Direct primary care pediatrics is not for everyone. There are definite drawbacks to owning your own practice, especially when practicing direct primary care pediatrics. However, there are also many wonderful advantages to this practice model for pediatricians. In this article, we will walk through the positives and negatives when it comes to practicing pediatrics in this unique way.
My Direct Primary Care Pediatrics Story
Back in 2017 when I was considering what I wanted to do with the rest of my career as a pediatrician, I had a long and thoughtful conversation with my husband. At the time, he was transitioning from owning a captive insurance agency to opening his own independent agency. While this transition was taking place, I was a newborn hospitalist and was the main financial support for our small family.
When he decided to sell his Farmer’s agency after only a few years of owning it, I admittedly was extremely unhappy with him. In order for him to start over with something new, I needed to continue to financially support our family. This fact added tremendously to my already brewing feeling of burn out. While the hospitalist job had been good to me over the years, it was starting to wear on me. What started out as one week on and one week off became back to back shifts for days on end. This was compounded by answering pages multiple times every night while also caring for my young daughter who wasn’t consistently sleeping through the night. To add insult to injury, the “powers that be” were restructuring how they paid out our RVU bonuses (in their favor) as well as demanding that the physicians sign off on all of the nurse practitioner’s notes whether or not we had actually laid eyes on the patient or not. These were the final things that broke me and caused me to look elsewhere.
Is DPC Pediatrics Right for You?
Maybe you are a pediatrician who is working in the system and can relate to all or some of these feelings. When I came to this crossroads, I was sitting in my husband’s new office painting the walls on one of my days off praying for direction. I sensed that God was leading me to open my own practice in that office that my husband was planning to use for his insurance agency. At the time, it felt crazy to me. The last thing that I ever wanted was to own my own practice.
Fast forward to mid 2018, and the birth of 127 Pediatrics occurred during the excruciating heat of the long Texas summer. It was the first practice of its kind in Colleyville, Texas. And instead of setting up my practice in my husband’s office, I ended up using it as my home base and offered house calls only.
Maybe you are facing some similar decisions and you are wondering if Direct Primary Care Pediatrics is the right move for you. In order to figure that out, you need to contemplate both the positives and the negatives of this practice model as it applies to pediatric medicine.
Reasons to Say Yes to Direct Primary Care Pediatrics
For pediatricians feeling the immense pressures of the current healthcare landscape, Direct Primary Care Pediatrics offers a compelling alternative. It’s particularly appealing if you’ve experienced the burnout and disillusionment that often come with traditional practice. When the system has “chewed you up and spit you out,” DPC provides an opportunity to rediscover your joy and purpose in pediatric medicine. This model allows for a return to patient-centered care and emphasizes the core reasons why most pediatricians chose their profession in the first place.
Reclaiming Autonomy and Professional Satisfaction
As a DPC pediatrician, I would end my meet and greet conversations with “I opened a DPC practice so that I could love medicine again.” Many pediatricians in traditional practice models feel burdened by administrative tasks, insurance company demands, and high patient volumes, leading to burnout and less time for actual patient care. Transitioning to DPC offers the opportunity to regain control over your practice and your life.
In DPC Pediatrics, you can set your own schedule, determine appropriate patient loads, and eliminate the complexities of insurance billing. You can once again focus on clinical excellence and building strong, trusting relationships with families. This shift can significantly increase professional satisfaction by aligning your work more closely with your passion for pediatric medicine.
Building Deeper Relationships and Providing Great Care
In a DPC model, pediatricians typically manage smaller patient panels. This reduced volume translates directly into more time for each patient visit. This allows deeper dives into developmental concerns, behavioral issues, and family dynamics. It gives you back time for a greater focus on preventative care and proactive health management. DPC Pediatrics helps you to become a doctor who is not always just reacting and treating illness.
With appropriate boundaries in place, the ability to offer direct access (e.g., text, email, phone calls) outside of office hours fosters a continuous relationship with families. Even the most anxious parents find a sense of peace in knowing that you will be there for them and their child. Additionally, you can help parents to avoid unnecessary visits to the urgent care center or ER.
Financial Viability and Sustainable Practice Model
While the initial transition to DPC might involve a period of building a patient panel, the recurring membership fees offer a stable and predictable revenue stream. Instead of relying on fluctuating insurance reimbursements for payment, you have a predictable and simple income structure.
This financial predictability can allow pediatricians to offer unique services (e.g., home visits, lactation support), and better control overhead costs. However, it is extremely important to first plan out your DPC practice in advance. This includes an evaluation of the market in your area and a solid plan to market your practice.
The Downside of Direct Primary Care Pediatrics
The allure of autonomy and patient-centered care is what draws pediatricians to Direct Primary Care Pediatrics. However, it’s essential to critically examine the unique obstacles that can make this transition considerably more challenging than establishing a DPC practice for adult patients. The pediatric landscape presents distinct complexities from the financial considerations to the demands of anxious parents. Unlike adult DPC, you may need to involve the whole family in decision making. Understanding these inherent difficulties is vital for any pediatrician contemplating this significant shift in practice.
Patient Panel Growth and Retention
For a direct primary care practice whose main focus is adults, an individual can decide to join. For pediatrics, you often need to convince both parents that DPC is the right choice for their child’s healthcare. This involves not only understanding the DPC model but also accepting the financial commitment. There were several times in my own DPC Pediatrics practice where I would experience “buy-in” from mom, but not dad. Unfortunately, this usually meant that the family left the practice or never joined at all.
Furthermore, pediatric panels naturally “churn” as children age out of pediatric care. This requires a continuous effort to attract new families, especially newborns. This can make initial panel building slower and require more consistent marketing and outreach. My marketing strategy in the beginning was called, “talk to anyone and everyone who will listen.”
The Vaccine Challenge
Vaccinations are a cornerstone of general pediatrics and how these are handled in DPC can be a significant hurdle. Many traditional insurance plans cover vaccinations with minimal or no out-of-pocket cost. As a DPC pediatrician who is working outside of the traditional insurance system, you are unable to bill insurance for vaccines. In addition, the cash price for most vaccines can make them cost prohibitive for many families. And that doesn’t even account for how you will store them, as well as manage the inventory and supplies associated with their administration.
As a DPC Pediatrician, you will have to find a creative solution for vaccines. There are many different ways of going about solving this issue, and there are an increasing number of solutions as the movement of direct primary care among pediatricians continues to grow. You can start finding answers by downloading the DPC Pediatrician Free Start Up Guide.
High Parent Expectations and Potential for Boundary Issues
Understandably, parents are often highly concerned about their children’s health. As a result, they often have elevated expectations for accessibility and immediate responses from their pediatrician. While direct access is a major draw of DPC, pediatricians may find themselves recreating the rat wheel of burn out.
It’s essential for doctors practicing DPC pediatrics to set clear boundaries for how and when families can reach them. Be sure to clearly spell out expectations for response times and after-hours availability. Otherwise, the convenience of “direct access” can quickly lead to burnout, making it hard to maintain a healthy work-life balance.
Final Thoughts
When I started my Direct Primary Care Pediatrics practice in 2018, I had very few people to help guide me in practicing pediatric medicine in this unique way. I was one of the first pediatricians in my part of town, let alone the whole country to start a direct care practice. As a result, I learned a lot of these things that I wrote about in the article “on the job.”
As time went on, more and more pediatricians began to seek my advice in starting their own similar practices. I began to mentor other doctors and started a private Facebook group for pediatricians who wanted to practice in this way. It became a forum for pediatricians to compare notes and share resources. At first, it was just me and a few friends in the group, but over the years, it has grown to more than 600 members.
In December 2024, I closed my Direct Primary Care Pediatrics practice for my own personal health reasons. Even though my practice no longer exists, its legacy lives on in the many successful pediatric DPC practices that exist today. I marvel at how far we have come in bringing this movement to a place where pediatricians find the joy in practicing medicine again and families have a trusted pediatrician who walks alongside them in the good and bad moments of life. I continue to write articles and support DPC Pediatrician so that many more can experience medicine in the way that it was meant to be.
Dr. Andrea Wadley is a retired pediatrician who is passionate about helping other pediatricians succeed in Direct Primary Care Pediatrics.
