Question 1

Is direct primary care financially viable for a solo physician?

Accepted Answer

For most physicians, yes, but the math has to be honest. A solo panel of roughly 300 to 600 patients at $75 to $200 per month produces a workable income once overhead is covered, and DPC overhead is far lower than an insurance practice because there is no billing or coding layer. The risk is not the model, it is the runway. Practices that open with four to six months of operating cash and a real patient acquisition plan tend to make it. Practices that open on savings and hope tend to struggle in month five.

Question 2

Why do DPC practices fail?

Accepted Answer

Almost never for clinical reasons. The common causes are undercapitalization, no consistent patient acquisition after the first wave of friends and former patients, a membership fee set too low to sustain the panel, and the physician absorbing every administrative job personally until burnout returns in a new costume. Each of these is a business failure, not a medical one, which is also why each is preventable.

Question 3

Can I start a DPC practice straight out of residency?

Accepted Answer

It has been done, and some of the strongest practices we have seen came from physicians who never built insurance habits to unlearn. The tradeoffs are real: no existing patient base to convert, thinner lending history, and less clinical autonomy reflex. If you go this route, plan for a longer ramp to breakeven and lean harder on community marketing from day one.

Question 4

Do I need business experience?

Accepted Answer

No, and most physicians we work with do not have it. What you do need is a decision about who is doing the business work. Either you learn it, you hire it, or you partner for it. The failure mode is assuming it will get done in the margins of a clinical week.

Question 5

How much does it cost to start a DPC practice?

Accepted Answer

Typical launches land between $55,000 and $180,000 depending on space, staffing, and market. The low end is a lean solo practice in a small leased suite. The high end is a multi-provider urban practice with build-out. The largest line items are usually lease and build-out, equipment, and the operating runway you need before membership revenue catches up.

Question 6

How many patients do I need to break even?

Accepted Answer

Most solo practices break even somewhere between 120 and 160 members, which usually lands between months 6 and 12. Membership price moves that number more than anything else, so a practice at $150 per month reaches breakeven with a substantially smaller panel than one at $85.

Question 7

What should I charge for membership?

Accepted Answer

Most practices sit between $75 and $200 per month, with pediatric and family tiers priced below adult rates. Set it against your local cost of living and the panel size you actually want to carry, not against the cheapest practice in your city. Underpricing is the most common and most expensive early mistake, because raising a fee on existing members is far harder than setting it correctly once.

Question 8

Can I get financing for a DPC practice?

Accepted Answer

Yes. SBA loans, medical practice startup loans, and equipment financing all work for this model. The practical hurdle is finding lenders who already understand membership medicine so you are not spending the first meeting explaining the business model.

Question 9

Can I bring my current patients with me?

Accepted Answer

Many physicians do, though the conversion rate varies widely with how long you have been in the community and what your employment agreement allows. Plan the communication sequence before you resign, and have a member enrollment path ready on day one so interested patients have somewhere to go.

Question 10

What about my non-compete?

Accepted Answer

Non-competes vary by state and by contract, and enforceability differs from what the document claims. Have an attorney in your state read it before you make any move. This is one area where general advice is worth very little and a two hour legal review is worth a great deal.

Question 11

Can I keep taking insurance, or do I have to drop it?

Accepted Answer

Some physicians run a hybrid for a period, and some stay hybrid permanently. It is harder operationally because you are maintaining two revenue systems and two workflows at the same time. Physicians who intend to end up fully DPC usually find that a defined transition window works better than an open ended hybrid.

Question 12

What happens to my Medicare patients?

Accepted Answer

Medicare cannot be billed for services covered by a DPC membership, and physicians typically either opt out of Medicare or structure the arrangement so membership covers only non-covered services. The rules are specific and the paperwork has deadlines, so this decision belongs early in your planning, not the week before you open.

Question 13

How long does it take to open?

Accepted Answer

Most launches reach opening day roughly 16 weeks after kickoff. Lease timelines, state licensure, and build-out are the usual variables that stretch it. That cadence has held across 165+ launches since 2016.

Question 14

How do I find patients?

Accepted Answer

Early membership almost always comes from three places: former patients, local employers, and community presence. Paid advertising helps later, but it rarely carries a practice through its first hundred members. The practices that fill fastest treat patient acquisition as a weekly habit rather than a launch campaign.

Question 15

Do I need staff on day one?

Accepted Answer

Many solo practices open without clinical staff and add a medical assistant somewhere between 150 and 250 members. What you cannot skip is the administrative work itself. Someone has to answer the phone, chase labs, handle billing questions, and keep marketing moving, and that someone should not be you at 9pm.

Question 16

Which EHR should I use?

Accepted Answer

Use a DPC-native system rather than a scaled down insurance EHR. Membership billing, direct messaging, and simple charting matter far more than claim scrubbing you will never use. The wrong EHR is survivable but it costs hours every week for years.

Question 17

Can specialists do this too?

Accepted Answer

Yes. The membership and cash-pay structure works well in rheumatology, endocrinology, ENT, OB/GYN, surgery, and others, particularly where prior authorization burden is heaviest. The economics differ from primary care because visit frequency is lower, so pricing usually blends membership with transparent visit or procedure rates.

The questions physicians actually ask before starting a DPC practice.

What do physicians most often ask about starting a DPC practice?

Should I do this at all?

What does it cost and when do I break even?

How do I leave what I have now?

How does the practice actually run?

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