A home visit only pediatric direct care practice sounds ideal to a lot of pediatricians. Home visits afford you the luxury to spend time with the patients and get to know them in a deep way. In my experience as a pediatrician who did home visits only and having mentored others who have done the same, home visit only practices take a lot of diligence to make them profitable. There are a lot of things that you need to think about before you start out on this adventure.
Many direct primary care doctors start off their practices by offering home visits and telemedicine only while they are setting up a physical space. This article is intended for pediatricians who want to do home visits exclusively, but could also be helpful if you are considering home visits as an add on to your office based practice.
How many patients can I see in a day?
As a home visit only pediatrician, you need to take into account your drive time between patients before you can consider how many patients that you can see in any given day. On my busiest days, I could see between 6 and 8 patients in a day. These were patients who lived in close proximity to one another or siblings of patients that I already had on my schedule for the day. For this reason, it is important to price your practice appropriately to account for these numbers.
How many patients do I want to see in a week?
One of the many reasons why pediatricians start direct care practices is for the flexibility. When you are your own boss, you can set up your practice around your personal and family needs. Many DPC pediatricians only see patients on certain days of the week and/or at certain times of the day. When I owned a home visit practice, I scheduled the majority of my patient’s visits during the hours of the day while my daughter was in school. This limited the number of patients that I could see each week.
Do I want to work everyday?
This question goes along with the previous question. Be sure to price your practice and set expectations in a way where you don’t have to see patients every day if you don’t want to do so. Most everyone expects you to take weekends and holidays off, but also consider
Do I want to offer around the clock access?
Home visits themselves are not the only things that will occupy your time as a direct care pediatrician. The cornerstone of direct care is allowing the patients to have direct access to you as the physician. Before you start your practice, decide what you want that to look like.
Am I going to offer telemedicine/ remote visits?
Home visits are not a very efficient way to see kids who have “minor” complaints. Additionally, it is not always necessary to see a patient in person for certain things. Think about how you would like to offer care in different ways to meet the needs of your patients without spending so much of your day in the car.
Am I going to offer “one time” visits?
Our current insurance based health care system is set up on a one-off fee for service visit model. It can be difficult for people to wrap their head around the concept of a membership based medical practice. Often, pediatricians will ask me if they should offer “one-time” visits to patients instead of locking them into a recurring payment model. It is absolutely okay to offer these types of visits, but you just want to think through them well before you put it out there.
What should I think about before offering “one-time” visits?
- What is your ultimate goal in offering these types of visits?
- How are you going to manage the follow up of these patients who are no longer paying you?
- How are you going to price the visits so as not to compete with your own membership based model?
How many patients can I comfortably manage?
Managing a panel of patients includes not only home visits, but also managing all of the ways that patients can contact you. Also, if you have been in medicine for any period of time, you know that the work that you need to do for the patient doesn’t just end once the visit is over. Consider these parameters when you are deciding on how many patients that you want to add to your panel. In addition, younger kids require more visits and more work than a panel of school aged kids or older (in general). When my panel size got to about 100, I felt pretty busy because my patient panel was full of young babies and toddlers.
You should also take into consideration your life outside of medicine. If you are the primary parent to young kids, you may want to manage fewer patients than if you are someone with fewer responsibilities at home.
Are people in my area of town willing to pay for this premium service?
Parents like the idea of a home visit only practice, until they learn that they have to pay for the service. Not every town or city would be conducive to supporting a home visit only pediatric practice. The most successful home visits only pediatricians are able to create this type of practice for a certain neighborhood or geographic location where your service is in demand.
How far do I want to drive?
When you are setting up your home visits only practice, think about how much you want to be in the car. Set a mile and/or time radius within which you are willing to drive and stay within those parameters. I would recommend charging an extra fee for patients who want to join the practice, but live outside of your set driving radius. Alternatively, you could charge an extra fee for any home visit.
Final Thoughts
Practicing as a direct primary care pediatrician who offers home visits only is a rewarding experience. It was a refreshing change from working inside the insurance based medical system. However, owning your own business is not always easy. My goal in writing this article was to give you things to think about and learn from some of the things that I had wished I had known ahead of time. You can plan and prepare, but you will never know if owning a pediatric direct primary care practice is right for you unless you give it a try.
If you want more information on how to start a DPC Pediatric practice, download our free start up guide.
Here are the other articles in my home visits series:
The Math of Pediatric DPC Home Visits: 3 Ways to Manage Patient Expectations
The Math of Home Visits by Doctors: Master Your Business Overhead
The Math of Pediatric Home Visits by Doctors: Unseen Patient Time Considerations
3 Must Haves for Home Visits: Pediatric Direct Primary Care
Home Visit Bag Checklist for the DPC Pediatrician
Dr. Andrea Wadley is a retired pediatrician who is passionate about helping pediatricians run successful DPC practices. From 2018 to 2024, she owned 127 Pediatrics, which was a home visits only pediatric DPC practice. Currently, she is working in her family’s insurance business and writing articles for DPC Pediatrician.
