By Marina Capella, MD
I recall the crisp, fall day in October when I officially opened my practice. I had spent a few months doing all the “right” things on the DPC startup checklist – registering my business, creating a website, getting my business license, decorating my space, setting up my lab, and so on. Hopeful visions of happy kids and their parents signing up for memberships danced in my mind.
And yet, for the first few months: crickets.
Over the ensuing six months, getting my first ten patients felt like the hardest job I’d done since residency.
If you’ve ever felt like I did, you’re not alone. In marketing terms, what you were experiencing is the customer acquisition cost (CAC) curve — a concept that can help us as DPC physicians make sense of the ebbs and flows of the effort, money, and time it takes to grow a sustainable practice.
The Steep Climb: Your First 50 Patients
In the earliest stages of launching your DPC practice, every patient feels like a victory — and also like a heavy lift. You spend hours talking to friends, networking at local events, posting on social media, and perfecting your website, all to sign up those first handful of families. Each “yes” comes with a disproportionate amount of work. In this phase, CAC is at its peak: you’re putting in the maximum amount of time, money, and effort for relatively few patients.
During my second year in practice – still looking to keep growing – I spent six hours giving free swag and talking to parents at a natural health expo. Parents were happy to take free swag, but by the end of the day only two families expressed genuine interest, and only one of them signed up nearly months later! This is the reality of the steep climb: lots of effort for modest returns. But those first 50 families are the foundation you will build the rest of your practice upon.
The Sweet Spot: Word of Mouth and Organic Growth
Once you’ve signed up a core group of patients — often around 30–50 for many pediatric practices — something begins to shift. Parents start telling their friends, siblings bring in younger siblings, your Google reviews gain traction, and your practice has stories to tell. You also get better at talking about your practice and clearly explaining the benefits of membership. Marketing begins to feel less like pulling teeth and more like a natural extension of the work you’re already doing. At this point, CAC starts to drop — it takes less effort per new patient, and your practice begins to grow more organically.
One pediatrician described how she used to spend hours writing blog posts, posting on Facebook, and designing flyers to hand out at local businesses. Now, she finds that most of her new families come from patient referrals. “It’s like my patients are doing my marketing for me,” she said. “When a mom posts in a local Facebook group about looking for a pediatrician, one of my families jumps in before I even see the post.” That’s the sweet spot in action.
The Busy Plateau: When Effort Costs Rise Again
Interestingly, the CAC curve doesn’t just slope downward forever. Once your practice gets close to capacity, acquiring new patients starts to cost more again. Not necessarily in dollars, but in opportunity cost. Every hour you spend on marketing is an hour you could have spent seeing a patient or resting to avoid burnout. You may also need to hire help — whether it’s a part-time administrative assistant to handle calls and billing questions, or a medical assistant to help room patients, schedule visits, and manage vaccine inventory — and those added expenses raise your CAC again.
By year three of my practice, I realized that I was spending my days off and evenings fussing around with Instagram reels, even though my practice and schedule was bustling. I finally hired a virtual assistant who could help me edit and post my reels. I accepted that my time was best spent on patient care and doing the CEO work that only I could do.
In this phase, CAC rises again — not because patients are harder to convince, but because your practice is busy enough that your time and energy are scarce resources.
What This Means for DPC Pediatricians
Understanding this curve can help you set realistic expectations and avoid discouragement.
- Don’t panic if the first few months feel like pushing a boulder uphill — that’s normal, and it gets easier.
- Lean into the middle “sweet spot” by encouraging reviews, testimonials, and patient referrals.
- When you hit the plateau, decide if growth is still your priority, or if you’re comfortable maintaining your current panel size. At that point, protecting your time with patients might be more valuable than aggressive growth.
The CAC curve reminds us that practice growth is not linear. There are seasons of hustle, seasons of flow, and seasons of recalibration. Recognizing where you are on the curve can help you make smarter decisions with your time, effort, and money — and most importantly, keep your practice aligned with the life you want to create.
If you’d like more guidance launching or growing your own direct care practice, DPC Pediatrician offers a free startup guide, a Startup Foundations group coaching program, Healer’s soul, on-demand courses, and even one-on-one consulting.
