What are the Nuts and Bolts of Starting a Direct Primary Care Practice
This week, I received another question from a prospective Direct Primary Care doctor. The heading was “Nuts and Bolts” and these are some great questions to ask. First, thank you for your question, dear reader. Second, if you (audience) are reading this and have your own questions for me, feel free to send them to firstname.lastname@example.org and I’ll answer them fully. Without further ado, here’s the question in full:
Dear Dr. Thomas,
I just finished reading your book this past weekend. Thank you! You instilled in me a tremendous motivation. May I ask you a few questions? I planning my transition into DPC and your responses will be greatly appreciated.
1. What EHR do you use?
2. What scheduling system do you use?
3. What recurring billing company do you use?
4. What phone system do you use? Who covers your phone when you are away?
5. How big does my office need to be?
Thank you so much.
______ ______, MD, MBA
These are all fantastic questions, so let’s dive in!
Which EHR or EMR should you use for your Direct Primary Care practice?
Before I give you the answer to this, I want to tell you that it’s not the decisions, it’s the decisiveness. Meaning that there are literally thousands of decisions that you will make on your way to starting a Direct Primary Care practice, and it’s better to make the best possible decision more quickly than waiting months until you have the perfect answer.
And making imperfect decisions is a hard skill for physicians to learn. In business, decisions must be made quickly and often. That’s why executives are called executives - they literally kill off other possibilities and make a decision. If you spend too much time hemming and hawing over which EMR to use, you’re losing valuable time focusing on building your brand, building your business, and recruiting new patients.
That being said, there are two leading Electronic Medical Record Systems in use in the Direct Primary Care space. They are ATLAS MD and HINT + ELATION. Personally, I use ATLAS MD because it allows me to take notes on my patients, inventory and dispense medications, as well as hold credit/debit/bank information and charge my patients on a recurring/monthly basis.
Many DPC Doctors use ATLAS and many DPC Doctors use HINT + ELATION. There is no right answer because there is no perfect system for your Direct Primary Care practice. Each EMR has its flaws, omissions, and issues, but on the whole they both are tools that allow you to take good care of your patients in this model.
Which scheduling system do you use for your Direct Primary Care practice?
For scheduling, there are 100 ways to schedule patients for your practice. For me, I prefer that my patients text or email me to request appointments. That way, I can triage them via text and then get them in for an appointment in a timely manner. I use Google Calendar to get this done, which allows me to input the time, the location (our office address), their email address so that they get a reminder email, as well as instructions on how to get to our office. We sub-lease a one room office, so our location is slightly difficult to find.
Another way to schedule patients would be through our EMR, ATLAS, which has a built-in scheduling tool. This also has an automated reminder email system and you can personalize the messaging in your appointment reminders. This system can sync with iCal or Google Calendar.
Another way to schedule would be to have a front desk staff person who takes calls and inputs your appointments into your iCal, Google Calendar, or Outlook Calendar.
Still another way is to use an app like Orchestra One and have patients select their own appointment times. The reason I don’t use this tool is that I prefer to have total control of my schedule (within reason). I’m gonna be at the office most days from 9 am - 5 pm, and I want to control who I see when and for how long. Someone may just need a med pickup, but if they had access to Orchestra One, they could make a 30 minute appointment for this, which would be unnecessary and not the best use of my time.
Which recurring billing company do you use for your Direct Primary Care practice?
As mentioned in the Electronic Medical Record system answer, I use Atlas for my recurring billing. Other DPC Doctors use Hint and Elation.
Additionally, I use Square to get payments for Medical Records release documents. Often times, the law firms and insurance companies who request these documents offer to pay $30 - $50 for records. To collect this money, I’ll take a credit card payment over the phone and put that information into Square and run the charge. It’s a good way to collect revenue for one-time payments as well.
Finally, I’ll use QuickBooks to send some invoices. There’s an invoice tool within QuickBooks that allows me to charge for certain services to outside vendors. This is good for Business to Business transactions.
Which Phone System do you use for your Direct Primary Care practice?
There are 100 ways to answer the phone. The easiest is to get a phone number for your business and use Google Voice. That is a customer-facing number for non-members. Once members sign up for the practice, I give them my cell phone number and encourage them to either text or email me for the fastest possible response.
I discourage phone calls unless it’s an urgent manner because it takes more time to answer these questions and takes me away from the task in front of me. Now, keep in mind that this is for a solo doctor with no staff. As of right now, I do not have a traditional land line and I take every call via my laptop (Google Voice) or my cell phone (Google Voice forwards calls to my cell if I don’t answer right away on my laptop).
If I had a front desk person/medical assistant, their primary job would be fielding phone calls and taking notes on requests from patients and filtering that information back to me via the Electronic Medical Record. Another great aspect of ATLAS is that you can have a second user on your account who can assign TASKS or check boxes to be completed based on requests like this.
Many doctors in the Direct Primary Care space use some sort of VOIP system. You can read more about general phone systems for business from this INC article. You can read more about VOIP Systems in this PCMag article. Most doctors that I’ve talked to go with Ring Central or 8x8.
How big does my office need to be to practice in the Primary Care practice model?
For me, I’m practicing out of a 12 foot by 16 foot office, or roughly 190 square feet. I have a desk where I consult with my patients, some chairs, and an exam table. I have a bookcase with medications, a closet with procedure supplies, a refrigerator with insulin and vaccines. I have some open shelving with papers, books, and magazines as well as syringes, needles, shipping supplies, etc…
The point is this: you don’t need much more than your brain and your stethoscope to be successful in this Direct Primary Care model. More to the point, you don’t need a big, fancy office to deliver excellent primary care services and you don’t need a big, fancy office to attract paying customers to your Direct Primary Care practice.
There are so many of examples of doctors practicing out of small, sub-leased, retro-fitted, and otherwise atypical spaces. One doctor even practices out of his family home, with patients entering from one side of the building and his family using a different entrance. It’s really up to you how big or how small you want to be.
However, I am happy that I started in a small space. I rented my small office for $600/month and this has allowed me to grow at my own pace, without a great deal of pressure because of a high rent and a higher overhead. Having a smaller space helps to keep your overhead low and helps you to be more profitable and therefore more successful.
That being said, I’ll be growing into a larger space later this year as I’ve added a second doctor to my staff and it’s the right time for me to take the next step.
Thanks for all of your questions, and have a great day!
-Dr. Paul Thomas with StartUpDPC