For the first eight years of my career as a general pediatrician, I cared for newborns in the first two days of life as a newborn hospitalist. While this was an amazing job to have straight out of residency and I loved every minute of caring for babies and families, I missed general pediatrics. When I chose pediatrics as a profession, I imagined myself being a child’s pediatrician for the duration of their childhood.
As I surveyed the horizon of pediatric care in my local community, I saw that the majority of practices were owned by a single hospital system. All of them were fee for service, insurance based practices. For a variety of reasons, this model did not fit well with my goals as a pediatrician and my personality as I relate to patients. I wanted to have time to get to know patients and take care of families in a holistic way.
When I researched the direct primary care model, I felt like it fit my personality and my practice style better than the insurance based model. At the time, the problem was that I would be the only pediatrician practicing using this practice model in my area of town.
Benefits of Home Visits
As a result of both my desire to keep my practice overhead costs low and to provide care in the best way possible for families, I chose the home visits only as my practice model. While home visits for pediatric DPC is not for everyone, it was the model that worked for me.
Direct primary care offers the opportunity for physicians to have more freedom in the way that they practice medicine. You can offer home visits only or you can offer home visits as part of your (mostly) office visit based DPC practice. In this article, we will look at a few things to consider when offering home visits to patients through your direct primary care practice.
Safety
One of the most frequently asked questions that I get when I tell colleagues that I do home visits only is “well, what about safety? Do you feel safe going into people’s homes?” If you think about other service providers who enter people’s homes to deliver services, safety is a concern for them as well. There are ways that these service providers can account for safety that we as solo primary care doctors offering medical services in people’s homes just cannot.
However, there are a few things that you can do to account for your safety.
Meet and Greet
A great way to get a feel for a family and to do the preliminary work to ensure that they are a good fit for your practice is to offer a free meet and greet. As a home visit pediatrician, I offered meet and greet discussions over video chat. You can describe your practice, how the direct primary care model works, tell them the cost of the monthly membership and how to receive medical care in your practice. Often, in a 20-30 minute discussion, you can get a feel for whether or not the family is a good fit for your practice.
If you get a bad feeling when you speak with them or something that they say brings up a safety concern in your mind, you can politely decline offering them a spot in your practice. While this is not fool proof, you can generally get a sense of whether or not you will feel safe going to this family’s house.
Someone Knows Where You Are
Another way to protect your own safety while you are taking care of patients in their home is to have someone who always knows where you are. While I ran my practice by myself, my husband always knew where I was when I was out seeing patients. You can give this person admin access to your electronic health record and/or your schedule so that they can have an idea of where you are supposed to be and when to expect you to return.
Safety Devices
In addition to these things, there are also many companies who make and sell personal safety devices/ panic buttons. They come in all different forms that you can either wear or keep on your key chain. Of course, you would always want to bring your personal cell phone with you to call for help if needed. However, these devices can offer a more discreet way to alert the authorities that you need help immediately.
Logistics
Whether you are setting up your direct care practice as home visit only or are offering them as an add on to your office visit based direct primary care practice, you need to consider some logistics involved with visiting pediatric patients and providing medical care in their home. Offering primary care services, addressing health concerns and direct patient care can all take place in your patient’s home. However, home visits limit the number of patients that you can see in a day, so make sure that you account for that in your membership fees.
Scheduling
When you are taking care of pediatric patients in their home, you need to account for how to schedule these visits. In general, I would schedule or allot about 30 minutes for a sick visit and an hour for a well child check. Most often, the actual visit wouldn’t take this long, especially as I got to know patients and could see sick visits fairly quickly. But this amount of time gives me a cushion of time so that I am not always feeling rushed.
Newborn visits can take longer than an hour, especially the first few visits and when this is a parent’s first baby. I would always allot more time for the initial few visits with a newborn to give the parents time to have all of their questions answered. This would also ensure that I could provide the level of care that I expected from myself and that the family deserved.
Driving
As you set up your schedule for seeing patients in a day, be sure to account for driving time between patient homes. As a home visit pediatrician, I limited my driving radius to a small enough range that I could generally get to my patients’ homes from my office in 5-30 minutes depending on the distance. In addition, for scheduled visits, I would try to cluster several different patient visits in a particular geographic region.
Supplies
When it comes to how to choose supplies for your home visit pediatric practice, you need to consider several things. Your goal is to bring the entire contents of an office visit practice to your patient’s home. This means that you need to choose items that are easily moved and able to be packed up into a reasonably sized container. I found a rolling suitcase/ tool box set on Amazon that I used to pack and transport all of my supplies to home visits.
Portable
Choosing supplies that are easily portable is key. When I first started, I used a portable standiometer to measure kids’ heights. While it was portable, it was still heavy and I needed to assemble it at each family’s house before I could use it. Later, I switched to a standiometer that measured height using an ultrasound sensor. You hold it to the child’s head and when it is balanced, you can push one button to measure the height of the child. It weighs less than a pound and has saved me from lugging around the much heavier standiometer.
Other examples of items to buy that have portability are scales, devices for measuring the height of a baby (lying down) and a portable otoscope/ opthalmascope. You can find portable scales and other items wherever you buy your medical supplies. I found a lot of great supplies on Henry Schein as well as Hopkins Medical.
Different Types of Visits
As part of your home visit practice, you need to decide what kind of services that you would like to offer and buy your supplies based on what you want to do. As a general pediatrician and lactation consultant, I offered in home well child checks and as needed sick visits for my membership pediatric panel. My sick visits included a limited number of point of care testing for certain conditions such as flu and strep. I also offered a limited number of procedures such as stitches, gluing abrasions, staples and administering vaccines.
In addition, I offered tongue tie clippings and lactation/ breastfeeding medicine consults to both members of the practice as well as families outside of my regular practice. As a result of offering these different types of procedures, I not only needed the specific supplies for each kind of procedure, but I also needed a way to sterilize my equipment.
Pets/ Animals in the Home
One thing that I did not take into consideration when I decided to do a home visit only practice was pets. Many families, including my own, have pets that live inside of their homes. You need to take into consideration what kind of animals that you feel comfortable with and whether or not you have allergies to certain kinds of pets.
Most families will put their dog(s) away whether or not you ask them to do so, but others consider their animal a part of the family and don’t think about it. This is always something that you should feel comfortable with verbalizing to the family prior to your arrival at their home. I felt comfortable with most of my patient family’s pets and got to know some of their animals as part of my visits to their home.
Insurance
Another consideration when setting up a home visit only practice is finding the right malpractice insurance. Not every insurance company is able to write a policy that covers you as a home visit pediatrician. It is best to work with an insurance broker who can understand exactly what you are doing and find you the best policy to cover you in the event of a malpractice claim.
In addition, it is also very difficult to find a business owner’s insurance policy to cover your home visit only medical practice. Most insurance companies do not know how to risk assess for a home visit medical practice.
Home Visits Are a Joy
For six years, I practiced direct primary care pediatrics as home visits only. I developed deep bonds with many of my patients and their families. My love of medicine was renewed and refreshed through my home visit practice. There were many times that I had the privilege to walk alongside families in both the good and bad circumstances of life.
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Dr. Andrea Wadley is a pediatrician who owned 127 Pediatrics from July 2018 to Dec 2024. 127 Pediatrics was a home visit only pediatric DPC practice. Although, she retired from clinical medicine in Dec 2024, she is still a big advocate for direct primary care pediatrics.
