Tips for Opening Your Own Family Medicine Practice

Have you dreamt of owning your own medical practice, or is it an idea that is new to you and you want to learn more? 

In this Convention discussion hosted by Briana Clark, DO, MPH, CNPM, CLC, Dr. Piccinini and Dr. Leonard shared their experience in direct patient care and discussed the challenges and opportunities of having your own practice.

The Benefits

Dr. Piccinini referenced the freedom to make changes within the practice without needing to run it through several layers of approval. In one humorous example, he said the team was using “green sheets,” the name given to this particular form because it was printed on that color paper. When he asked why, it was just a legacy preference. The green paper was changed to standard white and saved the practice $10,000 a year.

When she shared her experience, Dr. Leonard noted the benefit of having control over her time and schedule. She shared an example of her own: “I needed to visit the post office. My office hours technically begin at 9:00 a.m. and that is when the post office opens. So, I went to the post office. When I arrived at the office at 9:30 a.m., there were no repercussions or lectures.” 

Dr. Leonard shared that accounting is often the discipline that concerns many hopeful solo practitioners. However, she pointed out that accounting is record-keeping, something physicians know all too well. She suggested reaching out to the Small Business Association. They offer free resources and while a counselor might not know about medical practices, they know about business.  

“It did not require going back for an MBA,” added Dr. Piccinini. “I found mentors and resources to help me.” Surprisingly, in his case, there was less administrative burden than when he worked for others. Dr. Piccinini’s practice hired an office manager to delegate many of the business tasks. 

Operating your own practice is a different kind of stress, but both panelists agreed it was just a different set of skills and not something impossible to master.

Addressing Challenges

After sharing the story of the “green paper,” Dr. Piccinini noted that making one’s own decisions is liberating, but it also meant understanding how to manage a business.

Dr. Clark posed the question: Is it overwhelming when you’re down to the last role of toilet paper or the light bill is due?

As the practice owner, you are responsible for the operations, but Dr. Piccinini reminded attendees that the responsibly does not mean one cannot delegate. By hiring a capable office manager, he transferred many of those tasks to them. Dr. Leonard does not have an office manager and she does it all herself, which included ordering the toilet paper. 

“The system that works for me,” she said. “Is to keep a list of things the office needs and when it turns from a reminder to a do to, I mark it red.”

Another topic that came up was how to manage the lack of backup. Unlike physicians in a practice or part of a hospital system, doctors like Piccinini and Leonard do not have others to take on patient care in their absence. For Dr. Leonard that meant planning. When she wanted to attend a conference (like the ACOFP Convention), she just rescheduled clients.

Marketing can be another area that has those early in direct patient care at a loss. Dr. Piccinini joined different culture clubs and let family and friends know he was available for new patients. He also leveraged that he spoke Italian and reached out to that community. Dr. Leonard shared that word of mouth worked best for her. She joined one or two local groups and the chamber of commerce. Soon after, a new patient shared their experience with others in their church and now several dozen patients were referrals from that one.

DCP vs. Concierge Care

Dr. Leonard said there is quite a bit of overlap between direct primary and concierge care, with the difference often defined around financial threshold and availability.

“Typically, patients of concierge doctors are wealthier and expect the doctor to be available any time they are needed.”

Dealing with Insurance

Dr. Piccinini evaluated the fees of similar practices in the geographic area he wanted to practice and charged a rate somewhere in the middle. Despite his research and diligence, he recently had to part ways with an insurer because he was losing money seeing their patients. 

For Dr. Leonard, the best part was removing insurance from the equation. “I no longer have to document BMI four different ways to see $5.” 

Effect on Patient Care

A concern raised by the audience was the effect on existing healthcare disparities as more physicians move to the DPC model. 

Dr. Leonard addressed this directly: She reserves a percentage of her practice to help underserved communities at a significantly lower cost than other patients. She acknowledged not all DPC practitioners do that, but it was important to her. 

Further, both doctors noted the DPC model allowed them to give the level of care they wanted – not what insurance or practice norms dictated. The word “liberating” was again used to describe being able to go overtime, extend an appointment and do what was necessary to provide the highest quality care.

What Else Should I Consider?

Moving into Direct Primary Care does not mean building a practice with thousands of patients. Many practitioners stop when they reach about 200-250 patients, called micro–practices – which allows them to manage most things on their own. 

The DPC model is not for every physician. Those who want to learn more can watch the ACOFP website for updates and advice from the Practice Management Committee, which identifies educational and practice management resources for members to use for transitioning to advance payment and other alternative payment models.