When running a business, overhead refers to the ongoing costs required to keep things operating—expenses that aren’t directly tied to delivering goods or services. When you are offering home visits by doctors in a direct primary care setting, this can include everything from medical supplies to insurance. If you’re a pediatrician who offers only home visits, your overhead will look different from that of a traditional office-based physician. Still, these costs play an essential role in shaping your pricing strategy and determining the ideal size of your patient panel.
In this article, we’ll explore how to master your overhead expenses so you can build a sustainable, efficient, and profitable practice.
Time to Run Your Business
In addition to other unseen patient time considerations, you should also consider the time that you spend on actually running your business in your business plan. While it is not a tangible piece of overhead, your time spent on running the business takes you away from other revenue generating activities. If you are a solo pediatrician, you are doing it all. And you are the most important and expensive employee in the business.
Many of the pediatricians that I talk to don’t realize just how much effort it takes to be an entrepreneur. Not only are you seeing patients, keeping up with CME and the other requirements of maintaining your medical license, but you are also the head marketer, bookkeeper and payor of bills.
The more patients you have in the practice, the busier things get. You need to consider whether or not you want to have a small practice that you can manage yourself or grow your practice in a way where you are able to hire people to do the things that you don’t love doing. There is not one right answer for everyone, and often these thoughts change over time for each individual pediatrician. While you think through those decisions, also include the time you will spend in your car driving to and from appointments.
Home Visits by Doctors, Overhead Differences
Often, pediatricians choose a home visit only practice because they want to keep overhead low while they are starting out. This was definitely one of the reasons why I started this type of practice. There are most certainly differences in overhead expenses between a home visit only practice and an office based practice, but you still need to consider these expenses.
Office Based Practice
As a home visit only direct primary care pediatrician, you are not paying for the overhead involved with an office space. Oftentimes, an office space requires a build out as well as ongoing rent payment obligations. If you are choosing to sublet from another doctor or find an alternative office space, such as a co-working office space, your expenses will likely not be as high. Additionally, you need to consider what kind of insurance you need to have in place in an office setting. Often, your landlord will require you to have certain limits on your business owner’s policy in order to rent space in their building.
If you choose to buy an office space or building, you need to consider additional costs such as taxes and potentially HOA fees. My husband and I bought an office suite that we used to run both of our businesses. We had not anticipated the HOA fees when we were considering the overhead of an office space.
Home Visits Only
Home visit only pediatricians have unique overhead expenses that can differ from office based pediatricians. Not all malpractice insurance providers will write a policy for a doctor who is doing home visits only. When you find one, often these policies are a little more expensive. This is part of the three must haves for home visits.
Additionally, you have to consider expenses:
- Gas and car maintenance
- The expenses of “renting” a commercial address
- Cost of mobile internet or “hotspot”
- Commercial Auto Insurance
Keep Your Overhead as Low as Possible
Whether you decide to do home visits only, an office based practice or a combination of the two, keep your overhead as low as possible. This is a general rule for any small business, really. As my friend, Dr. Nitin Gupta of Rivertown Pediatrics always says, “your first few weeks of pediatric DPC will not be like Black Friday at Walmart.” You shouldn’t expect a rush of patients that will be demanding that you use the latest and greatest piece of diagnostic equipment.
This means that when you are starting out, you need to buy the least amount of equipment possible to get started. You can add more expensive items as your patient numbers support it. For example, I did not buy a hearing screening device when I first started. About 3 years into my practice, I had enough school aged patients that needed a hearing screen. At that point, I could justify the cost of the purchase.
Remember, as a direct care pediatrician, you are not going to be charging for every use of a piece of equipment, like a hearing screener, like you would in a fee for service insurance based practice. This is something that I had to constantly remind my Henry Schein rep of every time she wanted me to buy the latest and greatest piece of equipment.
I put together a home visit bag checklist and included items that I think you can wait to purchase until you are busier.
Expenses are Expensive
In my mind, the whole idea of direct primary care is to recenter the focus of the healthcare experience on the doctor-patient relationship. So much of our healthcare system as it stands in 2025, is profit driven at the expense of both the doctor and the patient.
While profits should not necessarily be your ultimate goal, if you aren’t able to run a profitable business, you won’t be able to help patients in this special way. The old saying goes, “no margin, no mission.” Keeping your overhead as low as possible by scrutinizing every purchase will go a long way.
If you would like extra help to get your business off the ground, we offer a variety of resources to support you as a DPC Pediatrician. Click here to download the free start up guide.
Dr. Andrea Wadley is a retired pediatrician who owned a house calls only pediatric DPC practice from 2018-2024. She is currently writing for DPC Pediatrician in order to support direct primary care pediatricians.
