When I launched my pediatric DPC practice in Dallas/Fort Worth in 2018, I felt like a pioneer. While there were other family practice physicians in my area who had successfully implemented the DPC model, I had to learn the specifics of running a pediatric DPC practice on my own. Many of those early days felt like walking down a lonely road. My days consisted of figuring out everything from vaccine protocols to how to build a panel of pediatric patients whose parents were willing to pay out of pocket.
After running a successful pediatric DPC practice for six years, I’m ready to share the most valuable lessons I learned through trial and error. Whether you’re new to pediatric DPC or have been practicing this way for a while, these insights are meant to provide guidance and reassurance. You’re not alone in learning as you go. I hope these lessons will help make your journey smoother than mine was.
Running a Business is No Joke
As a physician, you’re trained to be an expert in medicine, not business. In a DPC practice, however, you have to wear many hats. Not only are you the doctor, but you’re also the CEO, the head of marketing, and the customer service representative. One of the most common tasks you’ll encounter is explaining the DPC model to prospective families. You will find yourself answering “Do you take insurance?” over and over again. It’s imperative to have a clear, concise way to explain the value of pediatric DPC to potential patient families.
Beyond patient education, a DPC pediatrician must also navigate some legal and regulatory hurdles. It’s essential to understand the rules around your state’s DPC laws, and specific issues, such as whether or not you can accept patients with Medicaid. It’s wise to consult with a lawyer who understands DPC to ensure your practice is compliant from the start.
Lastly, in order to avoid being the only employee forever, you need to set up repeatable systems from day one. This includes everything from a standardized onboarding process for new families to clear protocols for scheduling, billing, and communication. Establishing these systems early will not only make your life easier but will also prepare your practice for future growth, allowing you to eventually hire staff to take on some of these administrative roles. By building a scalable foundation, you can ensure that your practice remains sustainable and that you can focus on what you do best, which is providing excellent pediatric care.
Building a Practice Is a Long Game
Before you even see your first patient, you need to have a deep conversation with yourself about your vision for the practice. Who do you want to serve, and how? This isn’t just about demographics. It’s about understanding the specific needs of your ideal families and designing your practice to meet them. Whether you want to focus on newborns, have a passion for managing complex chronic conditions, or want to integrate lactation support, clarity of your mission will guide every decision you make.
Once you have that clarity, the hard work of building your practice begins. A lot of this process comes down to marketing your pediatric DPC practice. In the DPC model, patient families are your customers, and you are responsible for finding them. This means you must become your own marketing department. You need to be visible in your community, both online and in person. This could involve creating a strong social media presence, networking with other small businesses, speaking at local parent groups, and building relationships with OB-GYNs and midwives who can refer new families to you. Consistent, strategic marketing is the best way to build a sustainable patient panel.
Finally, you must manage your financial expectations for the first year or two. A hard truth for many new DPC owners is that you should expect to not be able to pay yourself a full salary for the first 18 to 24 months. Building a patient panel from scratch takes time, and your monthly revenue will grow gradually. It’s important to have a financial runway and a plan to get through this period. For more detailed strategies on navigating this initial phase, you can refer to my article on three ways to push through the early days of starting a pediatric DPC practice. This long-term perspective is vital to avoid burnout, squash the desire to quit prematurely and ensure the long-term success of your practice.
Medical Stuff is Harder with a Small Practice
While a DPC model frees you from insurance paperwork, it introduces new logistical challenges. Obtaining medical supplies and services essential for a pediatric practice can be more challenging than if you were in a larger practice. Vaccines are a perfect example. In a bigger traditional practice, vaccine inventory and administration are handled by a dedicated team with established protocols. As a solo DPC pediatrician, you are now responsible for the entire process: obtaining vaccines, ensuring proper cold chain storage, maintaining inventory, and creating a reliable system to ensure your patients receive their immunizations on schedule. This requires meticulous attention to detail and careful planning to avoid shortages or waste.
Another challenge is navigating relationships with medical supply companies. You may find that Group Purchasing Organizations (GPOs), which can secure better pricing, are a significant help. However, you’ll also quickly realize that traditional medical supply representatives are accustomed to working with practices that bill insurance and order in large volumes. They may not understand your DPC model or how to best assist you, which can make it difficult to get the support and pricing you need.
A small practice also means you don’t have the storage space or the need for large quantities of supplies. Instead of ordering a case of tongue depressors, you need a way to get smaller and more manageable quantities. Finding vendors or creative solutions for obtaining smaller amounts of items is a constant task. For ideas on what kind of supplies you will need, I wrote an article titled “Home Visit Bag Checklist.” Resourcefulness is key to making a pediatric DPC practice financially sustainable.
Set Boundaries Early and Consistently Enforce Them
While direct access is a huge selling point for DPC, it’s a double-edged sword. It’s essential to set and enforce clear boundaries with families from day one. In fact, if I were starting over, I would not offer 24/7 access or after-hours availability. Instead, I would establish and communicate clear expectations for communication channels, response times, and an after-hours plan.
For evenings, weekends, and holidays, it’s also vital to plan ahead. This doesn’t mean you have to be on call all the time. You can use technology to your advantage, such as a secure messaging app for non-urgent questions during business hours, while designating an emergency-only phone line for after-hours. Clear guidelines around what constitutes an emergency versus a routine question need to be non-negotiable. For more ideas, you can read an article I wrote about boundaries in pediatric DPC. Setting appropriate limitations around your time from the start protects your own well-being and ensures your practice remains viable for years to come.
Home Visits Only Are Difficult to Sustain Long Term
While the idea of a practice built entirely on home visits is appealing and I did it for 6 years, it presents significant challenges that can limit a practice’s long-term sustainability. The logistics of a mobile practice naturally limit the number of patients you can realistically serve. To maintain a reasonable balance between working with patients and being available to your family, you need to keep travel time manageable. This often translates to restricting yourself to a specific geographic radius which in turn limits your potential patient panel.
Furthermore, home visits are inherently more time-consuming than in-office appointments. There’s time spent in the car, parking, and setting up and packing up equipment. This extra time requires consideration. As a result, you must charge more to make your home visit practice successful and profitable. For a deeper dive into how to account for this time, consider the unseen patient time considerations.
Finally, a home-visit-only model requires special considerations beyond just the extra time. You need a dedicated system for carrying all your supplies, ensuring you have everything from a mobile electronic health record system to the right medical equipment for every possible scenario. Before committing to a home-visit-only model, it’s helpful to think through these logistics. Here are five things to consider for pediatric DPC home visits. Planning ahead is important when you set out to see patients via home visits only.
Rewarding, but Challenging: Pediatric DPC Practice
Shifting from a traditional practice to a pediatric DPC practice is a profound change that can be incredibly rewarding. The DPC model truly offers a path to reclaiming your professional autonomy, allowing you to build the kind of practice you’ve always envisioned. You’ll forge stronger, more meaningful relationships with families and finally achieve a healthier balance between your professional and personal life.
However, it’s essential to be realistic.This journey is not easy.
It demands a significant amount of entrepreneurial spirit and a willingness to embrace challenges that extend far beyond clinical medicine. You are not just a doctor. You are a business owner, a marketer, and a boundary-setter. By preparing for the logistical hurdles and financial realities, you can build a sustainable and deeply satisfying practice that allows you to focus on what matters most, providing exceptional care to children and families on your own terms.
Dr. Andrea Wadley is a retired pediatrician. She owned a home visit only pediatric DPC practice from July 2018 to December 2024. She continues to be passionate about helping other pediatricians find freedom through direct primary care.
