In 2018, I started a pediatric direct primary care practice in an area of the country where direct primary care was largely unknown. Additionally, at the time, there were very few pediatricians in the entire country that were practicing medicine in this way. Over time, I was able to grow my practice and serve many families. Along the way, the pediatric DPC movement started to catch on and I was able to help many pediatricians start similar practices. In my experience, these are some of the mistakes that I made early on and ones that I have also seen other colleagues make as they have started their practices.
Charging Too Little
The premise of a direct primary practice is to create an affordable practice where patients have direct access to the pediatrician. While affordable can mean something different to different people due to a variety of factors, charging too little for your services will cause your business problems in the long run. It can even cause you as the doctor to grow weary and possibly even burn out.
When you are first starting out, introductory pricing for a small number of new patient families is a great way to get families in the door and create a group of raving fans for your practice. Just be sure to have a plan to increase your prices fairly quickly. In order to understand how much you need to charge, you have to think about your own goals. A simplified way to think about it is to calculate how many patients you want to have as your max, decide on how much money you would like to pay yourself and calculate the price per patient based on these factors plus your overhead expenses. There is a great calculator for this in DPC Pediatrician’s Start Up Guide.
Lastly, charging too little will devalue the professional services that you are offering. I have seen many physicians say that you “should charge your worth,” and while the premise of that is helpful, the execution is less so. Every human being has infinite worth, so charging what you think that you are worth will not give you a great estimate for what to charge your patients. Charging appropriately for your time and professional services is a better way to think about this concept. You have many years of training and likely experience if you are at the point where you are starting your own DPC practice. In addition, your profession requires a certain amount of investment for licensing, continuing medical education and liability insurance. Accounting for all of these factors should be a part of your calculations when deciding what to charge for your services.
As a final thought on this topic, think about the amount of money that lawyers charge per hour to their clients. Your professional expertise is just as important.
Buying Too Many Supplies
I have seen it over and over again and I was also guilty of this myself when I first started out. Don’t buy too many supplies until you have the patient numbers to support these purchases. My friend, Nitin Gupta, who is a pioneer for pediatric DPC and runs a successful Rivertown Pediatrics, a successful pediatric DPC practice in New York once told me, “It’s not like black Friday at Walmart when you first open.” In the beginning, most new practices will experience growth that is slow enough to account for adding supplies along the way.
Try to avoid purchasing expensive point of care testing machines, hearing or vision screening equipment or expensive wound care supplies until you have the revenue to support such purchases. Your patient service rep for your medical supplies may try to convince you that buying these types of supplies will “pay for themselves,” but remember that your practice is direct care and not fee for service. You won’t be charging for every little thing or “nickel and dining” your patients to pay for your equipment and supplies. In addition, remember that things like point of care tests for strep, flu etc will expire and you won’t be able to use them anymore after that. You may end up throwing away a lot of money.
When you are first starting out, your (medically trained) brain and your stethoscope will be the most important pieces of equipment that you will need. I would also recommend obtaining supplies that will help you to perform a physical exam for both well visits and sick visits. Practicing direct primary care will help you learn to go back to the tried and true basics which are physical exams and a thorough history. You can diagnose a lot of things and help a lot of children with these few things.
Allowing the “Marketing Experts” to Make you Doubt Yourself
When you open your business, seemingly everyone will want a piece of you. You will get emails and phone calls all day long from people who want to help you (and charge you) to grow your business. While some of these companies are truly legitimate and might actually help you, I would recommend finding your own voice first before you invest in an expensive marketing service. Before anyone can help you to grow your business, you must first understand who you are trying to serve and where to find these people.
I recommend planning and executing on your own marketing plan before you bring in additional voices. Instead of just throwing things at the wall to see what sticks, sit down and write out a plan to market your practice that both fits your personality and targets your ideal client. I wrote a blog post for DPC Pediatrician called Tips for Marketing Your Pediatric DPC Practice that can give you some practical tips on how and where to start.
Eventually, you may want to buy some advertising or buy the services of a marketing firm, but in the beginning, it is best to “pound the pavement” yourself to get the word out about your practice. This approach not only keeps your overhead low, but it gives you the ability to build a practice that you enjoy running.
Accepting All Patients into Your Practice
Many small business owners find out along the way that “not all business is good business.” For DPC pediatricians, this means that not everyone is a good fit for pediatric direct primary care in general or your practice in particular. When I was first starting out, I had a wide eyed view of how I was going to “save the world” and get all of the kids vaccinated whose parents had doubts. While I do believe that I was able to get kids their vaccines that otherwise would not have gotten them, I eventually found out that some of the families who opposed vaccines could not be won over even with kindness. When I had a mother of a patient accuse me of “coercing” her into vaccinating her baby despite many conversations prior to that appointment, I re-evaluated my goals and decided to only accept families who were not “completely opposed” to vaccines.
Another thought along these lines is to know what you are built for. In pediatric direct care, we are built for a lot of things that our fee for service, insurance accepting colleagues are not. However, we can also have some limitations. Distinguishing between the two will go a long way to get people to the right place for the care that they need.
As a home visit only direct primary care pediatrician, I was not built well to perform circumcisions. Despite my past experience as a newborn hospitalist and my history of performing the procedure hundreds of times per month, I did not include this offering in my peds DPC practice. I was not set up to do this procedure as a single doctor with no staff who did home visits. Additionally, the market in my area did not support a demand for this. Most babies were delivered at a hospital where the procedure was performed routinely or the home birth/birthing center counterparts sought out the procedure from a local Rabbi. He was willing to do this procedure at people’s homes and did not ask questions when it came to a baby’s vitamin K status. I did not see a path to recouping my investment in supplies by performing this procedure. Therefore, I did not offer them as part of my practice.
Understanding who your ideal client is and what your practice is or is not built for will go a long way to ensuring that you have a thriving practice that you enjoy.
Dr. Andrea Wadley is a retired pediatrician who owned 127 Pediatrics from 2018-2024. It was a direct primary care pediatric practice in the heart of the Dallas/Fort Worth Metroplex.
