Listen to the podcast here: Is the Grass Really Greener in DPC?
Episode Summary: In this podcast episode of DPC Pediatricians, Phil and Marina explore whether the grass really is greener in Direct Primary Care. They share both the benefits of DPC—including greater autonomy, flexibility, and the ability to practice medicine on their own terms—and the challenges of practice ownership, such as financial uncertainty, marketing, and self-accountability. Ultimately, they offer a balanced look at why DPC can be incredibly rewarding while acknowledging that it comes with its own set of challenges.
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 going to be talking about whether the grass is really greener in the world of direct pediatric care. That’s a question that we got from One of our registrants to the virtual summit happening in September. A great question.
We may have touched on it a little bit in a past episode when we were first starting the podcast, but it’s been two and a half years and it’s worth touching on this question again, because it is definitely one of the most common questions we get from people who are contemplating whether the leap into DPC would be worth it for them. So Phil, I’m curious, maybe you can start us out with your perspective on this question.
So I’m gonna quickly read the question that came in because I think it is really insightful and kind of sets the stage in a good way. This was a person that registered for the virtual summit and said, Her 12 month goal is to know whether I want to do this or not and have enough information to know if it could suit my life. I currently work two to three days per week and make 200 K per year. So I think I’m really wondering if the grass is actually greener on the other side, despite the frustrations of working for the man. So this is a really good question.
And I think this is where a lot of people are right now. Like things are okay. Could I do this for the rest of my career? Well, I’m not really sure, but If I take this leap, is the grass really greener? And I think in the big picture, well, one, first and foremost, I think it is much greener than it was before, despite the things that we talk about, all of the different things related to starting your practice and maintaining your practice and all of the business things that fall much more squarely on your shoulders. I do think the grass is much greener on this side.
From the pay And on the patient side of things, my patients have a lot more time with me. We are able to go into a lot more depth. We’re able to handle a lot of hassles or inconveniences a lot easier. And patients stay, which tells me that they are very satisfied with their care.
They send their friends and family. So I think a grass is greener from the patient side. Yes, definitely. From the physician side of things, it’s greener for me compared to the work environment that I was in before. I was actually, this is an aside that I wasn’t going to share, but I will. Marina’s a big reader.
I’m a big reader. I track all my reading on Goodreads because I get the dopamine hit of like putting it in and the deadline of I have to read this many books by the end of the year. But I was looking back at my old challenges.
And in 2017, I had a book on my list that I read called The No Asshole Rule. And it made me stop and think. At one point in my career, I was spending my time outside of work reading books on how to deal with colleagues because… Because I was surrounded by some.
I had some great people that I worked with. I’m not saying that I didn’t, but I had some that I had to read books on how to handle them. And so being outside of the system, being outside of the administrative burdens, being outside of people that don’t have the same values and don’t have the same interests that I do has been so much greener for me. I also have a lot more flexibility and control over my schedule.
Last week, our kids were in this camp and I did not realize that there was like a performance on the last day. It was a performing arts camp. Of course, there’s going to be a parent performance. If this had been in My traditional practice where I had, you know, 20, 30 patients scheduled, I would have just had to miss it. But I just texted the families and said, Hey, I didn’t realize my kids are in this performing art performance at 11 o’clock.
Would you be able to move up? And like, oh my gosh, yes. My niece is in that too. Of course we’ll move. The flexibility. And I think that that is one of the things that makes the grass greener for me as well as like, I’m done at 430 every day and not just me being done, but our whole team is done at 430. And so I’m home making dinner, spending time with my family. Exactly. Yeah, because we don’t want to give a completely biased perspective.
There are challenges. From my perspective, I think it’s funny you mentioned books because when I was at the peak of my burnout many years ago, this is about 10 years ago when I was working at a community health center and I started to recognize, oh my God, did I just waste a decade of my life pursuing this training and career that is making me kind of miserable and is there a way out and all this stuff. And I did eventually work with a burnout coach who helped me to see that I had options, but also I was at Barnes and Noble like every weekend.
I was reading books. Finding books about motivation. How is it that my organization is using carrots and sticks to motivate people instead of intrinsic motivation. Things about a lot of business books, like The Culture Code, Leaders Eat Last. Trying to understand the dynamics that were happening and that I was observing within the organization to try to make sense of why is this such a sucky place to work and why is it that as a physician who has… More education, more training than anyone above me. Why is it that my voice is not valued, right? And then I also attended like a burnout conference and everything.
But I think you and I were on parallel tracks trying to use both to the expense, right, of what was going on. But in terms of the grasping greener, for me, the leap has definitely, no question about it, been worth it. It just opened so many doors for me to, first of all, become the kind of pediatrician that I really wanted to be, the kind of physician and an integrative physician that has brought me so much joy.
I’ve had the schedule flexibility to go to a lot of seminars, a lot of conferences, a lot of trainings. And also because of the finances of running a business, you get to run those expenses as a business expense. I mean, is it still money? Yes. But it’s much less expensive to you when it’s going through as a business expense and you’re not paying taxes on it as opposed to using your own personal funds to do that. And so, yes, absolutely.
Like I learned so many integrative modalities. I did my fellowship. I’ve met some really cool people. And I get to practice medicine in a way that I feel truly addresses… What healing is, which is wholeness and seeing the whole child, seeing the whole person, seeing the whole family dynamic, right?
And getting to the root causes of certain cases, maybe not all cases, but many cases where I know that this child has been to physician after physician, after specialist, after ER, and nobody has asked them the questions that I have the time to ask them.
Right.
And that’s a really beautiful thing. So for me, that alone would have made it worth it. But also… I’m the kind of person I like to have control and autonomy and freedom. I really hated practicing medicine within settings where I felt like I had my hands tied behind my back and I had good ideas,
but everybody said, no, you can’t do that because of this stupid rule. And no, you can’t do that because of this stupid restriction or this red tape. Or that’s just not the way we do things. Just fall in line, Marina. Just stop complaining.
That was how I felt working for other people was that I just couldn’t shine in the way that I was meant to shine. And yeah, so I agree that the schedule flexibility, totally worth it. The autonomy, totally worth it. The freedom to practice medicine in a truly aligned way
where it’s not also it’s not just about helping our patients to heal. It’s also about healing ourselves. I’ve been able to really work on dissecting some of the issues that were developed within me through a really toxic system of medical training and education and early career. And I’ve been able through the modalities that I’m learning also help.
And so I think in an ideal world, we allow our physicians to be as whole as our patients, right? And we facilitate that for, and it’s a symbiotic relationship. The more healed and whole our physicians in society are, the more healed and whole our patients are going to be. So that’s my take on that.
So I’m curious, Phil, how about for you regarding…
So just to echo one thing that you said too, is I heard so many times before I started my own practice, that’s not the way it’s always been done. And like, just, I brought the research, I brought the data to support, we should do it this way instead,
and just constantly And now being in a practice where we get to make decisions on the fly with our small team without having to go through committees or like we have things that work out, we have things that fail, but we’re able to do things because we’re willing to take those risks that big organizations,
even when I was an owner of the practice, wasn’t able to get any traction behind. I think on the flip side, what parts of it are less green? Number one, I think it’s lonelier. And I think that that is something that people don’t realize is like not having all
the same colleagues that you previously had and people that have gone through it. You do have to find a way to fill that void of often, especially in pediatric DPC, you’re starting solo. Maybe you have one employee or something along those lines, but it’s a much different way of practicing when you don’t have colleagues that you’re seeing,
when you don’t have somebody that you can bounce something off of. You find ways to do that and you find communities and groups that will allow you to do that in different ways. But I think that is one thing to keep in mind. And especially because physicians often work so much
that like their colleagues become pseudo friends or real friends, but that void requires filling. Otherwise it can be kind of lonely, especially when You are suddenly kind of the boss and also elevated above your employee in terms of responsibility, liability, risk, all of those sorts of things, that it can be a little bit lonely.
And then I think along those same lines that the… Maybe a lot of this is related to loneliness. You don’t have the same support and accountability that comes from having other people that are in it with you and depending on you. And so what that looks like is you have, yes, you have a lot more time.
But you have a lot more time that you can dilly-dally and waste and not be efficient and then beat yourself up of why can’t I just do this? Well, before I had this external accountability of like, eventually somebody’s gonna be like, hey, why aren’t you signing your notes? Why aren’t you doing this? Why aren’t you doing that?
And when you’re the boss, that accountability has to come from somewhere up here. Otherwise things fall behind, things fall through the cracks. You don’t have those external kind of scaffolds that are holding you up. And so I think those are, Two very manageable mountains that have to be considered and taken
into consideration as you enter and grow in your career and figuring out how to fill those. And that has been something that has been just a challenge for me to kind of figure out how to make those things happen. And then I think the third thing that,
and the last thing that I’ll say in terms of the grass being not so green is you have to figure out how to get new patients. You have to figure out how to get out there because it’s not simply, they looked at their insurance card. It said where to find a provider.
And so then they went on the website and they found one that was close to their zip code. And then they called around and found somebody that was accepting and they signed up and they don’t know you or anything like that. These are relationship-based Patients and families.
And so it takes more work to get in front of them and to then to talk to them and then to make them understand the model and what you have to offer. And so you have to figure those things out again, very figureoutable, but something that takes more work than just like putting your,
you’re not, you’re not putting your shingle up. Somebody’s putting your placard on the door and they’re accepting new patients for you and they’re getting your credentialed and insurance and all those other sorts of things that get done. It just requires you to put yourself out there in ways and figure out different ways.
Obviously this is all very figureoutable. There’s so many successful pediatricians that have done this, that there’s no reason that any pediatrician couldn’t do that. But those are things that are definitely worth considering that should be taken into account when you’re saying, is the grass really greener or should I stay where I’m at under the frustrations
of working for as this questioner had said the man. How about you, Marina? What are the things that have been spots in the lawn where it hasn’t been quite so green?
Yeah. Well, I think one thing to definitely consider that represents a little bit of a browner spot for me is the tolerance for risk. You have to ask yourself, what is my risk tolerance? Because any entrepreneur starting a business has to have some tolerance for risk.
If you’re the kind of person that’s just too afraid and is never willing to step out of your comfort zone and And it’s just like, no, no, no. The prospect of failing, the prospect of losing money, it’s just too much. I can’t do it. And it’s probably not for you, right?
You have to have some tolerance for risk. And I definitely felt that those moments of terror in the beginning where I was just seeing the money, I was seeing my bank balance fall further and further as I purchased supplies and I set things up and I thought, oh my gosh, I’m hemorrhaging money.
And is this money ever going to be recovered? And am I ever going to, I had to, I had to visualize paying myself my first paycheck and all of these things just to keep myself motivated that yes, this was possible. But the first year I relied on my primary income to keep myself afloat, pay my bills.
I was still doing PRN shifts in urgent care. So for me, I didn’t have an established base of patients who knew me in my community. And I was definitely more introverted and shy on the marketing front. And it took me a long time to really figure that out and get more confident
in forming the relationships I needed to form with other business owners in Just speaking about my services in a way that wasn’t hesitant and didn’t start off with, well, I don’t take insurance. But so that took just some time. And a lot of this is personal development. It’s not just about a business checklist.
It’s about developing yourself as an entrepreneur, as someone who can market yourself, as someone who feels confident about the services that they offer. Despite working outside of the insurance model, then that can be hard because a lot of our, even our colleagues say judgmental things about like, oh my gosh, why would you not take insurance?
And you’re just treating rich entitled families and that can get in our heads, right? So we have to get really good about ignoring some of the negative chatter that’s out there and also our own negative mind chatter and just saying, nope, I really,
My heart is telling me this is the way to go and this is a way for me to practice in a more aligned way and just trust that instead of trust all the fears and all the stuff other people are saying. So the financial part of it was hard.
It really took about a year to start paying myself and then I was paying myself very little and then it took two years to pay myself at least a decent amount where I could start, stop doing urgent care shifts and then three to four years to get in a happy, happy space.
So I think that that’s something that You hear some of those really rapid success stories and you think, okay, if it takes me six to 12 months to start making a full salary, I can do that. But you have to consider what if it takes you two to three years?
So you really have to ask yourself, what’s my risk tolerance? How am I using my savings or creative side gigs or things like that to give myself a longer runway in case it does take me longer? It’s better to err on the side of caution. Then plan for instant success and then be disappointed when it doesn’t happen.
And there can be a lot of troubleshooting along the way too. I think the responsibility you alluded to also rings true that in the beginning, it was just me. So I was also a little lonely, like you said. It was just me in the office greeting patients,
taking phone calls, figuring out how to centrifuge blood samples and all that stuff. And with that also comes a lot of administrative So even when I’m not seeing patients, I am responsible for making sure my malpractice insurance is paid, making sure my licenses are up to date, making sure that overseeing my team,
making sure supplies are ordered and all of that stuff. So you are ultimately responsible for all the business back and stuff. You have to consider that when you’re designing your schedule. Am I going to give myself some administrative time that’s protected so that it’s not like, well, this is my Clinical schedule,
but I didn’t think about all those other administrative responsibilities and shoot, I didn’t make time for them.
Right.
But yeah, I started out, I swerved around a little bit. It was lonely in the beginning and then I started to hire employees and now I have For employees and I’m responsible for their paychecks. I’m responsible for running their payroll. I’m responsible for making sure that we have enough money that everybody gets paid.
So there is that level. And then when issues come up because interpersonal issues can arise and I have had employees who were just not a good fit and eventually ended up leaving. I have to manage all those interpersonal things because my employees come and complain to me and I am the one who has human resources in addition
to Business administration and CEO and clinician and all of that stuff. So it’s responsibility and not everybody has a lot of employees. Some people really dream of having a micro practice and maintaining a micro practice, whereas other people really want to grow their team and want to have a little community so that it’s not as lonely.
And it’s up to you what feels optimal for your situation.
Love it. I think those are really good insights into where the grass looks greener, where it doesn’t look as green, or maybe it’s a little bit more brown. I think that hopefully over the course of all these episodes and the community on Facebook, the virtual summit, the in-person mastermind,
there’s a whole community of people that have made the leap and said, yes, the overall grass is much greener, despite having to learn all these things. And I think The only things that I would end on are one, physicians are great learners. And so we have the ability to learn like no one else.
And all these other businesses that are starting the million plus businesses that launch around the country, a lot of them have a lot less flexibility and are taking on a lot more risk than we are because there is always a way out and another option. You say like, I’m putting everything into this,
but if for some reason you changed your mind or you had a career pivot or it didn’t work out the way that you were hoping, there’s always another physician job out there. And so I always try and like encourage people like, yeah, well, what’s the worst that could happen?
Well, I would have to close and then I have to get a different job. Okay. Well, does that still seem like it’s worked to you? Because those are things that you have the ability to do like almost no one else in the world when it comes to starting a business is you have that flexibility
and higher ability to do that and to keep learning and to figure out how to do all those sorts of things.
Yeah, definitely. I would say one, just one last thing, big things to consider for yourself as to whether the grass would be greener for you. Consider your values. What are your top values, right? And how are they being met or matched in your current employment situation versus how they would be met or matched in DPC?
Consider your risk tolerance, especially financial risk tolerance, but also risks in terms of like, What if I get patients who are not a good match? Am I going to be comfortable firing them and things like that, right? And also your desire to practice creatively.
Are you okay in the current system and you’re like practicing medicine in a way that feels okay for you? Or do you really want to spread your wings more and have that freedom to practice in the way that you feel is best? So big three topics to consider and ask yourself as you decide for yourself whether
the grass would be greener.
Now, if you’re like, okay, I’m still not quite sure, or I’m definitely sure, we have a virtual summit coming up September 24th and 25th. The first day is really designed for those that are in the curious or launching event. It’s a virtual summit, so you don’t have to travel anywhere, you don’t have to get a babysitter,
and we specifically designed it so that you’d have time before and after to catch up on any patient communications, inbox visits, and those sorts of things. If that’s of interest to you, it’s summit.dpcpediatrician.com to get your ticket, and ticket prices do increase on September 1st,
so don’t Put it off and procrastinate the way that I do for literally everything in life. Just go right now. You can sign up from your phone. You’ll get the tickets and then we will see you at the summit.
All right. Thanks everyone. Until next time.
