How to Start a Direct Primary Care Practice Right Out of Residency

Excessive prior authorizations, burdensome documentation requirements, and other administrative hassles have caused many family medicine residents to question whether they want to practice in the traditional, insurance-based payment model. That was the case for both of us and why we chose to take a leap and start direct primary care (DPC) practices straight out of residency.

DPC is commonly defined as a practice that charges patients or their employers a periodic fee (typically monthly) for a contracted suite of services and does not bill third parties (e.g., insurance) on a fee-for-service basis.¹ While previous FPM articles have detailed how to transition from an existing practice to a DPC practice,² we will focus here on our experiences starting a DPC practice directly after residency, including both the challenges and the benefits.

Using your time strategically during residency to learn about DPC can prepare you to open a practice and start bringing in revenue as soon as possible. Here are some ways to do it:

• Attend DPC Summit. Co-hosted by the AAFP, this is the largest national DPC conference and occurs every summer. Some states offer their own DPC meetings as well. These gatherings are a great place to learn from practicing DPC doctors, which brings us to our next piece of advice.
• Find a mentor. In addition to DPC meetings, the online DPC Mapper can help you locate physicians in your area who could serve as mentors. With about 3,000 DPC practices across the country, the path has been paved and you don't need to go it alone.
• Read up on DPC. We recommend the website DPCNews.com, as well as two books: Startup DPC by Paul Thomas and The Official Guide to Starting Your Own Direct Primary Care Practice by Debra and Douglas Farrago. Ask your mentor for others.
• Build business skills. It's not necessary to get a Master's in Business Administration or other formal business training. Neither of us had that when we opened our practices. But you can do some online research on starting a small business and begin those tasks during residency, e.g., building a practice website, registering your business (as a limited liability corporation or other format, depending on your situation), identifying a location, and researching low-interest small-business loans if you need them.²

It's natural to worry about the financial challenges of starting a practice right out of residency, when most physicians are burdened by student debt, but it can be done. We both moonlighted during residency, which allowed us to gain confidence, build medical skills, and save funds to smooth the transition to independent practice. Many physicians opening their own practice (DPC or otherwise) after residency rely on side jobs to pay the bills until they are able to pay themselves a salary from their practice. Options include working at an urgent care clinic or hospital, offering veteran disability or U.S. Department of Transportation exams, and providing patient consults for a telehealth company.