To be the kind of physician she wanted to be, Julie Gunther, M.D., of Boise, Idaho, knew she had to change the way she practiced medicine.
Julie Gunther, M.D., explains during the 2017 Direct Primary Care Summit how she built her direct primary care practice from the ground up.
Making the transition wasn't without sacrifice, however, Gunther said during a presentation she gave at the 2017 Direct Primary Care (DPC) Summit(www.dpcsummit.org) held here June 15-17. The summit featured numerous speakers who discussed a wide range of DPC-related business aspects -- from finding office space to designing a logo.
"I wanted to do comprehensive care and be 'Dr. Julie,'" she said. "That's the Marcus Welby model. People say that model doesn't exist. It does exist. We can make it exist because it's what our patients want."
Know that DPC can be exhilarating, but it won't be easier, Gunther noted. "You're not going to work less, but you'll feel a whole lot better," she said.
For physicians who are exploring a change in their practice because, for example, they recently had children or they want to reduce personal frustration, Gunther advised carefully considering their options.
- The recent 2017 Direct Primary Care (DPC) Summit featured speakers who discussed a wide range of DPC-related business aspects.
- Family physician Julie Gunther, M.D., was among those who spoke, describing her experience setting up a DPC practice.
- Among other tips, she noted that DPC practices stay competitive by offering special care options, so aspiring DPC physicians should consider ancillary services such as dispensing medication, providing wellness counseling or offering cosmetic services.
"Do you really want to do DPC, or are you just really unhappy?" she asked. "If you still love medicine, maybe DPC is for you."
It is essential to find a mentor to show you the ropes, Gunther noted, and fortunately, many DPC physicians are willing to share their expertise. She explained that she called other physicians she knew who were using the model, asking to shadow them for a week. One physician told her one day would be sufficient, and sure enough -- after a single day, she had learned enough to apply the experience to her own practice.
Gunther said she wrote a 33-page business plan and submitted it to a loan officer, which helped her secure a loan. Even so, changing her practice model meant making significant personal sacrifice. For Gunther, that meant selling her house and a truck and taking her children out of private school. She also found ways to cut the family's expenses by $2,000 per month.
Many DPC start-ups fail because the aspiring physician attempts to achieve his or her entire vision for the practice in the first year, and the overhead costs prove too high, Gunther said. Even when expectations are realistic, prospective DPC entrepreneurs should be prepared to not turn a profit for about two to three years while investing in the new practice.
Keep in mind that office space is important, said Gunther, but also know that during the transition, a fledgling DPC physician could rent space from a dentist, a chiropractor or even a spa. Patients are not looking for a fancy office, she said, just someplace that is clean.
Exam rooms should measure about 11 feet by 11 feet, with one or one-and-a-half exam rooms per physician. Overall office square footage can range from 600-2,900 square feet depending on the number of physicians and staff, as well as the layout and menu of services the practice expects to provide.
The good news is that DPC practices are particularly well-suited to offering special care options to help them stay competitive. For example, said Gunther, DPC physicians should consider ancillary services such as dispensing medication, providing wellness counseling or offering cosmetic services such as Botox treatments.
It's also important to recognize that in a traditional practice, the physician consults with a given patient an average of 2.7 times annually, whereas in a DPC practice, the average is five times per year, she noted.
Gunther warned that prospective DPC physicians should not try to do everything themselves, especially when it comes to establishing a brand and developing a logo. Imagining her own practice name, Gunther said wanted something that was "tight, crisp and honest" and did not mention "health care." (She eventually settled on "sparkMD" in reference to the many fires the area is known for.) She hired a graphic design team for $3,000 and received a logo, business cards and a website.
Regarding that web presence, physicians should purchase the online rights to their name and every related URL address they can think of, because the cost to do so ranges from only $3 to $15 annually and increases the chances patients will find the practice.
In addition, Gunther cautioned, be prepared for the reality than when a physician leaves a health system, only about 10 percent of his or her patients will follow that physician to the DPC practice. After a year or so, however, more patients will seek the physician out.
Still, she added, "Thirty percent who join will not stay, but don't take it personally."
Managing the practice's patient panel is crucial. Between 5 percent and 10 percent of patients in DPC will not pay consistently. Gunther advised dropping these patients with the proviso that they can rejoin if they pay a special fee to do so.
It's also a smart move for the DPC physician to purchase personal disability insurance as a way to "protect the investment."
Gunther's final piece of advice: "Be a great doctor, and create a system that allows you to be a great doctor."
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