Direct primary care

[deleted87716]

Wasn't assuming that at all, but that doesn't change the fact that if you're intending to make 500k+ you're going to have to serve the wealthy and that shouldn't be confused with what DPC is.

How does charging $80 a month instead of $50 equate to "serving the wealthy...?" It's still <$1000/year.

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[HipsterLorax]

How does charging $80 a month instead of $50 equate to "serving the wealthy...?" It's still <$1000/year.

Wasn't making a comment on the $80 charge. But since you mentioned, how does the math work out to over 500k? I think it's also worth keeping in mind that the more you charge the less patients you will likely have since it's all about the value (ie your time or services that require more overhead) that you're offering. Maybe that's not true yet, but if DPC becomes more popular and there's competition that will surely be the case.

 

[deleted87716]

Wasn't making a comment on the $80 charge. But since you mentioned, how does the math work out to over 500k? I think it's also worth keeping in mind that the more you charge the less patients you will likely have since it's all about the value (ie your time or services that require more overhead) that you're offering. Maybe that's not true yet, but if DPC becomes more popular and there's competition that will surely be the case.

It's >$500,000 gross. How much you keep depends on your overhead. $80/mo. * 12 mo. * 600 patients =$576,000.

Also keep in mind that "competition" isn't just about being the cheapest, unless you're Walmart.

 

[deleted480308]

Wasn't assuming that at all, but that doesn't change the fact that if you're intending to make 500k+ you're going to have to serve the wealthy and that shouldn't be confused with what DPC is.

Wasn't making a comment on the $80 charge. But since you mentioned, how does the math work out to over 500k? I think it's also worth keeping in mind that the more you charge the less patients you will likely have since it's all about the value (ie your time or services that require more overhead) that you're offering. Maybe that's not true yet, but if DPC becomes more popular and there's competition that will surely be the case.

again, you're making some pretty wide assumptions as you claim that DPC can't be about serving wealthy people...it's more specifically about serving patients without 3rd party interference. It happens to allow services to be performed with less expense but the notion that aiming the model at wealthy patients somehow makes it "not DPC" isn't necessarily accurate

 

[HipsterLorax]

Also keep in mind that "competition" isn't just about being the cheapest, unless you're Walmart.

Good point.

aiming the model at wealthy patients somehow makes it "not DPC" isn't necessarily accurate

I think there has been an effort to separate Concierge and DPC, though. And perhaps on a personal note, everytime I've brought up DPC to faculty members I essentially get shamed because they think I've lost touch with the values of family medicine and really only care about the $$$ when mostly I care about the autonomy it offers. So maybe I'm projecting a bit.

 

[VA Hopeful Dr]

Good point.



I think there has been an effort to separate Concierge and DPC, though. And perhaps on a personal note, everytime I've brought up DPC to faculty members I essentially get shamed because they think I've lost touch with the values of family medicine and really only care about the $$$ when mostly I care about the autonomy it offers. So maybe I'm projecting a bit.

Yeah, most academic family doctors don't like the idea of anyone being independent. F-em.

 

[FamilymedMD]

everytime I've brought up DPC to faculty members I essentially get shamed because they think I've lost touch with the values of family medicine and really only care about the $$$

They should spend a few hours at a real DPC.
My panel is 1/4 uninsured, 1/2 high deductible and very blue collar with more poor than wealthy patients. On average, they're sicker and need more care than the panel of patients I had across town two years ago at a traditional practice. Many of them save a lot of money on primary care, tests and medications compared to using the hospital owned clinics here.
While I'm very happy and financially stable now, it's not because I make gobs of easy money off wealthy patients.

 

[VA Hopeful Dr]

They should spend a few hours at a real DPC.
My panel is 1/4 uninsured, 1/2 high deductible and very blue collar with more poor than wealthy patients. On average, they're sicker and need more care than the panel of patients I had across town two years ago at a traditional practice. Many of them save a lot of money on primary care, tests and medications compared to using the hospital owned clinics here.
While I'm very happy and financially stable now, it's not because I make gobs of easy money off wealthy patients.

That's been my experience as well.

 

[notinkansas]

The average I've heard (since I'm not at 600 yet) is 18-24 months. That's with a cold start. If you have a regular practice for a year or two before that, I bet it would be much faster - I bet BD could fill a DPC in a few weeks if he so chose.

The majority of patients won't overuse it. I tell all of mine that I'm there for them 24/7, they have my cell phone number for any after hours issue. So far, they have all said some variation of "I don't want to bother you" and then I have to explain that its what they're paying me for. You'll of course probably end up with a few worriers. My plan with them is to essentially set up weekly appointments where they can bring up all of their concerns. That should cut down on phone calls if it becomes an issue.

That's amazing. Where do you get patients in the "I don't want to bother you" category? I'm more familiar with the ones who seem to deliberately wait until 2 am Saturday morning to address a non-urgent issue: "I''ve had this rash for 6 weeks, no it doesn't itch, doesn't hurt, doesn't bother me at all. I want some cream for it"; "I missed by pre-op appoinent for surgery that's scheduled for Monday morning, what do I do"; or "I ran out of pain medicine and need you to call in refill immediately"

One of the things that keeps me from going DPC is that I don't want to be constantly called during off hours.

 

[VA Hopeful Dr]

That's amazing. Where do you get patients in the "I don't want to bother you" category? I'm more familiar with the ones who seem to deliberately wait until 2 am Saturday morning to address a non-urgent issue: "I''ve had this rash for 6 weeks, no it doesn't itch, doesn't hurt, doesn't bother me at all. I want some cream for it"; "I missed by pre-op appoinent for surgery that's scheduled for Monday morning, what do I do"; or "I ran out of pain medicine and need you to call in refill immediately"

One of the things that keeps me from going DPC is that I don't want to be constantly called during off hours.

I suspect its self-selection. My patients care enough about their health to pay monthly even if they know they aren't likely to need me every month.

Do an experiment: keep track of that type of patient you're worried about having in DPC (the Saturday 2am ones) and see what they payer status is. I'd bet its majority medicaid OR super low co-pay/deductible type plans ie. the kind that don't actually value what we do because they pay little/nothing for it.

 

[Carouselambra]

Ok these questions are for a nurse who wants to go back to medical school to do family practice. However, seeing how much stuff nurses and physicians have to chart has always been somewhat of a turn off for me. What is your charting like? Do you do full soap notes like I see in the hospital or just quick notes about the current visit since you don't have to appease insurance companies? I'd love to be able to see more patients and chart minimally.

I saw the question asked a couple of times but don't think I saw the answer. With about 600 patients how many are you seeing per day? If that were to be 800, about how many?

Thanks for your time

 

[VA Hopeful Dr]

Ok these questions are for a nurse who wants to go back to medical school to do family practice. However, seeing how much stuff nurses and physicians have to chart has always been somewhat of a turn off for me. What is your charting like? Do you do full soap notes like I see in the hospital or just quick notes about the current visit since you don't have to appease insurance companies? I'd love to be able to see more patients and chart minimally.

I saw the question asked a couple of times but don't think I saw the answer. With about 600 patients how many are you seeing per day? If that were to be 800, about how many?

Thanks for your time

So I'm at 400 patients now, and just had my busiest day ever on Monday - I saw 10 patients.

Here's what one of my acute visit notes looks like:

S: Pt with 2d h/o left eye green discharge, mildly irritated, no blurry vision or pain.

O: 98.8 °F, 71 bpm, 16 RR, 127/77, 100 %, 64 in, 150 lbs, 25.75 BMI
Eye: PERRL, EOMI, left conjunctiva with erythema and watery discharge

A/P:
1. Conjunctivitis - likely viral, acular for symptoms


I have my EMR's version of dot phrases for many things, so that note took me about 60 seconds. Some of my more standard ones (ADHD, URI, HTN) more like 15 seconds.

 

[Carouselambra]

So I'm at 400 patients now, and just had my busiest day ever on Monday - I saw 10 patients.

Here's what one of my acute visit notes looks like:

S: Pt with 2d h/o left eye green discharge, mildly irritated, no blurry vision or pain.

O: 98.8 °F, 71 bpm, 16 RR, 127/77, 100 %, 64 in, 150 lbs, 25.75 BMI
Eye: PERRL, EOMI, left conjunctiva with erythema and watery discharge

A/P:
1. Conjunctivitis - likely viral, acular for symptoms


I have my EMR's version of dot phrases for many things, so that note took me about 60 seconds. Some of my more standard ones (ADHD, URI, HTN) more like 15 seconds.

Oh my... that's beautiful. Usually hospital notes are a page long and it seems so redundant for the majority of it.

 

[northernpsy]

So I'm at 400 patients now, and just had my busiest day ever on Monday - I saw 10 patients.

Here's what one of my acute visit notes looks like:

S: Pt with 2d h/o left eye green discharge, mildly irritated, no blurry vision or pain.

O: 98.8 °F, 71 bpm, 16 RR, 127/77, 100 %, 64 in, 150 lbs, 25.75 BMI
Eye: PERRL, EOMI, left conjunctiva with erythema and watery discharge

A/P:
1. Conjunctivitis - likely viral, acular for symptoms

I have my EMR's version of dot phrases for many things, so that note took me about 60 seconds. Some of my more standard ones (ADHD, URI, HTN) more like 15 seconds.

Picturing how much easier and more fun my job would be if my documentation could be this straightforward makes me very jealous of you.

 

[VA Hopeful Dr]

Picturing how much easier and more fun my job would be if my documentation could be this straightforward makes me very jealous of you.

Even direct pay psychiatry will likely need slightly more than that.

That said, I've trained my smart phone pretty well on medical terms so I bet you could dictate on one of those given a few weeks training it up.

 

[FamilymedMD]

Ok these questions are for a nurse who wants to go back to medical school to do family practice. ...

...I saw the question asked a couple of times but don't think I saw the answer. With about 600 patients how many are you seeing per day? If that were to be 800, about how many?

Thanks for your time

The rule of thumb I've heard from several experienced family medicine DPC docs is that a full time doc will see about 1% of the panel each day on average. So 600 patients means about 6/day with more during your growth phase since new patients come in a few times before settling down, more on Monday, fewer on Wednesday and Thursday, etc.

 

[VA Hopeful Dr]

The rule of thumb I've heard from several experienced family medicine DPC docs is that a full time doc will see about 1% of the panel each day on average. So 600 patients means about 6/day with more during your growth phase since new patients come in a few times before settling down, more on Monday, fewer on Wednesday and Thursday, etc.

That seems about right, and honestly I think that 1% number is true across all practice settings. Regular FPs have panels of 2500-3000 and see 25-30/day depending on how they schedule.

 

[Carouselambra]

The rule of thumb I've heard from several experienced family medicine DPC docs is that a full time doc will see about 1% of the panel each day on average. So 600 patients means about 6/day with more during your growth phase since new patients come in a few times before settling down, more on Monday, fewer on Wednesday and Thursday, etc.

Thank you. That's really encouraging to hear. Today was one of the few days in three years as a nurse that I've been able to really take the time and educate a receptive patient. Today was a great day. So to potentially practice in a setting where I have more time to do right by patients is really exciting to think about.

 

[notinkansas]

Thoughts on Medicare paying for DPC?

It seems to me that if Medicare paying for DPC becomes widespread, that then subjects the DPC practice to the regulatory and reporting mandates. Getting away from this burden is one of the major benefits of a DPC practice. I don't see how it would work out. What am I missing?

 

[VA Hopeful Dr]

Thoughts on Medicare paying for DPC?

It seems to me that if Medicare paying for DPC becomes widespread, that then subjects the DPC practice to the regulatory and reporting mandates. Getting away from this burden is one of the major benefits of a DPC practice. I don't see how it would work out. What am I missing?

The approach that I've seen suggested from the doctor end is have Medicare essentially give its beneficiaries HSA accounts that they can then use to get care however they please.

 

[deleted480308]

The approach that I've seen suggested from the doctor end is have Medicare essentially give its beneficiaries HSA accounts that they can then use to get care however they please.

Which seems too logical and simple for Medicare to agree to.....but yeah it would be simpler

 

[VA Hopeful Dr]

Which seems too logical and simple for Medicare to agree to.....but yeah it would be simpler

And that may very well change. I know that Qliance up in Washington State sees a hefty number of Medicaid patients. What I don't know is whether or not they have to jump through all the usual regulatory burdens. My gut tells me know, otherwise what's the point of doing DPC - but I can't say that for sure in this case.

 

[SansaStarkMD]

Cash only contracts with employers + rural EM to supplement. Screw the gubment.

 

[Straw Hat]

How is vacation time factored into a DPC practice? You're supposed to be available 24/7. Does your partner just pick up the slack on those days and schedule your patients into his? Or do you just schedule a week off of the clinic or something but still take calls/text/email?

 

[SansaStarkMD]

My agreement will be 24/7 availability M-F or something similar.... Hopefully with a partner to cover during the week. Need those weekends off to supplement wth rural EM income while business is getting started.

 

[VA Hopeful Dr]

How is vacation time factored into a DPC practice? You're supposed to be available 24/7. Does your partner just pick up the slack on those days and schedule your patients into his? Or do you just schedule a week off of the clinic or something but still take calls/text/email?

Before a second DPC opened up in my area (we cover each other at need), I told patients that I was generally available 24/7 but that sometimes things would come up when I wouldn't be - out of town, sick kids, stuff like that. If you're available 98% of the time, people are pretty forgiving that other 2%, and the ones that aren't - good riddance.

 

[VA Hopeful Dr]

My agreement will be 24/7 availability M-F or something similar.... Hopefully with a partner to cover during the week. Need those weekends off to supplement wth rural EM income while business is getting started.

I would make sure you at least have email or text availability during the weekend - that's what people are paying you for after all.

 

[SansaStarkMD]

THEY'LL BE PAYING ME FOR WHATEVER WE AGREE TO.

 

[VA Hopeful Dr]

THEY'LL BE PAYING ME FOR WHATEVER WE AGREE TO.

True, but I've yet to see a subscription based DPC practice not offer some kind of weekend coverage - that's part of the point

 

[SansaStarkMD]

Crap, other doctors take insurance. Guess DPC isn't possible

 

[Mad Jack]

Crap, other doctors take insurance. Guess DPC isn't possible

What, exactly, do you mean by this?

 

[JustPlainBill]

I've spent some time talking to an IM doc that's punching out of a hospital system into DPC in my area. Haven't heard from him in a few months but we were talking about me coming in to provide the pediatric side of the equation --- don't know how much of a need that will be with the plethora of peds in the area -- but then again, aren't they all just small adults . This could get interesting....

 

[SansaStarkMD]

What, exactly, do you mean by this?

No problem, can clarify if you're having trouble. Their point was that other doctors don't do something, implying that it's impossible or unlikely. By definition DPC is something that most doctors don't do.

 

[Mad Jack]

No problem, can clarify if you're having trouble. Their point was that other doctors don't do something, implying that it's impossible or unlikely. By definition DPC is something that most doctors don't do.

Oh, I get it, sarcasm- I thought that's what it might be but wanted to make sure.

 

[Neopolymath]

As someone with an entrepreneurial background, I'm interested in this practice style and how it further develops in the next 5-10 years as well. I also won't shy away from admitting that my reservation is vacation related. It doesn't seem to gel with the whole idea/advantage to patients in the first place (read: 24/7 coverage) and a large part of being your own boss for me, professionally, is being able to make your own schedule. I guess pretty much anything in primary care can be planned for ahead of time though?

 

[deleted480308]

As someone with an entrepreneurial background, I'm interested in this practice style and how it further develops in the next 5-10 years as well. I also won't shy away from admitting that my reservation is vacation related. It doesn't seem to gel with the whole idea/advantage to patients in the first place (read: 24/7 coverage) and a large part of being your own boss for me, professionally, is being able to make your own schedule. I guess pretty much anything in primary care can be planned for ahead of time though?

Pay a locums when go on vacation or grow your practice enough to hire a second doc

 

[Mad Jack]

As someone with an entrepreneurial background, I'm interested in this practice style and how it further develops in the next 5-10 years as well. I also won't shy away from admitting that my reservation is vacation related. It doesn't seem to gel with the whole idea/advantage to patients in the first place (read: 24/7 coverage) and a large part of being your own boss for me, professionally, is being able to make your own schedule. I guess pretty much anything in primary care can be planned for ahead of time though?

This is why most physicians have partners. For guys have to take every fourth night call, while one guy is taking call every night, plus going solo it's basically impossible to take vacation without hurting a locum.

 

[VA Hopeful Dr]

As someone with an entrepreneurial background, I'm interested in this practice style and how it further develops in the next 5-10 years as well. I also won't shy away from admitting that my reservation is vacation related. It doesn't seem to gel with the whole idea/advantage to patients in the first place (read: 24/7 coverage) and a large part of being your own boss for me, professionally, is being able to make your own schedule. I guess pretty much anything in primary care can be planned for ahead of time though?

Meh, its not that big of a deal. My first year I had no one else to cover for me. When I went on vacation, I told my patients that I was leaving town ahead of time. If they needed refills, my assistant was at the office to handle that. They could still e-mail or text (I checked about twice a day). Anything else would require an urgent care.

Since then, a second DPC practice has opened up in town and that doctor and I cover for each other when we need to be gone.

When patients realize that 95% of the time you'll be there for them, they are very forgiving of the times that you can't be.

 

[VA Hopeful Dr]

No problem, can clarify if you're having trouble. Their point was that other doctors don't do something, implying that it's impossible or unlikely. By definition DPC is something that most doctors don't do.

I think you're missing the point.

DPC mainly works because we provide a service that patients value - that's why they are willing to pay us outside of any insurance benefits. The more restrictions you put on that, the less value many people will see in it. Truthfully, that was one of the trickiest things for me when I started - when patients asked if we could do X or Y, I had to start trying to find ways to say Yes instead of No.

Could you set up a DPC practice that has no weekend availability of any kind? Yes, I think you likely could and probably do OK. But you will have a not insignificant number of patients who, when they need you on a Sunday and can't reach you, really rethink if its worth it. After all, in the subscription-based model the patients are paying you to be available. If you're not available, what are they paying you for? Besides, the weekends really aren't all that bad. Outside of cold and flu season, I bet I get maybe 2-3 patients per weekend who text/e-mail with anything and at most twice that during cold/flu season. When I first started, I did a lot of moonlighting on the weekends and didn't have any problem texting/e-mailing with patients at the same time.

Now you could set up a fee for service DPC, there's a fair number of those around as well, and you'd avoid this problem from the start.

 

[VA Hopeful Dr]

This is why most physicians have partners. For guys have to take every fourth night call, while one guy is taking call every night, plus going solo it's basically impossible to take vacation without hurting a locum.

Nonsense, its quite possible.

 

[Mad Jack]

Nonsense, its quite possible.

If you say you're available 24/7, it's possible but your life can suck.

 

[Carouselambra]

Hey VA Hopeful Dr, are a lot of your patients complex in your practice? One thing that worries me about DPC is that you're taking care of patients who care enough to pay an extra monthly subscription for their care. While it'd be great to have patients who actually care about their health, exercise, eat mostly right, and follow directions, I worry about missing out on complex stuff that would potentially keep my mind sharp and on edge. Plus you're seeing far few patients per day and over the course of the year than normal practices? Do you feel like this is a potential disadvantage? You see outpatient

I guess what I'm asking is what's your patient mix like? Percentage wise? Like some very healthy people, some middle of the road, then some pretty to very complex? And outpatient only iirc?

I'm in Florida and I see concierge docs picking up a lot of ALF people who seem to have a fair list of medical problems. They also see their patients in the hospital though. They're mostly pulm/cc docs or cardiologists who have transitioned to concierge pcp. I have a feeling they're charging obscene amounts of money though which is not what I'm interested in.

 

[VA Hopeful Dr]

If you say you're available 24/7, it's possible but your life can suck.

You didn't read my previous posts, did you?

 

[Mad Jack]

You didn't read my previous posts, did you?

I should have placed emphasis on the word "can." It's really going to come down to your patients- if you've got entitled people that signed up because they want to utilize 24/7 care, it's possible to have a bad time. Hell, I've known people in regular practices that have patients blowing up their phone when they're on call.

 

[VA Hopeful Dr]

Hey VA Hopeful Dr, are a lot of your patients complex in your practice? One thing that worries me about DPC is that you're taking care of patients who care enough to pay an extra monthly subscription for their care. While it'd be great to have patients who actually care about their health, exercise, eat mostly right, and follow directions, I worry about missing out on complex stuff that would potentially keep my mind sharp and on edge. Plus you're seeing far few patients per day and over the course of the year than normal practices? Do you feel like this is a potential disadvantage? You see outpatient

I guess what I'm asking is what's your patient mix like? Percentage wise? Like some very healthy people, some middle of the road, then some pretty to very complex? And outpatient only iirc?

I'm in Florida and I see concierge docs picking up a lot of ALF people who seem to have a fair list of medical problems. They also see their patients in the hospital though. They're mostly pulm/cc docs or cardiologists who have transitioned to concierge pcp. I have a feeling they're charging obscene amounts of money though which is not what I'm interested in.

Its a fairly good mix of everything. For example, I saw 5 patients yesterday: undifferentiated fatigue (I think its a combination of depression and single mom to 3 kids under age 6), diabetic with aortic stenosis and h/o CVA x3, uncomplicated URI, smoking cessation, and familial adenomatous polyposis.

The day before I saw 8 people: rotator cuff tear, plantar fasciitis, PCOS infertility, anxiety, migraines, hypertension, back pain, and a really nasty abscess.

There's plenty of pathology out there, as long as you have a decent patient panel you'll be OK.

 

[VA Hopeful Dr]

I should have placed emphasis on the word "can." It's really going to come down to your patients- if you've got entitled people that signed up because they want to utilize 24/7 care, it's possible to have a bad time. Hell, I've known people in regular practices that have patients blowing up their phone when they're on call.

Ah, OK I get what you're saying.

It is a risk, but there are enough of us doing this that haven't had too much trouble that I'm not worried about it. DPC has 2 advantages on this score. First, in traditional practice (as many here will tell you) patients call often because coming into the office costs money while a phone call is free. Second, its often hard to get an appointment even if they want one. Neither of those are true for DPC.

Plus, most of us have plans in place for super-needy patients. I have a guy that I see in the office every week and have for 6 months. Its really just a chance for him to air all his worries, he's quite healthy. Its a mild nuisance, sure, but it beats getting lots of after hours phone calls from him.

 

[Neopolymath]

@VA Hopeful Dr, thank you for the continued contribution to this topic!

 

[VA Hopeful Dr]

@VA Hopeful Dr, thank you for the continued contribution to this topic!

Glad to do it.

As a side note: if anyone is interested in DPC you're more than welcome to visit. I'm listed as a clinical site for VCOM but can usually work with most any school to get a rotation approved.

 

[Dakayus]

I have a few questions which I'm presuming will be extremely obvious and location/situation dependent
1. How much extra time do you allocate for maintaining the corporation/taxes/business side of things?
2. How do you handle telephone calls in the sense is it recorded or documented?
3. Are you paying for a front office staff, MA or lvn?
4. How do the cost of vaccinations affect your practice since they're expensive/perish easily/shelf-life/etc
5. How do you handle people who want to order the more rare expensive tests like hormone testing/genetic testing/etc
6. What was the start up cost initially for you?
7. When would you advise someone to take on DPC in their practice? I'm currently 1.5 years out of residency and I may move to another location in a few years so I was wondering about started brand new in a location where no one knows you

 

[VA Hopeful Dr]

I have a few questions which I'm presuming will be extremely obvious and location/situation dependent
1. How much extra time do you allocate for maintaining the corporation/taxes/business side of things?
2. How do you handle telephone calls in the sense is it recorded or documented?
3. Are you paying for a front office staff, MA or lvn?
4. How do the cost of vaccinations affect your practice since they're expensive/perish easily/shelf-life/etc
5. How do you handle people who want to order the more rare expensive tests like hormone testing/genetic testing/etc
6. What was the start up cost initially for you?
7. When would you advise someone to take on DPC in their practice? I'm currently 1.5 years out of residency and I may move to another location in a few years so I was wondering about started brand new in a location where no one knows you

1. Very little. I pay my accountant to do payroll/taxes. Paying bills is maybe 2 hours per month in total. Maybe another 1 hour/week going over the bank account to make sure nothing is amiss. Another 1-2 hours/month with inventory/supplies.

2. Documented in the EMR just like regular practice. If an outgoing call, my EMR will record how long it lasted and I can go in and add a note about what we talked about.

3. I have a single MA that does front desk, patient work up, and blood draw/injections. $15/hour, no benefits at the moment.

4. I don't offer any except tetanus and PPD.

5. If a test is over $40, they pay up front for it or go to the lab themselves - usually costs more, but payment isn't required up front.

6. All told including advertising budget - about 215k. You can do for much less if you have smaller office space or advertise less (I spent a lot on advertising, but its paid off well).

7. That's a loaded question. If you can take the income hit, sooner is always better (my wife is a hospitalist, so didn't need my income). If you can't, there's something to be said for getting an employed job, building a patient panel for a few years, the going DPC and trying to take those same patients with you. Its vaguely dishonest, so I'd only do that to a hospital system not a private group. If you take that approach, pay close attention to any non-compete clause.