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Is DPC Right for Me? Feasibility, Fit, and Determinants of Success

As the primary care landscape becomes increasingly challenging with declining reimbursements, the pressure to do more with less resources, and an increasing tendency for employers to use non-physician practitioners or require supervision of these clinicians, more primary care (and even specialists) are considering direct primary care (DPC) and direct specialty care models. We receive many questions from doctors in our physician communities about how to determine if DPC is a feasible option for them, what the earning potential is, and more. Below, we go over a checklist of things to consider when exploring if DPC or direct specialty care is the right fit.


Disclosure/Disclaimer: Our content is for generalized educational purposes.  While we try to ensure it is accurate and updated, we cannot guarantee it. We are not formal financial, legal, or tax professionals and do not provide individualized advice specific to your situation. You should consult these as appropriate and/or do your own due diligence before making decisions based on this page. To learn more, visit our disclaimers and disclosures.


Assessing if direct primary care is the right model for physicians and how to tell if it's feasible to start a DPC practice


What is direct primary care (DPC)?


Direct primary care (DPC) is a model of healthcare delivery that allows patients to pay their physicians directly, thereby bypassing insurance. It is usually based on a subscription model that has patients pay a monthly or annual fee. This model emphasizes more time with doctors, as well as increased access to doctors via direct communication and same-day or next-day visits. While there is an emphasis on primary and preventative care, additional services may be offered.


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What is direct specialty care?


Direct specialty care is similar to DPC, but as the name implies, applies to specialist care. Some examples of specialties increasingly utilizing this model include cardiology, psychiatry, gastroenterology, neurology, endocrinology, and even some dermatologists and orthopedic surgery practices. In fields where procedures are common, they may offer bundled pricing. Usually, physicians in these specialties offering direct specialty care as a model are hoping to help with chronic conditions, focus on elective procedures, offer second opinions, or are addressing long wait times in their specialties. 


While this article focuses on direct primary care, similar considerations apply when considering direct specialty care.



How do I know if the direct primary care (DPC) model is right for me, and if I will be successful at it?


Look up regulations about direct primary care in your state, and what nuances exist


While DPC is technically legal in every state, there are different regulations that may limit your ability to successfully launch a DPC practice. Your state medical board or state laws may have specific wording about these practices. Some explicitly recognize DPC as a model, whereas others may have “not insurance” related statements by the insurance commissioner or related legislative efforts. This may require additional disclosures to your patients or more red tape type issues that you have to navigate.



Are you willing to opt out of Medicare and/or Medicaid?


Seeing Medicare patients can be very challenging in a DPC setting, most often requiring opting out of Medicare. Even then, there will be additional hurdles you have to comply with to ensure that you stay compliant with regulatory requirements in this patient population. In a worst case scenario, you may not be able to see Medicare patients. You will also not be able to bill third parties on behalf of these patients.


Learn more about opting out of Medicare.



Are you confident that you will have patients follow you or that your area has a patient demographic that can participate in the DPC model?


While DPC is not concierge medicine and the fees are set to be affordable to most patients, you will have to feel confident in your ability to get patients that will subscribe to this model over using traditional insurance. 


DPC practices typically carry a smaller patient panel than conventional insurance based primary care practices, usually carrying a few hundred patients instead of a few thousand. You will want roughly this many to have a sustainable practice. 


This will typically require or be more favorable if you have:

  • A name or brand within your community, or the ability and willingness to build that brand

  • Existing patients that would follow you to a new practice or support the conversion of your existing practice

  • The lack of a noncompete in your current practice if you are planning on leaving to start a practice in the vicinity (or the willingness to negotiate or fight your current noncompete)

  • A patient population that can afford to pay the fees

  • A long waiting list for patients to be seen in this area, thus encouraging patients to sign up for a better access model


If you’re considering changing models, run the idea by your patients and see what they think! This may require some education about the model.



Are you willing to run a business?


Running a DPC practice is different than running a conventional insurance based practice in some ways, and similar in others. But regardless, if you’re used to an employed model, you have to be willing to navigate the nuances of running a business. This includes ensuring customer service, getting creative about offerings that make your practice attractive, and navigating the business aspects of a practice and learning the business of medicine.


Learn more about the pros and cons of private practice.



Can you afford to cover your expenses until your practice is profitable?


A new practice can take a while to build, and requires upfront investments. You’ll want to ensure that you have enough money saved or have access to enough funding to get you through the startup period. Many physicians start saving accordingly for months or years before they launch their practice.


At the minimum, you’ll need to afford a space, an EMR, a messaging system, equipment, legal fees, and related licenses and insurance. Make sure you have a reasonable pro forma and business plan in place.


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Related PSG resources: 



Conclusion


Direct primary and direct specialty care can be an extremely rewarding practice model for physicians looking to spend more time with their patients and avoid the hassles of dealing with insurance companies. However, it’s important to understand the model and know what factors will make you successful, and plan accordingly before venturing into this route.



Additional private practice resources for physicians


Explore related PSG resources:


We offer a free private practice educational series for physicians interested in virtual events to help you start and manage your practice. Sign up for our PSG weekly newsletter for alerts on upcoming events and registration links.


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