Setting prices for your pediatric DPC practice can feel both daunting and deeply personal. Unlike traditional fee-for-service medicine where insurers dictate reimbursement, in DPC we have both the freedom and responsibility to decide what our services are worth. That freedom is powerful, but it can also feel overwhelming when you’re starting out or adjusting your fees after a few years in practice.
Fortunately, business strategy offers a useful framework: five classic factors to consider when setting prices—value, loaded costs, competition, market, and financial goals. Let’s explore how each applies to pediatric DPC, and then look at some pediatric-specific considerations like age tiers and membership levels.
1. Value: What Parents Believe They’re Getting
Value is about perception. Families aren’t just comparing your membership fee to the copay at an urgent care; they’re evaluating peace of mind, continuity of care, and the trust they feel in you as their child’s doctor.
Think of two families:
- One has a medically complex toddler who is in and out of the ER. For them, your 24/7 access and continuity of care are worth far more than the monthly fee—they see you as a lifeline.
- Another has a healthy 8-year-old who rarely gets sick. They may value your unhurried visits and personal relationship, but their willingness to pay might be anchored more to convenience and alignment with their parenting values than medical necessity.
Both families see “value,” but in very different ways. This is why the ability to clearly articulate your unique value proposition—whether that’s personalized attention, integrative care, or same-day visits—matters so much in setting and justifying your fees.
2. Loaded Costs: What It Really Costs You to Deliver Care
Loaded costs include everything it takes to run your practice, from rent, utilities, and staff salaries to malpractice insurance, EHRs, vaccines, and even your own time and energy. For pediatricians, these can look different than for adult DPC practices.
Take vaccines, for example. Stocking them means thousands of dollars in upfront purchases, refrigerator costs, and ongoing replacement. If you don’t build those expenses into your membership fees (or create a vaccine surcharge), your pricing may unintentionally erode your margins.
Or consider your time. Newborn and infant families may need far more visits, extended phone calls, and after-hours reassurance than a teenager’s family. If you don’t account for that, your loaded cost per patient will be much higher than expected, especially in the first two years of life.
Loaded costs remind us that pricing decisions shouldn’t just be about what “feels fair”—they must cover the true costs of doing business.
3. Competition: Who Else Is in the Game
Competition isn’t just about other pediatric DPC doctors—though if there are several in your area, you should certainly understand their price ranges. It’s also about indirect alternatives: urgent care clinics, telehealth platforms like Teladoc, or the traditional insurance-based pediatric office down the street.
For example, if families in your area are used to $25 copays at large pediatric groups, you’ll need to communicate why your $100–200 monthly membership is a different category altogether. On the other hand, if concierge practices in your market charge $300–500 per month, your DPC model may be perceived as both affordable and high-value.
Competition also means awareness of substitution behaviors. If families believe “we can just Google it” or “nurse hotlines are free,” then your ability to highlight how your care saves stress and prevents unnecessary ER visits becomes essential.
4. Market: What Your Community Can Support
Your pricing must align with the realities of your local market. A suburban area with high-income, dual-working parents may support higher fees, especially if they value convenience. In contrast, a rural or mixed-income community might require creative adjustments like family discounts or sibling bundles.
For example:
- In an affluent suburb, one pediatric DPC physician positioned her practice as a concierge-level service at $250 per child per month and attracted families seeking personalized attention.
- In a rural town, another pediatrician structured fees at $75 per child with a family cap of $250 per month, which resonated with larger families who otherwise would have struggled with the cost.
Knowing your community’s demographics, values, and expectations allows you to balance sustainability with accessibility.
5. Financial Goals: What You Need to Thrive
Finally, pricing must align with your personal and professional goals. Define your desired take-home (owner pay before personal taxes), your realistic panel size, and your annual overhead—then work backward.
Example: you want to take home $200,000/year and your overhead is $100,000/year, so the practice must generate $300,000/year in total revenue.
- At 250 patients:
- Overhead per patient per month ≈ $33 PMPM ($100,000 ÷ 250 ÷ 12)
- Take-home portion per patient per month ≈ $67 PMPM ($200,000 ÷ 250 ÷ 12)
- Required average fee ≈ $100 PMPM to hit $300,000 total revenue.
- Overhead per patient per month ≈ $33 PMPM ($100,000 ÷ 250 ÷ 12)
- At 150 patients:
- Overhead per patient per month ≈ $55.56 PMPM ($100,000 ÷ 150 ÷ 12)
- Take-home portion per patient per month ≈ $111.11 PMPM ($200,000 ÷ 150 ÷ 12)
- Required average fee ≈ $166.67 PMPM to hit $300,000 total revenue.
- Overhead per patient per month ≈ $55.56 PMPM ($100,000 ÷ 150 ÷ 12)
In practice, most clinicians add a modest buffer for payment processing fees, churn/empty slots, scholarships, and reinvestment, so you might round those targets up (e.g., $105–$120 PMPM at 250 patients; $175–$190 PMPM at 150 patients) based on your specifics.
Additional Considerations for Pediatric DPC
While the five core factors provide a solid foundation, pediatrics adds unique wrinkles that many adult-focused DPC practices don’t face.
- Age-Tiered Pricing: Infants and toddlers typically require more visits, more coordination of care, and more parental handholding. Many pediatric practices reflect this reality by charging higher rates for infants and toddlers, then lowering fees as children get older and need fewer visits. This structure ensures that high-demand families contribute more fairly to the time and resources they consume.
- Membership Levels: Some practices offer multiple service tiers—such as a standard membership covering routine care, and a premium membership that includes therapies (like OMT, counseling, or lifestyle medicine), home visits, or unlimited acute visits. Tiered memberships let families choose the level of access and services they want, while ensuring you’re compensated appropriately for expanded offerings.
- Family Discounts or Caps: Pediatric practices serve households, not individuals. Offering sibling discounts or family caps can make memberships more affordable for larger families while still ensuring that your revenue goals are met. For example, charging full price for the first child and reduced rates for additional siblings can balance fairness with family-centered appeal.
- Psychological Anchors: Parents often anchor their perception of cost to familiar reference points—like what they pay for daycare, sports, or extracurriculars. Positioning your fee within that mental framework can help families see it as reasonable.
Bringing It All Together
Pricing is both an art and a science. By weighing value, loaded costs, competition, market, and financial goals—and then layering in pediatric-specific considerations like age tiers, membership levels, and family caps—you can set prices that are both sustainable and aligned with your vision.
And remember: pricing isn’t permanent. You may need to adjust after six months, a year, or even several years as you learn what your families value, what your practice requires, and what your community will support. The flexibility of DPC is that your model can evolve with you, ensuring that both you and your patients thrive.
If you’d like more guidance launching or growing your own direct care practice, DPC Pediatrician offers a startup guide, coaching programs, on-demand courses, and even one-on-one consulting.
