🚀 The DPC Startup Handbook

DPC Frontier

This is the largest aggregation of resources for aspiring DPC doctors. There are guides to DPC-relevant state and federal regulations, information on how to start a practice, compilations of conference recordings, a list of upcoming events, a fascinating blog, and the DPC Mapper. Spend some time clicking around.

DPC Conferences

There are two main DPC conferences each year:

• DPC Summit - put on by the AAFP, FMEC, and ACOFP
• Hint Summit - put on by the patient billing company Hint

Consider attending one - being surrounded by other doctors who've already made the leap is invaluable.

DPC Nation

DPC Nation is a patient-centric site focused on educating patients about DPC. Reading through it can help you teach patients about DPC in an accessible way.

Facebook Groups

There are various Facebook groups for DPC practitioners. For some, you'll need to be invited by a current DPC doctor.

DPC Alliance

The DPC Alliance formed in 2018 as a national advocacy and support organization.

DPC Resources

A curated collection of tools, guides, and resources for Direct Primary Care physicians.

Regional DPC Alliances

Your area may contain a regional alliance. Google around for a website or Facebook group. Reach out to other DPCs in the area. Often they'll be more than willing to show you around their offices and discuss their workflows.

Docs 4 Patient Care Foundation

The D4PCF puts on the largest annual DPC conference, runs a direct-care-focused radio show, and have an email newsletter that's worth checking out.

Doug Farrago's Guide

Longtime DPC doctor Doug Farrago wrote a book called The Official Guide to Starting Your Own Direct Primary Care Practice.

Startup DPC

A practical guide to launching your own Direct Primary Care practice, covering everything from business planning to patient acquisition.

Podcasts

• My DPC Story - The essential DPC podcast. Dr. Maryal Concepcion interviews DPC physicians about their journey, business models, and lessons learned. Hundreds of episodes covering every aspect of DPC.
• DPC Frontier Podcast - Regulatory updates, interviews with DPC leaders, and deep dives on legal/policy issues.
• Docs Outside the Box - Broader scope covering non-traditional medical careers, including DPC episodes.

Online Communities

• Reddit: r/directprimarycare - Growing community of DPC physicians and patients. Good for candid questions and honest answers.
• Facebook Groups: "DPC Nuts and Bolts" and "DPC Docs" are the most active. You'll need to be verified as a physician to join some groups.
• DPC Frontier Forum: Discussion boards at dpcfrontier.com with regulatory and business topics.

Consider working as an employed DPC physician

DPC is at the point where many early practices are looking to grow to multiple physicians. If you're not cut out to run a small business, consider working as an employed physician in a DPC practice near you. You'll still get all the benefits of DPC (small patient panel, less administrative BS, etc) without the headaches of starting your own practice.

Check out DPC Frontier's Careers page to find job listings. Or reach out directly to the DPC practices in your area using the DPC Mapper.

Check if there are any legal hurdles to DPC practices in your state

This information has been compiled on DPC Frontier here.

Do you have a means of acquiring patients initially?

Are you known in your community? Are you migrating an existing non-DPC practice? Or if you're starting from scratch, can you take some patients with you?

A note on non-compete clauses: they are difficult to enforce in many states so don't be too intimidated. Also, don't be afraid to simply ask your employer to waive the non-compete clause.

If considering a transition, run the idea by your patients

Direct them to DPC Nation to learn more.

Are you likeable?

Sounds silly, but this can make or break a practice, especially in DPC. Most DPC practices rely heavily on word-of-mouth evangelism. Any new patient has to be convinced both of the DPC model and of you.

Do you have enough financial runway?

Most DPC practices take 6-12 months to become financially sustainable. Some take even longer. Make sure you have enough savings or alternative income to cover both your personal expenses and business costs during this ramp-up period.

Consider moonlighting, keeping a part-time position, or having a working spouse to bridge the gap. Many successful DPC doctors recommend having at least 12 months of living expenses saved before making the leap.

The good news first

DPC practices that survive the first 18 months have a very high long-term survival rate. The model works. Most failures happen early, and they're almost always preventable. The key is understanding what kills practices so you can plan around it.

1. Insufficient financial runway

This is the #1 killer. Most new DPC practices take 12-18 months to reach break-even. If you only have 6 months of savings, you'll run out of money before the model has time to work. The fix: have at least 12 months of personal living expenses saved plus 6 months of business operating costs before opening. See the Financial Model section for detailed numbers.

2. Wrong market

Opening in an area with too few potential patients, too much competition, or a population that can't afford membership fees. Do your homework: check the number of primary care physicians per capita, median household income, insurance coverage rates, and employer landscape in your target area. Rural markets can work great but need different strategies than urban ones.

3. Pricing too low

New DPC docs often underprice out of fear that nobody will pay. At $50/month, you need 400+ patients just to match a modest salary - and that's before overhead. Price for sustainability: most successful practices charge $75-150/month for adults. You can always run promotions, but raising your base price later is painful. See Pricing for geographic benchmarks.

4. Failure to market

"Build it and they will come" does not work in DPC. You are selling an unfamiliar product. Patients don't know what DPC is. You need to actively market from day one - Google Business Profile, social media, community events, networking, SEO, content creation. The practices that grow fastest treat marketing as a core skill, not an afterthought. See the Marketing section.

5. Scope creep - accepting insurance "temporarily"

Some physicians plan to accept insurance "just during ramp-up" and then phase it out. This almost never works. Insurance creates administrative overhead that defeats the purpose of DPC, confuses your brand, and makes patients expect insurance-based care. If you're going DPC, go DPC. A hybrid model is a valid long-term choice, but "temporary" insurance acceptance usually becomes permanent.

6. Physician burnout

Ironically, some DPC docs burn out by not setting boundaries. They answer calls 24/7, see patients on weekends, and never take vacation because they feel personally responsible for every member. Set communication expectations early. Use asynchronous messaging to manage demand. Take time off. DPC should give you a better life, not a different flavor of burnout.

7. Bad partnerships

Partnership disputes are a leading cause of small business failure across all industries. If you're starting with a partner, get everything in writing: ownership splits, decision-making authority, buyout clauses, non-compete terms, and what happens if one partner wants out. Hire a lawyer for this. See Incorporation.

8. Ignoring the employer channel

Individual patient marketing is slow. A single employer contract can add 50-150 members overnight. Practices that don't pursue employer partnerships leave the fastest growth channel on the table. See Employer Partnerships.

9. Wrong EHR choice

Choosing an EHR designed for fee-for-service medicine saddles you with unnecessary complexity. Switching EHRs mid-practice is painful and expensive. Do your research upfront - see the Technology Stack section for a neutral comparison of DPC-focused options.

10. Not differentiating

In markets with multiple DPC practices, "I'm a DPC doc" isn't enough. What's your specialty focus? Do you offer POCUS, sports medicine, weight management, addiction medicine, pediatrics? Having a niche helps with marketing, referrals, and patient loyalty. See Scope of Practice.

The runway calculation

Before you open, do this math: take your monthly personal expenses + estimated monthly business overhead. Multiply by 18. That's how much cash you should have access to (savings, spouse income, part-time work, or a line of credit). If you don't have it, keep saving or find a bridge strategy before launching. The Financial Model section has a calculator to help.

Pick a business name for your practice

Note that your legal business name doesn't have to be related whatsoever to your public-facing marketing name! Choose a business name quickly and don't drag your feet. You want to incorporate as fast as possible so you can start engaging with vendors as a legal entity.

Google around for your state's online tool for checking name availability.

Pick a marketing name for your practice

If you're very well known in the community, you may want to include your name in the practice name. If you plan to hire additional physicians or take on partners, you probably don't. Click around on the DPC Frontier Mapper for ideas.

Make sure memorable social media usernames are available. Use namecheckr.com to check availability across all social media sites. Use Namecheap to check domain availability.

Decide on your business hours

Consider whether to have posted business hours at all. If you only intend to be available on request, you may not want to commit to a pre-specified workday (though if you intend to have front-office staff, you probably should for their sake).

Decide whether to give your practice a specialist "flavor"

Some DPC practices have a bent towards a particular specialty/population, including pediatrics, geriatrics, sports medicine, PT, addiction medicine, pain management, endocrinology, wellness/nutrition, and more.

Decide whether to run a "pure" or "hybrid" practice

Some hybrid practices still accept insurance from a subset of their patients, or for certain non-included procedures. This is common for practices transitioning from traditional to DPC. See DPC Frontier's discussion here.

Note that billing any insurance company unquestionably makes you a "covered entity" under HIPAA. A pure DPC practice may not be.

Pricing benchmarks by geography

Monthly adult membership fees vary significantly by location. Here are realistic ranges based on current DPC practices across the country:

Pediatric pricing is typically 40-60% of adult pricing. Family plans often offer a 10-20% discount over individual pricing. Check the DPC Frontier Mapper for current pricing in your area.

Choose your pricing structure

There are lots of options: flat rate, age tiers, couple/family plans, annual discounts, or some combination thereof. Some practices charge a one-time enrollment fee. Others have no initial fee but charge for re-enrollment.

Some practices also do access/quality tiering: for instance, a Premium plan that includes guaranteed same-day scheduling, more comprehensive preventative testing, home visits, etc. Make it clear in your marketing materials that your members are paying for care, not access.

Important: Don't price too low out of fear. At $50/month you need 400+ patients just to match a modest income - and that's before overhead. Price for sustainability from day one. You can always run promotions or grandfather early members at lower rates, but raising your base price later is painful. See Why Practices Fail for more on this.

Decide on a re-enrollment policy

Some docs refuse to accept back any patient who disenrolled or missed a payment. Others require back-payment of all membership fees missed during a gap. Others charge a one-off re-enrollment fee (at least twice your monthly fee to discourage on-again-off-again behavior).

Rx markups

If you do in-office dispensing, decide whether to mark up dispensed meds. You can mark up meds quite a bit and still offer patients a great deal compared to pharmacy prices. That said, offering "wholesale prices" on drugs is often a compelling part of your sales pitch.

Lab markups

It is possible to mark up the cost of lab work while still offering patients a great deal. For pathology services, some states have laws against price markup by physicians.

Per-visit fee

Some practices charge a low per-visit fee to keep visit demand manageable. According to DPC Frontier, this fee should be lower than your monthly fee if you wish to qualify as DPC in most states.

Consider one-time cash-pay visits for non-members

Some practices do one-off visits with non-member patients, either for additional revenue or as a way to attract new members. Offer to credit the cost of the current visit towards their enrollment fee.

Consider one-year contracts

This can mitigate billing management headaches. For larger expenses, patients are more likely to pay by check or bank transfer, which means you lose less money to credit card fees.

Billing cycles

Consider whether to bill in advance or in arrears. Billing in arrears puts you on more solid legal ground and makes it cleaner for patients paying with HSA, HRA, or FSA funds. See the HSA + DPC section for details on billing considerations for tax-advantaged accounts, and DPC Frontier's discussion on Health Savings Accounts.

What changed and why it matters

Effective January 1, 2026, the One Big Beautiful Bill Act explicitly qualifies Direct Primary Care membership fees as HSA-eligible medical expenses. Before this, the IRS position was ambiguous - many patients paid DPC fees from HSA accounts anyway, but it was a gray area. Now it's law.

This means patients with a High Deductible Health Plan (HDHP) and an HSA can pay their DPC membership with pre-tax dollars. Depending on their tax bracket, this represents a 22-37% effective discount on membership fees.

How to position this in your marketing

This is one of the strongest selling points for DPC. Here's how to frame it:

• The math: "Your $100/month membership effectively costs $63-78/month after HSA tax savings" (depending on bracket)
• The comparison: A patient paying $500/month for a PPO plan with $40 copays can switch to a $200/month HDHP + $100/month DPC membership and save $200/month while getting better primary care
• The framing: "Pay for your entire year of unlimited primary care with pre-tax dollars"

Put this prominently on your website pricing page and in your enrollment materials.

The optimal patient stack: HDHP + HSA + DPC

Help patients understand the ideal insurance setup that pairs with DPC:

• HDHP (catastrophic coverage): Low-premium plan that covers hospitalizations, surgeries, and specialist care above the deductible
• HSA: Pre-tax savings account for medical expenses including DPC membership, deductible costs, and prescriptions
• DPC membership: Covers all primary care - unlimited visits, messaging, basic labs, procedures

Together, this gives patients comprehensive coverage at a lower total cost than most PPO or HMO plans, with dramatically better primary care access. The HSA also functions as a retirement savings vehicle since unused funds roll over and grow tax-free.

Billing considerations for HSA compatibility

To make things clean for patients paying with HSA funds:

• Bill in arrears: Billing for services already rendered (rather than prepaid) is more clearly a "medical expense" for IRS purposes
• Separate membership from non-medical services: If you offer wellness perks, gym discounts, or non-medical extras, keep them on a separate line item
• Provide clear receipts: Include your practice name, NPI, service dates, and a description that reads "Direct Primary Care medical services"
• Don't commingle: Keep DPC membership fees separate from any retail products, cosmetic services, or non-medical offerings

FSA, HRA, ICHRA, and QSEHRA compatibility

Beyond HSAs, DPC membership fees may be eligible under other tax-advantaged accounts:

• FSA (Flexible Spending Account): DPC fees are eligible. Remind patients of use-it-or-lose-it rules and annual limits ($3,300 for 2026)
• HRA (Health Reimbursement Arrangement): Employer-funded; DPC fees are typically reimbursable depending on plan design
• ICHRA (Individual Coverage HRA): Employers give employees a monthly allowance to buy their own health coverage. DPC + HDHP is a natural fit. This is a major employer partnership angle - see Employer Partnerships
• QSEHRA (Qualified Small Employer HRA): For employers with fewer than 50 employees. DPC fees are reimbursable. Monthly limits apply ($6,350 individual / $12,800 family for 2026)

Expand your mind

Not everything has to be 100% covered by a membership. Many practices offer additional services on a cash-pay fee-for-service basis. Consider what to include in the membership, what to provide at-cost, and what to charge extra for.

Watch this excellent talk by Drs. Lassey and Tomsen on expanding your scope of practice.

In-office dispensing

A lot of practices do this. It saves patients trips to the pharmacy and money. Some states require licenses, others impose limitations. See DPC Frontier's state-by-state legal analysis.

You can purchase pre-packaged pharmaceuticals from wholesalers like AndaMeds or Henry Schein.

Consider offering additional services

Point-of-care ultrasound (POCUS)

POCUS is increasingly standard in DPC practices. It expands your diagnostic capability, reduces unnecessary referrals, and impresses patients.

• Devices: Butterfly iQ+ ($2,500-3,000 + $420/yr subscription) is the most accessible entry point. For better image quality, consider SonoSite or GE portable units ($15,000-40,000).
• Training: Gulf Coast Ultrasound Institute offers hands-on courses. Online options include Butterfly's built-in education platform and POCUS 101. Many DPC docs start with focused cardiac, lung, MSK, and abdominal exams.
• Revenue potential: Some practices charge $50-150 for POCUS exams on top of membership. Others include basic POCUS in membership and charge for extended studies.
• ROI: A Butterfly iQ+ pays for itself quickly if you avoid even a handful of unnecessary ER referrals or imaging orders per month. The real value is better clinical decisions at the point of care.

Determine what business structure is best for your needs

First, check your state's guidelines on professional entities. Some states require you to operate as a professional entity (PLLC or PC). Here's a state-by-state rundown.

Basic rule of thumb: if you want to add an additional physician/partner, a PC will be easier. If you'll stay a one-doc shop forever, a PLLC allows pass-through taxation.

Draft Articles of Organization/Incorporation

This document creates a legal entity and provides basic information about it. Sample Articles of Organization for an LLC. Sample Articles of Incorporation for a corporation.

Draft an operating agreement/bylaws

This document details members' business interests, ownership shares, rights and responsibilities, allocation of profits and losses, and protocols for managing the business.

Sample Operating Agreement for an LLC. Sample bylaws for a corporation.

Find a registered agent

The role of a registered agent is explained in this video. It's almost always a good idea.

Incorporate the business through your state

This can usually be done online through your state's business center - just Google "[state] business entity formation". You'll need your Articles of Incorporation/Organization.

File a DBA with your state

Unless you want "Awesome Direct Primary Care, PLLC" as your patient-facing brand, file a DBA (Doing Business As) form. This may also be called a Fictitious Business Name (FBN) form.

Apply for your Employer Identification Number (EIN)

The EIN is like the Social Security number for your business. Apply online here - it's painless.

Patient Agreement (Membership Contract)

This is your most important document. It defines the relationship between you and your patients - what's included in membership, what's not, cancellation terms, and liability limitations.

A strong patient agreement should include:

• Services included: Clearly list what the membership covers (visits, messaging, basic labs, etc.) and what it doesn't (imaging, specialist referrals, hospital care)
• Explicit statement that DPC is not insurance: This protects you legally and sets patient expectations
• Fee structure: Monthly amount, payment schedule, what happens with missed payments
• Cancellation/re-enrollment terms: How much notice is required, any re-enrollment fees
• Communication expectations: Response time commitments, after-hours policy
• Liability limitations: Have your lawyer review this section carefully

Visit the websites of practices in your area using the DPC Frontier Mapper - many DPC practices publish their patient agreements online. See examples from Inspire Health DPC.

Release of Records form

Essential for transferring patient records between providers. Your form should comply with both HIPAA requirements and any state-specific privacy laws. Include fields for: patient name, date of birth, the provider releasing records, the provider receiving records, specific records requested, expiration date of the authorization, and patient signature.

Billing Authorization form

If you're accepting patient billing information on paper, you'll need an authorization form that captures payment method details and authorizes recurring charges. If patients provide billing information online via your billing vendor (Hint, Atlas.md, Stripe), this may not be necessary - but check with your vendor.

Include: authorized amount, billing frequency, card/account details, authorization signature, and cancellation procedure.

Patient History / Intake form

A comprehensive intake form for new patients. This is your first clinical interaction - make it thorough but not overwhelming. Consider using IntakeQ for a digital intake experience that patients can complete before their first visit.

Include: demographics, current medications, allergies, past medical/surgical history, family history, social history (smoking, alcohol, exercise), current complaints, and insurance information (even if you don't bill insurance - useful for referrals and emergencies).

Informed Consent forms

You'll need procedure-specific consent forms for any procedures you perform (joint injections, skin biopsies, POCUS, etc.). Generic templates exist, but customize them for your specific procedures and have them reviewed by your attorney.

If hiring: Employee Contract

Standard employment agreement for any staff you hire. Include: job description, compensation, benefits, work hours, confidentiality/HIPAA obligations, termination terms, and non-compete/non-solicitation clauses if applicable.

Run everything by a lawyer

Strongly recommended - especially your patient agreement and any employer contracts. A few thousand dollars in legal fees now can prevent five-figure problems later. Look for a lawyer familiar with medical law and DPC in particular. Many practices use Luanne Leeds who specializes in helping DPC practices.

Estimate startup costs

Itemize every upfront expense before you open the doors. The Financial Model section has detailed ranges, but here are the major categories:

• Office: Lease deposit, renovation/buildout, furniture, signage
• Medical equipment: Exam table, otoscope, BP cuffs, point-of-care testing supplies, POCUS (if applicable)
• Technology: EHR setup and first-year subscription, computer/tablet, communication platform
• Legal/professional: Incorporation, operating agreement, contract review, accountant setup
• Insurance: Malpractice first premium, business/property insurance
• Marketing: Logo, website, business cards, initial advertising, grand opening event
• Inventory: Medications (if dispensing), supplies, lab kits
• Working capital: 6 months of operating costs as a cash reserve

Project revenue growth

Your revenue is straightforward: patients x monthly fee. The hard part is projecting patient growth realistically. Don't plan for best-case scenarios - plan for the slow ramp.

• Month 1-3: How many patients can you bring from a prior practice or personal network?
• Month 4-6: What's a realistic pace of new patients per month? (5-15/month is common early on)
• Month 7-12: When do you expect word-of-mouth and marketing to accelerate?
• What monthly fee will you charge? (See Pricing for benchmarks)

Plot monthly revenue against monthly expenses to find your break-even month. For most solo practices, this lands between month 10 and month 18. The Financial Model calculator helps you run these numbers.

Calculate your total cash needed

Add up: startup costs + cumulative operating losses until break-even + personal living expenses for the same period. That's the minimum cash you need access to before opening. Add a 20% buffer for surprises.

If the number is higher than your savings, you have options: moonlighting income, a working spouse's income, a business loan, or starting with a cheaper setup (sublease, smaller space, fewer services).

If you need a loan: do your research

Physician-specific lenders understand medical practice economics. Check out this comprehensive review of physician loans. SBA loans are another option - the SBA has programs for small medical practices. Having a written business plan significantly improves your loan approval odds.

Consider completing a small business workshop

Check your local SBA Small Business Development Center for free workshops. Local colleges often offer cheap courses. Sometimes a certificate of completion will convince a bank to give you better rates on loans. The SBA's SCORE program also offers free mentorship from experienced business owners.

Revenue model

DPC revenue is simple: number of patients x average monthly fee = monthly revenue. Here's what that looks like at different scales:

Most solo DPC practices cap at 400-600 patients to maintain the small-panel advantage. Average monthly fees vary by geography - see the Pricing section for benchmarks.

Startup cost breakdown

Total startup costs typically range from $57,000 to $276,000. Here's where the money goes:

Most practices land in the $80,000-$150,000 range. The biggest variable is office space - a small sublease in a strip mall costs far less than a ground-up medical office buildout.

Monthly operating costs

Once you're open, expect these recurring monthly expenses:

Solo practices without staff typically run $3,000-$6,000/month. With one MA/front desk employee, expect $7,000-$12,000/month.

Break-even calculator

Use this calculator to estimate how many patients you need to cover your monthly costs. Adjust the sliders to match your situation.

Realistic ramp-up timeline

Don't expect to fill your panel on day one. Here's a realistic growth trajectory for a solo practice:

Practices that bring an existing patient base or land an early employer contract can compress this timeline significantly. Practices starting from zero in a new market should plan for the slower end.

Financial model spreadsheet

Download a free DPC financial model template to project your first 3 years of revenue and expenses. Customize it with your local costs and pricing.

Download Google Sheets Template →

Includes: startup costs worksheet, monthly P&L projections, break-even analysis, and sensitivity tables for different patient growth scenarios.

Set up accounting workflow

Quickbooks, Freshbooks, and Zoho are good options. Keep track of all business expenses from the get-go.

Hiring

Indeed and ZipRecruiter are easy to use and have a high success rate.

If you have employees: set up payroll

Gusto is excellent. Other options are Zenefits and Quickbooks.

Open a checking account for your business

You'll likely need your business's EIN and Articles of Incorporation/Organization. For an LLC, some banks may also require your Operating Agreement.

Apply for a business credit card

It's useful to have a line of credit available early on when cash flow is minimal. It may also help build your business credit score.

Update your contact info with everyone!

Update nearby hospitals, private practices, the DEA, state pharmacy board, state licensing office, city business licensing office, local labs, radiology centers, and anyone else in the medical community who knows you.

Consider your options

Most practices have a small dedicated space. It's okay to be small - just a waiting room and an exam room. Many DPCs have made that work. Others have rented spare rooms in nearby clinics, taken over a space from a retiring doc, or even run a micro-practice from home.

Decide whether to buy, rent, or lease

Each option has different implications for your cash flow and long-term plans.

Find a location

Check out sites like Crexi or Loopnet that focus on commercial listings. Or drive around nearby strip malls and business parks looking for real estate signs.

Arrange the front office space

Get the necessary office supplies and arrange your waiting room and exam areas.

Figure out the front-office check-in process

You could hire a front-office person, do patient check-in yourself, or use an iPad/kiosk for check-in. Remember, hiring employees makes you subject to OSHA.

If you have employees: set up HR/payroll software

QuickBooks is a tried-and-true option.

If you have employees: consider offering benefits

Life, health, and accident insurance - and of course free DPC subscriptions!

Decide when to opt out of Medicare

It is possible to open your practice while remaining opted-in. Simply don't accept any Medicare-covered patients initially. It's also possible to moonlight in limited circumstances (occupational medicine, correctional medicine, addiction medicine, urgent care). See more details here.

Complete an opt-out affidavit

Look up your state to find a link to the proper opt-out affidavit and the address to mail it to.

Mail affidavit at the appropriate time

For participating providers: New batches of Medicare opt-outs are made active on the first day of each calendar quarter (Jan 1, Apr 1, July 1, Oct 1). The Medicare carrier must receive your affidavit 30 days prior to the stated effective date.

If non-participating (NON-PAR): Your opt-out takes effect immediately upon receipt. Be careful if still employed or moonlighting!

Use Certified Mail with return receipt requested.

Find an Advance Beneficiary Notice of Noncoverage (ABN) form

All new patients must sign an ABN to acknowledge that you are opted out of Medicare. Download forms here.

Notify state Medicaid program

See the full DPC Frontier discussion on Medicaid dis-enrollment.

Private insurance

Often this must be done 90 days out. Notify all patients covered by that company that you are leaving their network.

Join one or more group purchasing organization (GPO)

This is often the best and easiest way to get cash prices on medications, labs, and DME. Groupsource or PedsPal can get you deals on medications and DME. Healthcare Procurement Solutions gets you deals from Labcorp, Quest, McKesson, and Medline.

If doing in-office dispensing: sign up with a wholesale medication distributor

If you don't join a GPO, sign up with Andameds or Henry Schein.

If NOT doing in-office dispensing: help patients save money at the pharmacy

Point them to Blink Health, GoodRX, Marley Drug, and NeedyMeds.

Establish a relationship with a lab

Many DPC docs negotiate prices with national laboratories (LabCorp, Quest, CPL, Life Line).

Don't forget to also negotiate a blood draw fee. The default is often high ($20) but they'll typically come down if you insist.

Establish a relationship with an imaging center

It is possible to negotiate low prices with imaging centers for your patients. Independent imaging centers are more flexible on pricing than hospital-affiliated ones.

Establish relationships with other providers

Consider arranging prices for bariatric surgery, breast health, digestive disease, endoscopies, eye surgery, general surgery, heart and vascular specialists, kidney stone treatment, oncology, orthopedic surgery, pain management, physical therapy, radiology, sleep health, and spine procedures.

eBay and Amazon

Often the lowest prices, especially for medical devices, will be on eBay and Amazon.

Select a domain name for your website

Use Namecheap to check availability and purchase your domain. Aim for yourpracticename.com. Avoid hyphens, numbers, or unusual TLDs. If the .com is taken, consider .health or .care, but .com is always preferred.

Make a website for your practice

You have three main options. For most DPC physicians, DPC Spot is the clear winner - it's purpose-built for DPC practices and handles the technical work that generic website builders leave to you.

• DPC Spot (Recommended) ($79-239/month) - Built specifically for DPC practices by people who understand the model. DPC-optimized templates designed for patient conversion, built-in SEO so you rank in local search, lead capture forms optimized for enrollment, analytics and reporting to track what's working, integration with Hint and Atlas.md for seamless patient onboarding, blog hosting for content marketing, and domain services. This is the best option for most DPC docs who want a professional website without becoming a web developer.
• Build yourself using Wix, Squarespace, or Webflow ($25-80/month) - Cheapest option but requires more time and technical comfort. You'll handle your own SEO, lead capture, and design. Good if you enjoy tinkering and have prior web experience.
• Hire a web design studio like Digital Silk, Hedy & Hopp, or Huge ($5k+) - Most expensive but fully custom design tailored to your brand. Worth it if you want a unique look and have the budget.

Essential website content

Regardless of which platform you choose, your website needs these elements to convert visitors into patients:

• Clear DPC explanation: Most visitors won't know what DPC is. Explain it in plain language, not medical jargon.
• Transparent pricing: Don't hide your prices. DPC patients specifically seek price transparency. Display your monthly fees prominently.
• Easy sign-up path: Prominent "Join" or "Enroll" buttons. Minimize friction between interest and enrollment.
• About you: Your photo, background, and why you chose DPC. Patients join DPC for the personal relationship - let them know you before they walk in.
• What's included: A clear list of services covered by membership.
• Contact info: Phone, email, address, and a map. Make it easy for patients to reach you.

Set up email hosting

Google Workspace includes email hosting at $7/user/month with your custom domain. Google will sign a BAA, so you can have HIPAA-compliant email through a familiar Gmail interface. Microsoft 365 is another option if you prefer Outlook.

The DPC software stack: 6 categories

A DPC practice needs software across six areas. Some platforms bundle multiple categories; others specialize in one. The right setup depends on whether you prefer an all-in-one solution or best-of-breed tools.

1. EHR (Electronic Health Record) - Clinical charting, notes, problem lists, medications
2. Membership billing - Recurring patient billing, enrollment management, payment processing
3. Patient communication - Secure messaging, phone, video visits
4. Scheduling - Appointment booking for patients and staff
5. E-prescribing - Electronic prescriptions including controlled substances (EPCS)
6. E-fax + lab integration - Receiving results, sending referrals, faxing records

EHR comparison

These are the main EHR options built for or commonly used in DPC practices:

Tip: Request demos from at least two platforms. Ask specifically about DPC workflows - appointment types without billing codes, membership tracking, and how they handle un-insured patients. Switching EHRs later is expensive and disruptive.

Membership and billing platforms

If your EHR doesn't include robust billing, you'll need a separate membership management platform:

• Hint - The gold standard for DPC billing. Handles recurring memberships, enrollment, payment processing, and reporting. Integrates with Elation and other EHRs.
• Atlas.md - Billing is built into the all-in-one platform. Simpler setup but less standalone flexibility.
• Stripe DIY - Some tech-savvy physicians build their own billing with Stripe subscriptions. Maximum flexibility, minimum hand-holding. Only recommended if you enjoy building systems.

Patient communication

Direct patient messaging is a core DPC feature. Choose a platform that's HIPAA-compliant and supports the communication style your patients expect:

• Spruce - Most popular in DPC. HIPAA-compliant messaging, phone, fax, and video in one app. $24-44/user/month.
• Klara - Patient messaging with automation features. Good for practices with staff handling triage. Pricing varies.
• OhMD - Two-way texting with patients from your practice number. Free tier available. HIPAA-compliant.
• Google Voice - Free business phone number. Voice and text only. Not HIPAA-compliant - fine for scheduling, not for clinical discussions. Google will not sign a BAA for Google Voice.

E-prescribing

Most DPC EHRs include e-prescribing. If yours doesn't, standalone options include:

• MDScripts - Also handles inventory management for in-office dispensing
• DrFirst - Widely integrated e-prescribing including EPCS
• DoseSpot - Embedded e-prescribing for platforms that integrate it

E-faxing

You'll receive referral letters, lab results, and records by fax whether you like it or not. Options:

• Spruce - Includes fax in the same communication platform
• RingCentral - Business phone + fax bundle
• Doximity - Free faxing for physicians (limited pages/month)
• HelloFax - Simple standalone fax service

All-in-one vs. best-of-breed

The fundamental decision: do you want one platform that does everything okay, or multiple tools that each do their thing well?

• All-in-one (Atlas.md): One login, one bill, less integration hassle. Trade-off: each individual feature may not be best-in-class. Great for physicians who want simplicity.
• Best-of-breed (Elation + Hint + Spruce): Each tool is excellent at its job. Trade-off: more logins, more invoices, potential integration gaps. Great for physicians who want the best clinical experience.

There's no wrong answer. Most DPC practices use 2-4 software products total. Start simple - you can always add or swap tools later, except the EHR (which is hard to switch).

Other useful tools

• Dictation: Dragon Medical or built-in OS dictation for charting
• Text expansion: TextExpander or Breevy for common note templates
• Cloud storage: Dropbox Business (HIPAA-compliant with BAA) or Google Workspace
• Specialist consults: RubiconMD for eConsults to avoid unnecessary referrals
• Forms/intake: IntakeQ for digital patient intake and e-signatures
• Inventory: MDScripts or Flexscan for in-office dispensing tracking

Synchronous vs. asynchronous telehealth

DPC practices typically use both modes:

• Synchronous (video/phone visits): Real-time appointments for acute issues, follow-ups, and anything that benefits from face-to-face interaction. Most patients expect this as part of their membership.
• Asynchronous (messaging): Secure text/photo-based conversations for questions, medication refills, lab results, and simple concerns. This is where DPC shines - most issues can be resolved in a 2-minute text thread instead of a 20-minute video call.

The combination dramatically reduces unnecessary in-person visits while keeping patients connected. Many DPC practices find that 30-50% of patient interactions happen asynchronously.

Telehealth platform options

• Doxy.me - Free tier available, HIPAA-compliant, browser-based (no app install for patients). Most popular in DPC for video visits.
• Spruce - Combines messaging, phone, video, and fax in one HIPAA-compliant platform. Best option if you want one tool for all patient communication.
• Zoom for Healthcare - HIPAA-compliant version of Zoom with BAA. Familiar interface for patients. $13-22/host/month.
• EHR-integrated - Atlas.md and Elation both offer built-in telehealth. Eliminates context-switching between platforms. Quality varies.

Recommendation: Start with Doxy.me (free) for video visits and Spruce for messaging. If you find yourself wanting consolidation, move to an all-in-one later.

Interstate licensing and the Medical Licensure Compact

Telehealth creates licensing questions when patients travel or live in other states:

• Interstate Medical Licensure Compact (IMLC): Allows physicians to practice in 40+ member states with an expedited licensing process. Check imlcc.org for member states. This is the easiest path to multi-state telehealth.
• Snowbird patients: Many DPC patients travel seasonally. The Compact makes it practical to continue caring for them remotely. Without it, you technically need a license in their state.
• State-specific rules: Some states have telehealth-specific exemptions for established patients. Others are strict. Research your patients' common travel destinations.

If a significant portion of your panel travels, the IMLC expedited license is worth the investment.

Telehealth-first and virtual DPC models

A growing number of DPC practices operate primarily or entirely via telehealth:

• Fully virtual DPC: No physical office. Lower overhead, wider geographic reach. Works well for straightforward primary care, chronic disease management, and mental health. Doesn't work for procedures, POCUS, or hands-on exams.
• Rural telehealth DPC: Serve rural populations that lack local primary care. Combine virtual visits with periodic in-person days at a shared clinic space. High demand, low competition.
• Hybrid model: Physical office for in-person visits + robust telehealth for follow-ups and quick questions. This is where most DPC practices are heading.

Virtual DPC practices can start with almost zero capital since there's no office buildout. Monthly overhead can be under $2,000. The trade-off is a narrower scope of practice and potential licensing complexity.

Malpractice insurance

Consider involving an independent broker familiar with direct primary care. Quotes vary hugely state-by-state. Ask for part-time rates since you won't be fully booked in early days.

Worker's compensation

If you employ people, you'll possibly be required to have a workers' compensation plan. Check state-by-state laws.

Disability insurance

If you have employees in CA, HI, NJ, NY, or RI, you are required to provide some form of short-term disability insurance.

Business interruption insurance

Practices in natural-disaster-prone areas may consider catastrophe insurance to make up for lost revenues.

Commercial property insurance (if applicable)

Protects your physical office space and equipment.

Commercial auto insurance (if applicable)

If you use vehicles for business purposes.

Decide whether to do any in-office testing

Many commonly performed in-office labs can now be performed by patients using home testing kits (HIV, Hep C, Strep, UTI, lipid panels, TSH, HgA1c, PSA, Vitamin D). See offerings at testkitsathome.com.

To do CLIA-waived tests: file for a waiver

Fill out a CMS-116 form and submit it to your state's CLIA Agency.

Additional requirements in: AZ, CA, CT, DC, FL, LA, ME, MD, MA, MI, NV, NJ, OR, PA, WA, and Puerto Rico.

Consider offering physician-performed microscopy (PPM) services

PPM is the next level up from waived status. It lets you do all waived tests plus microscopic procedures. However, it requires compliance with multiple CLIA subparts and is probably not worth the trouble early on.

Maintain best practices

Check out the CDC's best practices document for CLIA-waived facilities. Any CLIA-waived facility is subject to random audits, though they are rare.

Set up a reminder to renew your waiver every two years

FollowUpThen is a great free service for scheduling email reminders.

Determine if you are a covered entity under HIPAA

Check out DPC Frontier's thorough discussion of HIPAA. If you are not covered, feel free to ignore the rest of this section.

Check for state laws regarding patient privacy

In some states they are even more stringent than HIPAA.

Complete a Security Risk Assessment

This free tool from the ONC will make this much easier.

Draft a Notice of Privacy Policies (NPP)

The HHS publishes a sample NPP that can be easily customized. Once completed, publish the notice to your website.

Draft a Release of Records Authorization Form

HIPAA requires you to have this form on file for any disclosure of protected health information for purposes other than treatment, payment, and health care.

Keep an Accounting of Disclosures log for auditing purposes.

Draft a Patient Consent Form

Though not required by HIPAA, this lets the patient approve certain forms of communication (email, text, phone calls, answering machines).

Gather and maintain proof of HIPAA compliance

Full compliance involves writing a Breach Plan, Training Plan, Communications Plan, Disaster Recovery Plan, Audit and Monitoring Plan, and a detailed Policies and Procedures Manual. Check out the AMA resources to get started.

Gather Business Associate Agreements

You need a signed BAA from every company/product/service that handles your patients' health info. See a template here.

Find a biohazard/waste disposal service near you

Essential for proper disposal of medical waste.

Follow best practices when dealing with hazardous chemicals/waste

Use safe sharps, protective equipment, universal precautions, and clearly marked waste containers.

Maintain a list of hazardous chemicals in your office

Keep it available to employees. Print Safety Data Sheets for every chemical in stock (find them free online).

Buy a fire extinguisher and mount it on the wall

Basic safety requirement for any workplace.

Print the OSHA poster and put it on the wall

Here's a PDF.

Put your employees through annual OSHA training

Check out Medtrainer for easy online OSHA training.

Know how to report incidents to OSHA

Every employer must report workplace fatalities or hospitalization of three or more employees. Report online here.

With more than 10 employees: draft an emergency action plan

Required for employers with more than 10 employees. See OSHA's sample plan.

With more than 10 employees: do incident reporting and logging

Fill out OSHA Form 301 for all workplace illnesses/injuries. Use OSHA Form 300 for logging and Form 300A for annual summaries. All forms available here.

Month-by-month marketing calendar

Marketing isn't a one-time event. Here's what to focus on at each stage:

Add your practice to the DPC Frontier mapper

Go to dpcfrontier.com, click "Physician Login", create your account, and follow the instructions to create your mapper listing.

Add your practice to the Atlas.md map

Get listed on the Atlas.md DPC practice map to help patients find your practice.

Practice teaching people about DPC

Get your 30 second description of DPC down pat. Iterate on your language and pay attention to what patients find compelling. Direct interested patients to DPC Nation.

Create two Google Business profiles

Go to business.google.com. Create two profiles: one for your business, one for you as a physician.

Make a Facebook Page for your practice

Post regularly: preventative health tips, comments on current events, PSAs, and DPC developments.

Claim your profiles on online review sites

Update your information on Yelp, Vitals, RateMDs, WebMD, and Healthgrades.

Get professional photos taken

Post them to your Google profiles, Facebook page, social media accounts, review sites, and website.

Optimize your website for patient conversion

Your website is often the first impression potential patients have of your practice. Make sure it clearly explains DPC, has easy-to-find pricing, and makes it simple to sign up or contact you. Purpose-built platforms like DPC Spot are designed specifically for DPC patient acquisition.

Invest in SEO (Search Engine Optimization)

Help potential patients find you when they search for doctors in your area. SEO is a long-term strategy that compounds over time. If you're using DPC Spot for your website, on-site SEO is handled automatically - your pages are optimized for search engines out of the box. Focus your personal effort on the off-site tactics below.

• Google Business Profile optimization: This is the #1 local SEO lever. Complete every field: categories (use "Direct Primary Care" and "Family Practice"), services, hours, photos (inside/outside office, headshot), description with keywords. Post updates weekly - Google rewards active profiles.
• Review generation: Ask every happy patient for a Google review. Make it easy - text them a direct link after their visit. Aim for 20+ reviews in your first 6 months. Respond to every review (positive and negative).
• Local directory listings: List your practice with consistent name, address, and phone (NAP) on: Yelp, Healthgrades, Vitals, WebMD, the Atlas.md DPC directory, and the DPC Frontier Mapper. NAP consistency across all directories is critical for local search rankings.
• Content marketing: Write blog posts answering common patient questions: "What is DPC?", "How much does a DPC membership cost in [city]?", "Can I use my HSA for DPC?". DPC Spot can host your blog content. One well-written post per month compounds over time.
• Backlink building: Get other local websites to link to yours. Join the Chamber of Commerce (usually gets you a directory link), contribute articles to local news sites, partner with local businesses who'll link to you as their recommended physician.
• Guest posting: Write articles for local publications, health websites, employer newsletters, or business blogs. Position yourself as the local DPC expert. Each guest post typically earns a backlink.
• On-site optimization (if DIY): If you're not using DPC Spot, manually optimize your site: include keywords like "direct primary care [your city]", "DPC doctor near me", and "membership medicine [your area]" naturally throughout your site. Ensure your site is mobile-responsive and loads fast.

Brainstorm ways to get free exposure

Think about where lots of people go. Win over social connectors. Think about subpopulations that benefit from DPC: elderly, athletes, uninsured students, employers. Make a list of tight-knit communities where DPC could spread: country clubs, rotaries, bingo clubs.

Get a logo

Find a local graphic designer, someone on Upwork, or use 99designs. Don't try to design it yourself!

Custom printed stationery and marketing materials

Use Canva to design flyers, brochures, business cards, posters, signs, envelopes, and stationery.

Disseminate your marketing materials

Put cards/flyers at local gyms, day cares, YMCAs, universities, grocery stores, benefits consultants, and health establishments.

Ask for referrals

Chat with urgent cares and specialists nearby. Pitch them on DPC.

Check for retiring physicians nearby

They may be interested in working as an employed physician at your practice, or may send their patients your way.

Network with other small business owners

Check out BNI, local Meetups, Chamber of Commerce, Rotary, 1 Million Cups, NFIB, and Facebook Groups.

Reach out to nearby self-insurance TPAs/brokers

The DPC model complements high-deductible, low-premium plans. Brokers could bring an entire company of patients.

Talk to the specialists you refer to

Specialists tend to like DPC practices - they get paid in cash immediately. They may direct patients to you.

Consider paying for advertising

• Print: billboard, newspaper ads (generally poor investments)
• Local radio: good for explaining the DPC model to a targeted local audience
• Facebook: "boost" posts to reach people in your area
• Google Ads: specify exactly which search queries to show up for
• Yelp Ads: target people actively searching for doctors in your area

Make advertising partnerships

Partner with local gyms, YMCA, and health clubs. Exchange marketing materials and offer "exclusive partnership discounts."

Set up a referral program

Offer a $100 Amazon gift card to patients that refer someone to your practice.

Why employers are the best growth channel

Individual patient marketing is slow - you're convincing one person at a time about an unfamiliar model. Employer partnerships flip this dynamic:

• A single 50-person company can add 50-150 members (employees + dependents) in one contract
• Employers pay the membership fees - patients have zero friction to enroll
• Employer contracts provide predictable, stable revenue that doesn't churn like individual members
• Employers are motivated buyers: they're spending $15,000-25,000 per employee per year on healthcare and getting mediocre results
• One successful employer case study creates referrals to other employers in the same network

Types of employer arrangements

• Direct-pay: Employer pays DPC membership directly for employees as a benefit. Simplest structure. Employer gets a single monthly invoice.
• ICHRA (Individual Coverage HRA): Employer gives employees a monthly allowance. Employees use it to buy their own HDHP + DPC membership. Maximum flexibility. See HSA + DPC for details.
• Level-funded plans: Small employer health plan where the employer pays a fixed monthly amount. DPC can be layered underneath as the primary care component to reduce claims. Work with a benefits consultant on these.
• Self-insured + DPC: Larger employers (50+ employees) who self-insure can add DPC as a primary care carve-out. DPC reduces ER visits, specialist referrals, and overall claims cost.
• Concierge supplement: Some employers offer DPC as a premium perk alongside traditional insurance for executives or high-value employees.

How to find employer prospects

• Target size: Small businesses with 10-100 employees. Large enough to be meaningful, small enough that the owner makes benefits decisions personally.
• Target pain: Companies on high-deductible plans where employees complain about access and cost. Companies that just got their renewal letter with a 15-25% rate increase.
• Where to find them: Chamber of Commerce events, BNI chapters, Rotary clubs, local business associations, coworking spaces, and small business development centers.
• Warm introductions: Ask your existing patients where they work. Ask if their employer might be interested. Personal connections convert better than cold outreach.
• Benefits consultants: These are the gatekeepers. They advise employers on healthcare benefits and can bring you deals. See below.

The benefits broker partnership

Benefits brokers and consultants are the single most important relationship for employer partnerships. They advise small and mid-size employers on healthcare spending and can recommend DPC as part of a benefits strategy.

• How to approach: Invite them to lunch or coffee. Bring data on DPC outcomes (reduced ER visits, lower total cost of care, higher employee satisfaction). Offer to present to their clients jointly.
• What to pitch: Focus on how DPC + HDHP can save their clients 20-40% on healthcare costs while giving employees better access to primary care.
• Referral structure: Some brokers will refer employers in exchange for inclusion in the overall benefits package design. Others may want a referral fee - check your state's laws on this. Many are simply motivated by client retention (happy clients don't leave their broker).
• Find brokers: Search for local benefits consultants on LinkedIn, ask your existing employer contacts who their broker is, or attend local SHRM (Society for Human Resource Management) events.

Employer pricing guidance

• Per Employee Per Month (PEPM): $50-100/employee/month is the standard range for employer contracts. Lower than individual membership pricing because you're getting guaranteed volume.
• Dependent pricing: Add $30-60/dependent/month, or offer family pricing at 1.5-2x the employee rate.
• Minimums: Consider requiring a minimum of 10-20 employees to make the contract worth the administrative overhead.
• Tier structures: Some practices offer Silver/Gold/Platinum tiers with different service levels (e.g., Gold includes POCUS and wellness screenings).

Contract terms

• Term: 12-month minimum is standard. Aligns with employer benefits cycles.
• Termination: 60-90 day written notice for either party. Protects both sides.
• Enrollment: Specify when new employees can enroll (immediately, first of the month, open enrollment periods).
• Scope: Clearly define what's included in the membership and what's billed separately (labs, medications, procedures).

Have a healthcare attorney review your employer contract template. This is more complex than individual patient agreements.