Managing patient expectations is one of the biggest challenges in direct primary care (DPC) pediatrics—especially when your practice is home visits only. Unlike the traditional system, DPC fosters a more personal doctor-family relationship, which can be both rewarding and complex.
Many families turn to DPC after feeling dismissed by conventional care. Their questions have gone unanswered and their concerns have not been addressed. As a result, some may rely on non-evidence-based sources of medical information out of frustration. When they finally find a pediatrician who listens, their expectations for care and access can be high—sometimes overwhelmingly so.
To sustain your practice and avoid burnout, it’s essential to set compassionate but firm boundaries from the start. Here are three ways to manage patient expectations in a pediatric DPC home-visit model.
Managing Expectations for Minor Visits
Pediatricians are used to quick visits for issues like ear pain or red eyes—diagnoses like otitis media and conjunctivitis often take just five minutes in the office. But for home-visit-only pediatricians, the challenge isn’t the visit itself—it’s the travel time. These “minor” visits can quickly become inefficient without a plan.
I approached them in several ways: for trusted families, I might call in antibiotics and follow up with a quick visit during the next day’s rounds. Sometimes, parents used a camera otoscope to send a photo of the eardrum. Other times, I’d meet families in a car—whether at my home, my husband’s office space, or even a local parking lot. Post-COVID, “car visits” became more normalized and convenient, and families became used to this format.
Another time-consuming but common issue is ADHD care. While not a minor concern, most of the process—screening, follow-up, and even diagnosis—can be handled via telemedicine. I’d combine the initial physical exam with a well visit, sent the parents and teachers the rating scales, and followed up on all of the information with the parents over video chat. This saved travel time for me, and families appreciated not having to see a separate specialist.
Lastly, ear piercing can be considered a minor visit, and it becomes tricky to schedule as your practice grows. I initially offered it to both patients and the general public, but coordinating with well visits for my own patients was far more efficient. For non-patients, travel and setup time made the service costly and less practical. While some physician parents were still willing to pay, most found the price prohibitive. You don’t have to offer ear piercing, but if you do, carefully consider the time and cost involved—especially in a home-visit model.
Responding to Parent Requests
For many of the reasons that I mentioned in the opening of the article, parents who choose direct primary care pediatrics often have higher needs, especially when they first sign up. While it is essential to establish clear and consistent boundaries with all of the families in your practice, it’s also okay to have some flexibility while you are laying a foundation of trust. Just don’t let it get out of hand to where you can’t pull things back.
Decide in advance how you will address these demands. It will go a long way to protect your peace and help families to know what to expect.
- Same day visits
- Requests for immediate responses to text messages
- Asking for antibiotics for every sniffle
- After hours / weekends / holidays request for visits
- Use of the phrase, “I pay for this, so I deserve….”
In my six years of experience as a home visit only DPC pediatrician, the majority of families in the practice respected me and my time. Most of them were grateful for the direct access and the quick and thorough responses to their concerns that I could provide. Only a few of them had these demands that I listed. I ended up firing some of the demanding families from the practice while others decided to move on to someone else. However, most of the time, I was able to gently guide these patients towards appropriate boundaries.
Ways to Improve Efficiency as a Home Visit Pediatrician
Efficiency is the name of the game when you choose to do home visits. As a DPC pediatrician, you are charging patient families a membership fee. Often this means, they pay the same price whether you see their kid twice in one month or not all at. In order to stay in business, your goal should be to maximize these face to face visits and do the rest of the majority of the patient’s care via other means of communication such as text messaging or video visits. This is the part that makes home visit direct care pediatrics tricky. You need to price things well and master your overhead in order to pay yourself and run a successful practice.
These are some ways that I maximized my efficiency:
- Saw multiple kids in a family at one time
- Without the demands of insurance, you can see kids for their well visits earlier or later than their birthdays/ yearly.
- This is especially true if they don’t need vaccines at the visit or need vaccines that have time flexibility.
- See a sick kid in the family during another kid’s well visit.
- Telemedicine/ video visits for helpful
- Video visits are great for mental health / ADHD follow ups.
- Telemedicine is also a great way for parents to discuss things with you with or without their children present.
- Visits over video chat can also be a great way for a teen to have a “private” conversation with you.
- Supply families with tools
- With the advances in technology, you can provide families with/ have them purchase home pulse ox and/or video otoscopes.
Managing patient family expectations is key to success as a home visit only DPC Pediatrician. Dealing with minor visits, managing families’ expectations and maximizing efficiency are three ways to shine as you offer home visits to your pediatric patients.
For information on how to start your own pediatric DPC practice, download our free start-up guide.
Dr. Andrea Wadley is a retired pediatrician who is passionate about direct primary care. She owned 127 Pediatrics, a pediatric DPC Home Visit only practice in the Dallas/Fort Worth area for 6 years. She is currently working for her husband’s insurance agency and writes articles for DPC Pediatrician.
