is a direct primary care practice feasible for a pediatric doctor?
There are so compassionate doctors out there who want to take better care of their patients, and they see the direct primary care (DPC) model as a way to accomplish this honorable goal. During our Startup DPC Show Episode 5, we talk with Dr. Ashley Walker, MD of Hurley Medical Center about what it takes to start a Pediatric-focused direct primary care practice. For some context, this interview was recorded in mid-October 2019.
Ashley Walker, MD is a second-year pediatric resident at Hurley Medical Center. She has worked in the military as a general practitioner and is now completing her Pediatric Residency. Therefore, Dr. Walker has a unique perspective and should she start a DPC practice, she will bring her own unique strengths and insights to that practice.
Why do you want to go into the Direct Primary Care Model?
Dr. Walker discusses why she wants to start a DPC practice, and she talks about having more autonomy to do what’s right for her patients.
How much should pediatricians charge for direct primary care services?
Most Family Medicine direct primary care practices charge a price that’s based on age, and it increases as a patient ages. Our price point for kids is $10 per month for kids, which would not be sustainable for a pediatric practice. Other price points in the marketplace include places like Nova Direct Primary Care, and they charge $29 per month for pediatric patients.
During our conversation, I thought of a physician I met at the 2018 AAFP DPC Summit, Dr. J. Bryan Hill at Gold Standard Pediatrics. His prices are as follows:
· Birth to 2 Years: $70 per month
· 2 Years to 12 Years: $45 per month
· 12 Years to 18 Years: $35 per month
There are definitely fewer pediatricians operating DPC practices, so I was unable to find an average cost at this time, but the above is a reasonable place to start. The idea is that younger children will need more frequent visits, and thus will pay more for the service informs Dr. Hill’s price points.
This pediatric pricing is in contrast to how adult medicine pricing works for the typical DPC practice. The adult pricing usually increases as patients increase in age, with geriatric patients paying the most. In pediatric pricing, the youngest children will pay the most because they require more care and attention and more frequent visits.
Are There Conferences Where You Can Learn More About Direct Primary Care?
There are three major conferences where you can learn more about Direct Primary Care:
Paul Thomas, MD of Plum Health DPC and Ashley Walker, MD of Hurley Medical Center talk about what it takes to start a Pediatric-focused Direct Primary Care practice. We had fun with this one!
Docs 4 Patient Care Foundation DPC Nuts and Bolts Conference
American Academy of Family Physicians (AAFP) DPC Summit
Hint Summit 2020 — Take Direct Primary Care to New Heights
Is Direct Primary Care a more equitable way to practice Medicine?
I believe that direct primary care is a more equitable way of delivering primary care medicine. First, there are so many people who fall through the cracks of our current health insurance based system for delivering care. If you earn too much so that you’re disqualified from Medicaid and if you don’t earn enough to comfortably afford private insurance, the current fee-for-service can be harmful. DPC gives folks another option for receiving high-quality, compassionate primary care medical services.
Specifically for Dr. Walker in Flint, Michigan, anytime you work in an urban, underserved community, you have a great opportunity to give back to your community.
Are patients allowed to pay for Direct Primary Care services with HSA Funds?
As written, the current tax code precludes folks from using their HSA funds to pay for direct primary care services. Pragmatically, people are using their HSA funds to pay for direct primary care services. It’s up to you, with input from your trusted lawyer and trusted accountant regarding whether or not you want to take the additional risk of accepting payments via your patients’ HSA accounts.
How can you balance home and work life when you are a Direct Primary Care doctor?
You start by setting clear expectations for your patients about how you want them to treat you. You can teach people how to treat you by the way you respond to their requests. For example, it’s really good to be responsive to your patients’ phone calls, text messages, and emails. However, sometimes it’s better to be more responsive during the week days and normal business hours and less responsive during the weekends and after hours for non-urgent concerns. Of course if there’s an urgent or emergent concern, you should respond immediately and give proper guidance.
For me, I really protect my Saturdays and Sundays as dedicated time with my family. I make sure that all of my patients are aware of this. I also take enough vacation time to stay fresh and focused when I’m at the office and to create great memories with my family. This is a balancing act, and over time you can figure this out.
For patients who work long hours and can’t come in during normal business hours of 9 am to 5 pm, I can come in to the office early and see them at 8 am or stay late until 6 pm. I do this on mornings or evenings when my spouse is working so that I can maximize the time that I have with my family.
Do Direct Primary Care doctors typically use an answering service?
For me, all of my patients have my cell phone number so they can easily text or email me with their concerns. With their concerns clearly communicated, I can easily triage their text messages and concerns. I haven’t used an answering service for this reason. I think the majority of DPC doctors operate like this.
How do you negotiate prices for meds, labs, and imaging services?
There are typically flat prices from Medication Wholesalers like ANDA Meds out of Florida or Bonita Pharmaceuticals here in Michigan. We use Regional Medical Imaging in Flint, Michigan, and they have flat cash prices for their imaging services. We have a list of our prices and when we order an imaging study for one of our patients, we simply show them the price points and ask if they’d like to pay cash for the imaging study or use their insurance plans. For Lab services, this is a bit of a game and it takes grit and determination to get the lowest prices, especially when you’re working with LabCorp or Quest Diagnostics. My best advice is to ask around for other DPC practices’ price points on laboratory services and see if one of these lab companies will match those prices. Keep calling and asking until you get what you want.
How often do you do point-of-care testing?
We do point-of-care testing frequently. Just about every week, we’ll run an EKG, typically for folks with anxiety-related or musculoskeletal-related chest pain. An EKG machine costs about $1,700, so it’s an investment but ultimately worth the cost for the value it provides to our practice.
We also have a PFT machine that cost us about $700. This is another useful tool in our office. We do point of care glucose testing, fecal occult blood testing, rapid flu, and rapid strep testing. We also have a microscope in the office and we use this just about every other week or every month to help in diagnosing a case of vaginitis.
We don’t offer point-of-care testing for lipid panels or A1c testing because we get the results next day through our laboratory vendor.
Is Malpractice Insurance Affordable for Direct Primary Care Practices?
The biggest line items in your budget are square footage and staffing. If you hire a medical assistant and pay them $17.50 per hour, this will come out to $3,400 each month including salary and payroll taxes. When we were renting a small space, it was $600 each month. Now, we’re renting a larger space and it’s $2,800 each month. Each month, we buy roughly $1,500 to $2,000 in medications. Each month, we spend $1,500 to $2,000 on labs. These are the bigger line items in our budget.
As for malpractice insurance, it comes out to roughly $450 monthly or $6,000 for the year at our practice. Also, our practice in Detroit has some of the highest malpractice rates in the State of Michigan because I was told by my insurance broker that Wayne County is a highly litigious county.
How do you or how should you staff your clinic?
As a solo doctor, you can handle many of the daily tasks in your DPC practice and you don’t necessarily need to hire a Medical Assistant or Nurse. However, hiring a Medical Assistant to help you draw blood, fill out forms, return faxes, call the lab company, take incoming phone calls, and go through the contract with prospective patients can be tremendously helpful. This can free up your time to spend more of your time and energy to focus on patient care and grow your business by reaching out to new patients and small businesses with employees who may want to sign up for your service.
Thanks for reading and thanks for watching - sincerely thank you to Dr. Ashley Walker for the excellent questions about direct primary care - I wish you the best of luck in your journey!
If you’re looking for more excellent content like this that can help you start and grow your direct primary care practice, check out our courses on Writing a Business Plan, Attracting More Patients to your DPC practice, and How to Find the Perfect Space for your DPC practice.
- Dr. Paul Thomas, MD