to local realities. Phil and Marina explain that many rural areas have lower, more homogeneous incomes, so pediatricians must study median income and set realistic monthly fees—often lower than urban practices—while clearly defining what is included, such as a well‑child exam plus a limited number of sick visits, with extra services billed separately to keep the model sustainable. Sparse populations mean not all children will join DPC, so physicians must confirm there are enough potential patients and use strategic contracts and panel sizes to make the math work. A key opportunity is telehealth, which allows management of issues like rashes, parenting questions, and behavioral concerns without long drives, making DPC attractive for families who would otherwise face significant travel. Phil and Marina describe niche approaches—such as behavioral health, ADHD, autism, or PANS/PANDAS care and parent‑coaching micro‑practices—that rely heavily on virtual visits and can serve a wider region, and they note that some rural areas include pockets of higher‑income families (for example, a town with an elite boarding school) that can sustain higher‑priced pediatric DPC, reinforcing their point that each DPC practice must be uniquely designed for its community.
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. Today, Phil and I are going to answer this question that actually one of our listeners submitted a while back, and it was this question of, is DPC especially DPC pediatrics possible in rural communities, especially more remote, lower population, maybe lower income rural communities, especially.
So, this is a great question and something that I’ve thought about. Now, neither of us can necessarily speak from experience because neither of us are located in these really kind of more remote rural areas. But we do know that within the larger DPC community, there are physicians who operate in rural areas, especially family medicine physicians, because they can meet the needs of families as opposed to us pediatricians who are more focused on taking care of the kids. I would say my short answer to this is yes, it’s possible. However, there are maybe some special considerations that you have to think about.
So first of all, you really have to look at the economics of your area. What is the average household income in your area? And And are you going to have to adjust your prices accordingly, right? Many rural areas are unlike places like Los Angeles and Chicago and New York City that have households at all levels of the income strata. You have really low-income families and you have really high-income families and you have people in the middle. Rural areas tend to be a little more homogenous. Of course, depending.
You’re going to have exceptions out there, but in general, many rural areas are going to be a little more homogenous, economically speaking. And so you want to look at what is the median household income in your area? How much disposable income do they have? How many could even afford even a moderate fee of something like $50 to $75 a month per child.
Now, among the pediatric community we tend to charge higher rates than that because we really calculate kind of how much time children are going to need. Babies are going to need more time than older kids and more visits. And so we tend to charge actually higher than many family medicine practices.
But you’re just going to have to be really careful in making the calculations of what will work for your community. Because if you price yourself too high and nobody in your community can afford, even if they want it, right? If they can’t afford what you’re offering, then you’re going to struggle to really attract patients and to grow your panel in the way that you would like. And that doesn’t mean you can’t make it work though. Phil, any thoughts?
No, I think you’re spot on with all of that. I think that there are challenges and opportunities when it comes to rural is that obviously like people are more spread out. I live in Nebraska, which we have a lot of farm community. I’m not in a rural environment. We have people that come in
the more rural parts of this corner of the state to see us because there just isn’t access otherwise. And frankly, one of the nice things for them about DPC is we can do a lot of things without them having to make the trek in. There’s lots of times where we can tell you about a rash.
We can talk through a parenting issue. We can diagnose and manage over telehealth in a lot of ways that a typical practice is going to say, you got to come in and it’s going to be, I know it’s a 90 minute drive, You got to come in so we can look at this rash.
Like with a story and some pictures, I can probably do pretty good with a rash in general. And so parents actually really appreciate that, especially if their roads are bad and they don’t want to make the long trek in. That can be really a benefit to them. So I think kind of highlighting that yes,
you may decide that your kid has strep and you just want to go to the local urgent care to get swabbed and figure out if that’s what’s going on. But having us available for your big picture care and making the trek in and making
it worthwhile by seeing all three of your kids for their checkups on the same morning so that you can get all those visits out of there without multiple trips is actually really worth it to you for saving Gasoline and windshield time and all those different things.
So I think there’s definitely opportunity when it comes to the rural environment. And I guess I’d be curious to see as all of the marketplace plans change, like if we’re talking about rural, we’re often talking about farmers who are often on marketplace plans or self-insured and those sorts of things.
that that could be a place where there’s more turning to a more cost effective model of care in the coming years. If all of a sudden their insurance really sucks and they can’t get access or they have huge deductibles, then they’re going to be doing the math and they’re going to be seeing that, okay,
maybe there’s a different model out here. So if we can get in front of them and share some of the ways that we can help virtually and fit their budget, then we have a chance to really get in front of those rural folk and be able to help them.
It is kind of nice in one way for us that they’re far away because they, acutely are just going to go to their local place if they need a strep swab or something like that. So it takes a little bit of the burden off of us because we know if they’re driving
two hours and they just are wanting to know if their kid has strep, the likelihood that they’re going to drive in is low enough that they’re going to probably not need to take up time on our actual schedule. And we can do the mental help with them and help them through the thing without
having it take up time in our clinical schedule day. So there is the benefit of that too.
Yeah, definitely. Definitely. Obviously, aside from just income considerations and whether people can afford you or not, also rural areas are more sparsely populated. So you have to ask yourself, do I have a population of children, a sufficient population, right, that I’ll be able to attract? Because not 100% of children in your community are going to
be covered by DPC, right? There are also other options available to them. So you have to consider that. Is there enough of a population that you can attract a percentage of them realistically? Also, if you do have to lower your prices, Actually, I recall at the last DPC Mastermind,
the pediatric DPC Mastermind in Las Vegas in February 2025, during one of our sessions, a pediatrician raised her hand in the audience and she said that she works in a rural community somewhere in Appalachia. And she talked about the challenges with practicing in a rural setting. She said that in particular in her community,
average household incomes were pretty low. And so she found that she had to lower her rates in order to be able to attract families that would be able to pay those rates. And one of the beauties about DPC is that you can structure your contract and you can structure your model and you can structure your pricing.
However you need to, that fits for both you and your patients, right? So let’s say that you live in an area where families in general are not going to be able to pay more than, let’s say, $50 per child per month, right? And maybe you have a family max that’s lower, like $200 a month, right?
If that’s the reality, you still want to make sure that you’re careful about how do I include only what’s reasonable under that fee? So maybe instead of promising unlimited sick visits, you say, okay, that $50 a month includes their well child exam and two sick visits per year, right?
And on top of that, if you need something, then you have a fee schedule, right? Or maybe… It includes like your well-child exam and this many hours of both virtual access and in-person access, right?
So you can decide. Set it up.
Yeah, exactly. You can set up your rules so that if you do have to charge lower prices, you don’t end up resentful because families are getting like two visits a month and they’re only paying $50 a month. The math just doesn’t make sense for you as a physician to be making that little.
And perhaps if you structure your contracts in a strategic way, then you can have a panel of more patients, right? And maybe you can make the math work in that way. So there’s a lot of creativity that can happen. There’s a lot of customizability that you have control of when it comes to meeting
the needs of these particular communities. And then I’ll also add that not all rural communities are created equally, right? You have some rural communities where you might actually have pockets of really high income or middle income families. For example, Dr. Noemi Adame, who owns Culver Pediatrics in Indiana, she lives in this tiny little town.
I actually got the chance to visit her because she hosted a DPC women retreat this last year, got to like roam around her little town. Now her town is unique because it is home to a very expensive boarding school that attracts students from all across the country.
And so you have this pocket of very high income families that are willing to pay for her to be their kid’s pediatrician if they’re there for summer camp or during the school year. So she actually charges really high prices for her services because she has that pocket within her rural community. So you may…
Be in one of those communities where you can get creative in serving the needs of your particular population.
I love that. I think that’s super helpful to kind of paint the picture. There’s a lot of different ways. And I think one of the things that we say over and over again on this podcast is that when you’ve seen one DPC, you’ve seen one DPC. And if you are saying,
I really want to be a pediatrician and serve my rural environment, there’s a way to do it. And there’s a way to figure out how to make it work. And it might not look like suburban, urban pediatrician down the street that’s doing TPC, but there’s certainly a model there and a way to explore and figure out.
The other thing that I was thinking about as you were saying that too, is sometimes direct primary care pediatricians in general will have special specific areas of interest. And so some of those don’t require as much guidance in the exam room space because it’s a lot more of the behavioral issues or ADHD or
autism or those other things where maybe we have on a regular basis a physical check-in, but then a lot of it can be done virtually and we’re working on different things. And we’re, that’s kind of part of our model then is this behavioral care, which they’re often very lacking. in rural areas.
And so that’s a niche that if that’s something that we’re passionate about, that we could certainly look into, how can I make this an attractive offering to people and to serve people without them having to come specifically to our office? Like for example, for us,
we do a lot of pans and pandas work now because the only person in the tri-state area essentially retired and our We do most of those virtually now because they’re three hours away where this doctor was located, or they’re even further and would drive in to see her. And so they’re six hours away,
and we don’t want them to make that trek, especially in winter and all those sorts of things. So we can provide that care virtually in a way that a typical practice that takes insurance wouldn’t necessarily be able to do with our model of care.
Mm-hmm. Yeah, I’m glad you bring that up because I think that this option of virtual care that has really just like exploded since the COVID pandemic, it really opens up a lot of doors of opportunity for people to practice in unique ways.
So that reminds me of a pediatrician I know who I got to know through the pediatric hypnosis community. And she is down in a little town. Well, it’s not little exactly, but it’s kind of remote, St. George, Utah, which is in southern Utah. And she has a tiny,
tiny little micro practice where she does mostly behavioral health and kind of parent coaching. And she does a lot of virtual options and she sells courses and things like that geared at families needing help. help, especially with like kind of behavioral challenges in their kids. And so in addition to seeing people locally,
one-on-one and having some parenting courses locally, she also has a lot of these virtual options for families. And so even though she is in this relatively small town, she can offer virtual consultations to people throughout the state. Now, of course, when it comes to crossing state lines,
you have to be more careful because there are licensing restrictions about practicing in states that you’re not licensed in as physician. But there’s still, I mean, people will apply for licensure in other states if they are neighboring a state where there’s a high need.
So you can do it. And speaking from my experience, it’s not very hard, honestly, to do that because we did that because we knew this doctor. She’s in Iowa. We’re in Nebraska. She was retiring home. We knew we would be like, she kind of mentored us in our pandas practice because there’s no one else nearby doing it.
And we wanted to serve that community. And we said, well, let’s just get an Iowa license so that we can see these families. We can care for them in person and virtually. And now most of them will make a track at some point to come and see us in our
office so that we can get to know them, put the face with the name and all those sorts of things. But it doesn’t prevent us from getting to care for them because we have that license. So there’s a lot of different ways and a lot of different things that you can do.
Yeah, absolutely. So I guess the short answer to our question is yes, you can probably make DPC work, including pediatric DPC work in rural communities. But like with most things, you have to be thoughtful, methodical. You have to consider the unique aspects of your community, including income, including population of children, including
options to enter a niche form of practice where you can offer your services virtually to families in a larger area. So it’s not an absolute no. There are definitely possibilities, but you’re going to have to get creative about how you make it work in your particular community. Yeah. Thanks for listening, everyone.
Don’t forget to check out all of the courses and resources that we have on dpcpediatrician.com. We have resources like this podcast, as well as the free startup guide for those who are just newbies or exploring the world of DPC, as well as resources for more maturing and growing practices.
We have some courses about all the legal stuff involved in DPC, about the financial stuff, about SEO practices and gaining visibility. Phil also has courses on all the social media stuff. That is his area of expertise and automation. Don’t forget to check out the resources that we have there. And last but not least, we offer one-on-one consulting.
So check out our website for more details. Thanks for listening and until next time.
