When you decide to become a doctor, you are signing yourself up for a career in medicine and not just a job. While there are certain areas of medicine where you can be completely off for periods of time, outpatient pediatrics is not often that way. Whether you are in an insurance based, fee-for-service practice or have chosen the path of direct care, you likely won’t have a whole lot of time where you are completely off. The key to living a successful life is to balance your time between your patient’s needs and your own personal needs for family time, personal care, etc. I don’t believe that there is such a thing as true “work-life” balance when you are a physician. You will always have to choose how to prioritize your time depending on who is in front of you at the moment.
One of the greatest advantages of being a direct primary care physician is the enhanced flexibility it offers. As a direct primary care pediatrician, you have more control over your schedule compared to colleagues employed by others. Being your own boss allows you to set your own priorities and structure your work around what matters most to you. And since DPC tends to attract more high needs children, it is important to learn how to set boundaries from the beginning.
Set Expectations
Before you even sign up your first patient family for your direct primary care practice, think through what you would like your boundaries to be. DPC is a unique practice style that affords the patients direct access to the doctor. This direct access can look different for different doctors depending on what your desires and needs are. For example, when I first started my practice and my daughter was in kindergarten, I only took patients that were younger than school aged so that I could do the majority of their care during the school hours while my child was in school. Once she got a little bit older, I opened up my panel to school aged kids and offered after school appointments for days that my daughter was able to stay in after-care at school. This allowed me to both care for patients and be there for my young daughter after school and during the evenings.
Once you decide what your boundaries are going to look like, clearly communicate them to your patient families before they sign up for the practice. Whether that is through verbiage on your website, a discussion that you have during your meet and greet, the patient contract or all of the above, just be sure that your families are aware of what to expect of your time. Setting boundaries and sticking to them allows you to thrive and grow a sustainable practice. It also allows patient families to have the direct access that they are craving within parameters that will prevent you from becoming burned out.
Most people who sign up for a direct primary care practice understand that you, as the doctor, have a life outside of medicine. They just want to know that you will be available when you say that you are. Be honest about your home life responsibilities and needs and just make sure that your patients also get dedicated time where they are the priority. As a DPC pediatrician, I scheduled all my well child visits for an hour long appointment. Not every patient needed the whole hour, but it allowed both me and the child’s parents to not feel rushed. It also gave them the opportunity to address everything that they were concerned about and get all of the questions answered.
Boundaries are Important
Setting your practice up for success from the beginning involves establishing clear boundaries. As pediatricians, we are often caring and giving people that go above and beyond for our patients. While that is a noble quality, a lack of boundaries can quickly lead you down a path of burning out. Clearly communicated boundaries help everyone to know what to expect.
Whether your DPC peds practice is home based or office based, these are some boundaries that I would recommend thinking about how you want to handle.
- After school appointments: most parents will do their best to keep their kids in school all day long, even when they are sick. There were many times that parents would text me early in the day to tell me that their child was not feeling well, but then ask for an after school appointment. The way I handled their request depended on lots of factors. Anticipating this and planning in advance how to handle these situations will keep you from getting frustrated.
- After hours calls/texting: Make a plan for how you want to handle after hours calls and texts. Some DPC doctors don’t allow after hours texting while others answer every text. Decide what works best for you and make sure that your patient families understand your communication parameters.
- Weekends/holidays: Most people expect you to take weekends and holidays off.
- Vacations: Some DPC doctors take calls while they are on vacation while others find coverage from another practice.
While boundaries are important, so is flexibility. I didn’t routinely see patients on the weekends, but if it was more convenient for me to see someone on the way home from something on a weekend, I would see them. In addition, I would try my best to see kids that needed stitches after hours, depending on the time and if I was available. This kept families from needing to go to the ER for things like this, and they were very appreciative.
Honesty is the Best Policy
When I owned my DPC pediatric practice, I was the only employee. I did all of the doctoring as well as the administration. Although it was rare, there were definitely times where I had to cancel a patient’s appointment because something came up in my own life. For example, one year right before Thanksgiving, I got sick with COVID. I had a bunch of patients scheduled that week leading up to the holiday and I needed to reschedule them due to my own illness.
As things like that come up, just be honest with your patient families. You don’t necessarily have to tell them all of the details, but just let them know that you will have to reschedule their child’s appointment or they may need to take their child to urgent care if you are unavailable.
Direct primary care is a great way to practice pediatric medicine. While there are some drawbacks of the model, overall it is a better way to take care of pediatric patients. Both patients and doctors alike benefit from this way of doing medicine. Balancing your time between patient care and home life may seem challenging at first, but with time and the right strategy, you can have a thriving pediatric DPC practice.
Dr. Andrea Wadley is a retired pediatrician who owned 127 Pediatrics for 6 years. She is passionate about helping direct primary care pediatricians to succeed.
