Recently, I have seen an uptick in the amount of questions that pediatricians are asking about setting up a home visit practice in our Facebook groups. Home visits by doctors requires careful considerations. As a result, I wanted to write a series of articles addressing the different things that you need to think about before starting a home-visit-only pediatric DPC practice. Deciding on how many patients that you can comfortably see in this type of practice is more complicated than just throwing out a number. In this series of articles, we will discuss the different variables that you should consider before deciding on a goal number of patients.
As with many things in life, it is easiest to work backwards. If you are a parent, you understand the concept of working backwards well. If you need to be somewhere at a specific time, you start with that time and subtract the time that it takes to get the kids ready, find everyone’s shoes, deal with meltdowns and dirty diapers, etc and then you decide what time you leave the house to get to your event on time. Starting a direct primary care practice is similar. You want to start with the amount of income that you desire to bring home and then work backwards from there.
This series of articles will help you to think about the different variables that affect how you price your practice as well as how many patients that you can comfortably care for. In this article, we will consider the time that each patient requires in this type of care model.
Travel Time for Home Visits by Doctors
As a home visit pediatrician, you need to think about the time that traveling to homes will take you. When I owned this type of practice, I lived in a large metropolitan area that contained about 8 million people in total. I set my driving radius to 15 miles and charged extra for driving outside of that radius.
In addition to the actual miles covered, I needed to consider how long it would take me to drive to different places. Most things in the Dallas/Fort Worth metroplex take about 30 minutes to get to if you are traveling within 15 miles of your destination. As a result, I needed to add 30 minutes on the front side and back side of each home visit for travel time.
Certain factors increased this time significantly. Driving through school zones after school hours and attempting to go anywhere during morning or evening rush hour added to the time it took to get to patients’ homes. Knowing this, I carefully crafted my schedule to avoid these times as much as possible.
Time At The Patient’s House
Besides travel time, you need to consider how much time you are going to spend at each patient’s house. For one patient, I allowed 30 minutes for sick visits and an hour for well child visits. Also, procedure visits, such as placing stitches, generally took up about an hour of my time at the patient’s house. As I got faster at things and got to know patient families better, I rarely used my whole allotted time for these visits. However, these are things that you need to think about when deciding how many patients you can handle in your practice.
Additionally, it is important to consider how long it will take you to set up your equipment for visits as well as take it all down and put it away. I had a system of how I conducted each visit that included using equipment and putting it away. When you first start, this part may take you longer than when you are used to doing things a certain way.
Lastly, something that I did not account for when I set out to have a home visit practice was to allow for special “kid” time or “parent” time. Especially in the beginning, the novelty of home visits for certain kids feels very magical to them. They want to show you their room, their favorite stuffies and even their pets. These are things that make this type of practice model so special.
I also found that often, I needed to set aside extra time for parents to “just talk” about their kids or themselves. While I didn’t always have time to listen to things that were outside of the scope of the visits, I tried to make the time for these chats whenever I could. It helped me to truly care for the whole patient and family in a way that is unheard of in the “system.”
Spending Time on Patient Work
As a direct primary care pediatrician, you are offering a membership to families that includes things such as texting, phone calls, emails and telemedicine/video visits. These are items that take up your time as well. If you are going to offer any or all of these services to patients, you need to consider the time that it takes to accomplish them. When I was practicing medicine using this model, I spent a lot of my time returning text messages to parents.
Furthermore, you should consider the time it takes to do all of the other things that are involved in caring for the patient. Ordering and reviewing lab work, writing a note about the patient’s visit in your EMR and sending out referrals to specialists all take up your time and energy. Notes for school, triaging sick kids who may or may not need visits and interacting with the patient’s school are also things that add up quickly. As a DPC pediatrician, you are often the one doing these tasks unless you have a staff that is supporting you.
Final Thoughts
In this particular article, we covered time considerations. During the rest of the series, we will consider the other components that make up numbers to consider as you work backwards to get to your patient number goal and desired income.
Here are other articles that can help you set up a direct primary care pediatric practice focused on offering home visits by doctors:
- Five Things to Consider for Pediatric DPC Home Visits
- 3 Must Haves for Home Visits
- Home Visit Bag Checklist
Dr. Andrea Wadley is a retired pediatrician who owned a home visit only pediatric DPC practice in the Dallas/Fort Worth metro area from 2018-2024.
