Listen to the podcast here: Do I need a Competitive Edge in DPC
Episode Summary: In this podcast episode of DPC Pediatricians Phil and Marina tackle a common question among physicians considering or building a Direct Primary Care (DPC) pediatric practice: do you need a unique niche or “competitive edge” to succeed? They discuss why most successful DPC pediatricians begin with comprehensive general pediatrics rather than a highly specialized service line, and how relationship-based care, increased access, and the ability to spend meaningful time with patients can be powerful differentiators on their own. The conversation emphasizes that physicians do not need additional certifications or subspecialty expertise before launching a thriving DPC practice.
Phil and Marina also explore how clinical interests and niche services often develop organically once physicians have more time to learn, investigate complex cases, and pursue professional passions. Marina shares her journey into integrative pediatrics, herbal medicine, myofascial release, and clinical hypnosis, highlighting how confidence grows through experience rather than waiting for perfect credentials. The episode concludes with a discussion on physician marketing, value proposition, and practice growth, stressing that while a niche can make positioning easier, every DPC physician must clearly communicate what makes their practice different and why families should choose them.
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.
Hey everyone, welcome to another episode of DPC Pediatricians. Today, we’re talking specifically about in the startup world or in the growing your practice world, it’s often asked, do I need a competitive edge? Do I need something that makes me stand out? Because I’m seeing a lot of people in the pediatric DPC space that are doing all these really cool or different things or really niches.
And a lot of people want to do general pediatrics but in the DPC model and they feel intimidated or like I need to get all these extra trainings or those sorts of things in order to feel competent and confident and to grow and so this comes up a lot in the group is like do I need all these things I want to practice general pediatrics for now is this going to work in DPC and my take is always you can absolutely start and grow and maintain and sustain in pediatric direct primary care without having some super specific subspecialty niche or special offering.
And there’s so many examples of practices across the country. In fact, the majority of the practices across the country are regular old, not to say that there’s anything bad about regular and old, but regular old primary care pediatrics that is the base model that is what the vast majority of people do and the majority of people that even go on to do more niches start with the general model there are a lot of people that find and and I think Marina you can talk more specifically about this that as you grow and as you go you find specific areas and I think part of it is that you’re not seeing 40 patients a day and you’re just like trying to keep your head above water you have more time to think to dive deeper with patients to develop those clinical interests which then lead to those niches that you might find yourself in.
And so maybe Marina could you just kind of start and share your journey when it came to because you do a lot of integrative work herbal work myofascial release clinical hypnosis yeah Take me through that journey from where you started to adding all of those different lines of service.
Absolutely I think you’re right that the world of DPC it has both types we have people who are just wonderful lovely attentive pediatricians who want to spend more time with people and DPC is a way to do that and really have that relationship-based care and i know some lovely pediatricians in our DPC community who do just that and they differentiate themselves through their access and through that relationship DPC also attracts a lot of us who are interested in more of those niche areas.
So for me I knew I actually had no training specific to integrative medicine when I started but my heart and soul were saying there’s something here you’ve always been interested in like prevention and nutrition and plant medicine so now is the opportunity to really embrace that and even if you don’t know anything yet like you’re gonna figure it out and so I opened my practice with that name that was very integrative: healing arts pediatrics.
And there was some trepidation to be honest there was some terror of like what the hell do I think like who the hell do I think I am to be doing this and how am I going to learn and what courses do I take how do I start actually doing it in a way where I develop the confidence and so I just started I just started where I was and there were some of those first visits where people came to me asking questions about oh gosh like silver and about microbiome testing and about and about these supplements that I’d never heard of and I had to my inner self was really terrified and was really embarrassed and was like oh my gosh do I actually like am I am I fit for this can I actually do this but because I had the time I could just call myself and say I’m not familiar with
this but let me look into it and I’ll get back to you and because in the beginning it tends to be slow we usually have that time to do that yeah we do the deep dives and we learn along the way with our patients.
Now, in the fee-for-service world with 30 patients a day, I could never have done that. I would have burned myself to a crisp very quickly trying to do that level of care. But for me, I just, I started signing up for the class. It was the very first thing,
the modality that I was passionate about because it had helped me with my own back pain and with my own plantar fasciitis. And I was like, there’s something to this. I got to learn it. It was the myofascial release. And I started going to seminars,
and and then the seminars were all practicing on adults we were practicing on each other and I thought okay now I have to apply it to kids and so I started just practicing my friends and family my husband like anyone my people in my running
group that had like aches and pains right and I developed a little bit of confidence and then I said I’m never going to develop confidence on kids unless I just start doing it and that was scary and at first i felt on the inside like i had no idea what i was doing but on the
outside i was like this is just like learning to do a lumbar puncture for the first time this is just like ordering your first mri in residency like you’ve never done it before but you’re not going to get comfortable unless you just do it so i was
like look this is just putting hands on kids this is not doing any harm let me just do it and i got comfortable really really quickly but it just required stepping through that discomfort of doing it the same when it came to adding clinical hypnosis i
when i took the classes the seminars first on adults then on kids and i was like okay i just gotta do it and i may trip trip over my words in the beginning i may not be perfect but i’m not going to get better until i do it and now i feel really confident in it so
it just has taken that willingness to step out of my comfort zone just like we were thrown into internship and residency we’ve been through that discomfort so many times as doctors like pre-med years through medical school through residency through our first job we have stepped through the fire of discomfort so many times
and this is not an insurmountable challenge if you want to end up differentiating yourself in a unique way it does not have to be integrative it does not have to be lifestyle or functional or autism it can be anything you want it to be it can be
newborns it can be I just really love behavioral health and I just want to focus on the kids who need behavioral health and mental health support it can be whatever you want it to be but you do have to be willing to get comfortable being uncomfortable and just practice a new skill and even when it
comes to the new skill of spending an hour with your patients like yeah that’s like I’m so uncomfortable with that right the very first time I had an hour-long appointment after having worked in urgent care and it is like oh my god how do I
even fill the time right got any trips coming up you want to just like take a break and then come back in a little bit keep chatting
exactly it comes more naturally to some than others but yeah yeah I mean I don’t given the back to the overall question of do you have to have a competitive edge in the business world you have to have something that differentiates you and that makes people want to choose you over the bread and butter pediatrics,
but it doesn’t have to be one particular thing. It doesn’t have to be integrated. It doesn’t have to be pandas. It can be you just making your personality and your ability to connect with patients really shine through how you present yourself on your website, through videos, through social media, through your meet and greets with your family.
Like they feel that warmth and that connection emanate from you whether you intend it or not, right?
right i think the competitive edge in and of itself is simply that you are not the big organizational children’s hospital large employer group you’re you are the competitive edge in dpc doesn’t have to be any of the specific offerings it is the way that you practice and the way that you show up and care in those relationships
the ease of access all the things that we always talk about that is the competitive edge in and of itself so anything above that is gravy and can really help to show what you do and fill your clinical bucket, your interest bucket and all of those things. But I think I wanna reassure
people that are listening that are like, can I even do this? That you don’t need to have some super specialty training in order to be successful because the ability to get in touch with the actual person that knows you, the small patient panel, the ease of access, the unlimited visits, your glowing personality,
the funny jokes that you tell are all that you need in order to stand out and have that competitive edge, period.
Yeah, absolutely. Yeah.
and so everything above and beyond that does give you different competitive edges, but you don’t have to feel like, well, I have to do this if I want to do it because people really talk a lot about pandas or autism or ADHD or integrative or all those different things that we often find ourselves in.
because we had the time to get into the weeds and find those things that we’re passionate about and that we’re interested in when you were talking about lumbar punctures I was it I have a very clear memory of the first lumbar puncture that I
ever witnessed as a medical student and like how long the setup was and getting in there and doing it and then doing it as an intern and being so nervous then it like taking hours and then I don’t even think about that but like I had to do a lumbar puncture on an infant.
And this was when I was in my busy fee-for-service practice and I was like, okay, well, just let the other patient know that I’ll be a few minutes later. We got everything set up and we did a lumbar puncture just in the middle of clinics before we had to send them over to the hospital.
Like it can go from that stress and that dpcpediatricianadmin DPC Pediatricians of the things that we have happened upon his pans and pandas not out of specific clinical interest for me from the start but because there was no one else doing it
and I said I have the time to figure this out and help these families that are in a really tough bind and and the doctors that were doing it both retired in our region and so it kind of fell upon or at least I felt like I had to do something and
in the same way it’s like yeah we’re gonna try this yeah we’re gonna try this I’m gonna talk to some friends and get comfortable with it and then a year two years later like I’m really comfortable with here’s where we start here’s what we do here’s how I talk about it there’s three pillars for the
the management of pandas it’s infections inflammation and mind support those sort of things don’t didn’t start that way but they became much more natural and I can see the picture much more clear than I could and it is much less overwhelming for
me to take on a pandas patient now than it was two years ago simply because I’ve had enough experience with them and I’ve gotten more comfortable with it so I think that that is something that is really wise is you just have to jump in and you have to say I’m going to do this
I’m going to start piercing ears I’m going to start seeing integrative ADHD approaches I’m going to get the trainings I’m going to talk to Claude I’m going to figure these things out so that I can jump in there and do that yeah and you don’t
even have to I mean like you didn’t start out your practice thinking I want to specialize in pandas be a person in the community because nobody like it happened because it just crossed your path and the opportunity came and you’re a person who likes to learn and is curious and takes charge of things like that.
And that can happen with any practice, right? And things can shift. I think it’s okay to recognize that you don’t have to have your absolute forever vision of your practice when you start out. It helps to have a clear vision of what you want to start out with and some general vision.
principles really set so that you don’t unintentionally create something that you don’t want. But at the same time, things can shift. I actually recently stopped doing autism evaluations because I just felt like that era was over for me. And I wanted to, because I was only three days a week in the clinic,
whenever I would do those, I would be taking home a few hours of work and I hate it. I started to like not look forward to it and dread doing those reports. And I’ve learned what I needed to learn from this process. And now I can recognize it really easily.
I recognize the red flags in the patients who happen to be members or come for consults, then I can direct them appropriately, but I don’t have to be the one doing all the hard work of the core evaluation itself. So
As much as it had its time and its place and it helped me learn and it helped me bring in revenue for a period of time, that era is over. And so I just continued that page on my website and it’s fine.
We don’t even have a pandas page on our website. There’s nowhere on our website that you would even get an indicator of it. because that’s not how people find us for pans and pandas it’s through Facebook group and from from other parents and so those are things that like you can decide
how much you want to highlight that as something that you do or not and as you said like you can go through seasons where you’re doing more of that it served its purpose it’s not for me at this time maybe in the future maybe when my demands and
the community demands change then that’s something that we can pick up again
yeah speaking of seasons I also I’m still in the beginning phase of this but I’ve decided I want to see a select number of adults for really premium concierge packages of like three months three to six months and that’s kind of stepping out of my comfort zone
again that’s uh and it’s it would be sort of like an extra few hours tacked on to my three pediatric clinical days a week but I just something just told me recently hey this is your next phase of growth you’re still primarily a pediatrician and integrative pediatrician though what really sparks that is that all of the tools
that I’ve been using on these complex kiddos like Adults need them just as much, if not more, because they have lifetimes of trauma and psychological junk and old wounds and like built up and they need these modalities. And if somebody else in the community was doing what I do with this unique blend of approaches,
I would not feel the need to do that, to fill that space. I would say, Hey, there’s so-and-so and so-and-so and so-and-so, but I have so many parents and people that say, is there someone that can do what you do for me? And I, it’s hard to say, I don’t know. I don’t know that person.
I’m so sorry. And so, yeah, that’s my next adventure this year is adding just a couple of clients. It’s going to be a handful of clients or patients at a time.
I mean I think that’s the thing that like in a traditional fee-for-service practice seeing 40 plus patients per day you just don’t have time to even consider like this is a future for me and then as you get into pediatric direct primary care you find
those things that you’re really interested in like three years ago I wasn’t very interested in ADHD outside of like what I had done for the past decade when it came to the management of ADHD how’s your meds how’s your appetite those sorts of things
and now like having gotten into it and gotten to learn a lot more we take a much more like integrative approach to ADHD families love it and I love it too like it’s very clinically interesting to me and we get to see and check in on patients on a
regular basis so I think that that wasn’t something that I had envisioned but it has come to light as something that I really enjoy and having that ability in your career to not be stuck to doing the same thing because you’re moving too fast to even slow down and see what you really like is
such a blessing that dpc offers yeah
I also want to mention so I did a master class on strategy just a few months ago and you can find it at dpcpediatrician.com it’s one of the free master classes on our courses page so lots of other courses as well that are super helpful but that
one specifically talked more in depth about this principle in my MBA program I took a class on strategy and we read this book I actually have it sitting next to me it’s called the competitive advantage and the professor who taught the course actually wrote this book and one of the principles in the book was
talking about how in order to have a truly sustainable business in whatever sense that it has sustainable growth you have to think about a few principles and he called them foresight meaning that you have to kind of be able to predict something about the future about how the landscape of a certain you know business area will
change and in DPC what we have seen is that the ship of insurance-based healthcare is sinking in some ways. It’s leading to mass burnout, unsustainable costs, all this. So if we had the foresight to say, hey, this isn’t sustainable, there has to be a better way, right?
And then you have to have the insight about something unique that you can offer in your community that will provide value to people and that will attract customers. And then you have to have the cross-site to be able to Interact with other people and other services in a way that like networking, for example,
or maybe partnering with another service. Like in your practice, you have a therapist and you have a lactation consultant and you have those services that you bring into your practice. So you’re working together with others to really enhance what you offer. So that masterclass goes into detail about how that applies to DPC and the reason I
did that is because DPC in and of itself is a really great model and in and of itself like we’ve discussed today has competitive edge in the current landscape but what if we fast forward 10 or 20 years and suddenly there are 10 DPC practices
maybe five pediatric DPC practices in your city how are you then going to differentiate yourself and have that competitive edge in a sea of more competition so that’s something that we should think about even if you don’t think about it right now if you have no competition you should be thinking about it in terms of your future
sustainability of how am I going to truly continue to attract people even when there are multiple pediatric dpc practices around me why will people still choose me over the competition so that’s such a great oof that’s a good thought
um i think uh when i was starting my dpc one of the thoughts i had is if somebody else if i saw one open in town i would be so envious and that was something that i was like i want to be on the forefront of this and if i’m not i’m going to be
really jealous and then i’m playing catch up and i feel like right now if you’re if you’re listening to this and you’ve been on the the fence like let that last question of hers be the thing that pushes you over and says well right now
we are not in a red ocean where there’s lots of competition and you’re competing because they’re closer to you or your prices are lower this right now in pediatric dpc is certainly blue ocean meaning you don’t have competitors and you don’t have a lot of competitors even
even if like i can’t think of any city in the country where there’s too many dp pediatric dpcs like even when you think about phoenix or you think about houston those are huge populations or you know somewhere in florida i mean those are three big sites where there’s more pediatric pediatric dpc than anywhere else that is
still a tiny tiny tiny amount of the overall market but yes if insurance continues along this course which all signs point to you know yes keep past and go then there might be more competition in five or ten years so if you’re like I want to I’ve been thinking about starting get off the fence right now and
make that decision because it’s going to be much easier now than in five or ten years when there’s three pediatric dpcs in your community or something along those lines and then you’re fighting over the location or you’re fighting over price or those sorts of things like right now it’s wide open for you in your community
and so I think the the last point that I’ll say regarding the question of do you need a competitive edge is no you don’t need a competitive edge like you don’t need a special training or a niche or anything along those lines but you do have to then
show what your competitive edge is over their the the parents minds about a regular general pediatrician who you’re there comparing themselves to when you think about it in general, like if I’m going fee for service, I’m going to look on my insurance card and then I’m going to go to the website. I’m going to see, okay,
there’s this office and this office and this office, and I don’t know anything about them, but I assume that they’re all similar in the way that they’re set up and the things that they do and the things that they offer. And I’m going to pick the one that’s closest to me or I’m going to pick the one
that has the most availability that matches my schedule or something along those lines. You need to show how you stand out on a regular basis to the people that need to hear from you, how you actually stand out compared to the competitors who all look the same in the phone book.
but are geographically more convenient to your patients. So you do have to show that on a regular basis as to how you stand out to grow your practice. It is easier in some ways when you have a specific niche that then you can appeal to and you can say, I’m really interested in all these ADHD patients.
And so you are segmenting yourself into where do ADHD patients’ parents hang out and what do they have questions about and those sorts of things. That does make it easier in some ways to stand out, but you do not have to have that specific niche in order to stand out.
But you do have to get out there and share how you stand out compared to the competition, which there are certainly ways that you stand out and compare to the competition, not just being cheaper, not just being location-wise easier for fans.
Yeah. I echo that a hundred times over because that is where I feel like people have trouble and that’s in the whole realm of a marketing. How do you market yourself? How do you make your value proposition really clear to people so that if they spend three
seconds on your website they know why you’re different and why they should choose you and that’s the art of marketing and the sugar marketing and that involves stepping out of your comfort zone and really showing your personality which we’ve never had to do before when you know we worked for a big practice and it was just
like well your insurance assigned me and I just come here or I just randomly called and got a first appointment and I like I just called and they yeah I just called
and they You were open to new patients and here I am in front of you. Yeah, very different. Well, to end on, I want to make sure that you’re all aware because we don’t do a lot of ads on this show.
And one of the things I want to make clear is there are ways that you can work with Marina or I if you’re wanting more help if you go to DPC Pediatricians you’ll find a button where you can do a consult with us which is hopping on a call talking
through what you’re facing and getting help so that you can get unstuck if you’re stuck or if you need extra help when it comes to a specific thing that you’re offering or you just want to test the idea that is literally what we are here for
so go to DPC Pediatrician and check out the consults button to book a call with Marina or I
yeah and there are a ton of other resources a startup guide which i’m in the process of updating and it will be even bigger even longer and better and also a lot of courses you get sign up for a newsletter i spend time creating two really great articles every month in that newsletter that are
specific to DPC Pediatrics so yes if you’re not part of that community please become part of it we would love to have you thank you everyone for listening and until next time
