By Marina Capella, MD, M.Ed, FAAP, FABOIM
In most businesses, inventory means boxes on a shelf. But in DPC, your inventory is time.
Every patient uses a slice of it — not just for visits, but also for messages, school forms, phone calls, refills, and emotional labor. While a typical well or sick visit might last 20–30 minutes, the total time spent per patient over the course of a year is realistically closer to 4.0 hours when you include all touchpoints.
That 4-hour average accounts for variability in patient complexity and engagement. Some families will only reach out once or twice, while others will need more frequent support. By using a flat estimate of 4.0 hours per year per patient, you build in a fair and manageable expectation of time commitment. (In reality, your average time utilization per patient depends on a lot of factors, including age composition of your panel, complexity, and the degree of specialization you offer. You can follow the same math principles outlined below and change the average to a number more suited to your practice.)
How Much Time Do You Have?
Start by deciding:
- How many hours per week you want to see patients
- How many weeks per year you want to work
Here’s the math:
What Should You Charge?
Once you know your panel size, you can figure out your target price per member per month (PMPM). Let’s assume for the purposes of this exercise:
- Fixed overhead: $60,000/year
- Variable cost per patient: $25/year
- Salary goal will vary by example
We’ll compare three scenarios:
Scenario 1: Balanced Lifestyle
- 🩺 Goal: $200,000/year salary
- 🕒 Hours: 30/week, 4 weeks off ⇒ 1,440 hrs/year
- 👥 Panel: 300 patients
- 💸 Total cost: $200,000 + $60,000 + (300 × $25) = $267,500
Add margins:
- 20% margin → $92.89
- 30% margin → $106.15
✅ This model is sustainable, patient-friendly, and profitable at PMPMs between $90–$110, depending on your goals.
Scenario 2: High-Income, Full-Time
- 🩺 Goal: $300,000/year salary
- 🕒 Hours: 36/week, 4 weeks off ⇒ 1,728 hrs/year
- 👥 Panel: 400 patients
- 💸 Total cost: $300,000 + $60,000 + (400 × $25) = $370,000
Add margins:
- 20% margin → $96.35
- 30% margin → $110.12
✅ This doctor works more and earns more — but still needs to charge a PMPM near $100 for sustainability. With 400 patients, there’s less cushion per patient, so strong boundaries and efficient systems are key.
Scenario 3: Part-Time, Lifestyle-Focused
- 🩺 Goal: $150,000/year salary
- 🕒 Hours: 24/week, 6 weeks off ⇒ 1,104 hrs/year
- 👥 Panel: 250 patients
- 💸 Total cost: $150,000 + $60,000 + (250 × $25) = $216,250
Add margins:
- 20% margin → $90.10
- 30% margin → $102.97
✅ This doctor prioritizes time over income — and still has a viable practice with PMPM in the $90–105 range, assuming a smaller, more connected panel.
A Note About Seasonality
As any physician knows, there are ebbs and flows to patient care demands. Summer is often the slowest season in pediatrics, while the after-holiday winter months are the busiest. Therefore, it’s important to take these general calculations with a grain of salt. Realize that you may have weeks when you work less than you wanted to and weeks where you work more. It’s an expected part of the profession. This only emphasizes the importance of leaving generous margins for yourself – when it comes to time and money. Be realistic about what you can handle, especially if you’re aiming to remain a solo practitioner.
Bottom Line: Design What Fits You
There’s no one-size-fits-all answer. Your ideal panel and PMPM should reflect:
- The lifestyle you want
- The income you need
- The time you have
- The kind of care you want to give
Whether you’re aiming for high earnings or maximum flexibility, you can design a practice that works — with intention, not guesswork.
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, on-demand courses, and even one-on-one consulting.
