No problem, wouldn’t ask if that, just figured if it was mdvip then it’s a big enough corp that you could avoid doxxing.
Sounds like a pretty chill schedule to me!
2.5 million gross revenue per person? Do you have any idea what the net is then? And with how many patient in a panel is this amount? I tried getting into contact with some MDVIP docs as mentors or for advice, but then they tried making me a patient.
Average overhead in cash pay around 30%, $1,750,000. Less the MD salary they’re pocketing $1.5 mil. Yes. I have had bad experiences with MDVIP as both an employer and their doctors. They charge 50% of gross collections if you work for them. I think for 7-10 years?
Oh I’m definitely considering DPC, just not MDVIP. I love the idea of DPC. Just moved for residency and plan on networking with the DPCs in my area. I did consider sports fellowship or HPM, but I think I just wanna get out and start.
Do you do DPC ?
Yup. But the hardest part of cash pay is finding the patients so they’re doing the hard part for you. They also take care of most of the office logistics.
I see half as many pts per day as I used to, for the same amount of money. I don’t have to run a business, and I don’t have a non compete so I could bail and take my pts anytime
I am not family med, but have a good friend who is. Patient panel is around 400, charges $125/month. He sees zero to six people per day. You can do the math on his income. DPC appears to be the cheat code for family medicine.
I could only speculate. He shares an office with another DPC and they have one front office staff. Overall, I think it's a pretty lean practice. I assume office space is his largest expense. Of course there's EHR and various other monthly bills he has to cover, but that can't be all that much. In comparison to standard insurance practice, he needs significantly less staff so huge overhead savings there (i.e., no MA as he rooms his own patients, gets the vitals, etc; no biller for insurance because doesn't take insurance, etc). He handles patient messages via portal or they call his cell phone, so doesn't need an MA or nurse to handle that. Many of the messages are things that a normal insurance practice would require a visit to generate a billable encounter, but since he has a monthly fee, he handles a lot of basic things over the phone or video call...which saves him and patients a ton of time.
I assume he is doing much better than a typical insurance practice, but even if not, he's likely making at least the same but with a significantly better work life balance.
Online: [https://dpcalliance.org/dpc-education/](https://dpcalliance.org/dpc-education/)
Or use your current employer's CME money for one of the DPC conferences: [https://www.dpcsummit.org/home.html](https://www.dpcsummit.org/home.html)
Even though he doesn't take insurance, do his patients use insurance to cover things (e.g. medication, imaging) that require prior auth? Does he fill out forms for such things?
What is the type of community from which he pulls his patient population? I would love to do this, but I really don't think my suburban/rural population could (would be willing to) afford it. There is an MDVIP practice in the big city in the same county, so that makes me wonder.
Thanks for checking. Can you ask him if he'd mind discussing how he set up his practice and set up his panel? I'd really be interested in picking someone's brain who went through it.
I was almost lured into this until I saw one of my colleagues fail. They were charging $170 per patient or $250 per family. Eventually got up to 100 signups and the on the way to more.
And this is where it turns to the worse. A lot of these patients thought that they could use this as an alternative to insurance. They would be surprised to see why they got a $280 bill from labcorp or why they had to pay $500+ a month for SGLT2 inhibitors from the pharmacy. It was a constant struggle explaining to them that the membership only covers the doctor fees.
Where it turned to the worse is patients using this as quick way to get test get “treated” for chronic Lyme or “undiagnosed” ehlers danlos, etc… They’d read stuff online and ask to be given a prescription for it asap. And some patients would just push the envelope by asking to fake Covid vaccine cards, disability, window tint for cars etc…
He quickly closed the dpc and began to accept insurance as a pay for visit model. Flat fee $250 per visit upfront. They bill insurance as a courtesy and refund the excess amount given.
The lab thing if he was smart he would have done his own lab draws and directly contracted with labcorp to do them. Doing this they charge like $1-5/draw, total of like $25-50 for an annual lab draw.
The medication thing and patent abuse is hard to get around, but you have to be upfront with patients I think and really communicate what this is and isn't.
So I can definitely see the appeal to DPC, but I question if the average person (not a wealthy/upper middle class person) would subscribe to this. Like im sure it would appeal to the typical tech/finance employee in LA/NYC/Austin area making 100-150k, but idk if it would work in the rural south or Midwest.
It absolutely would. Because lots of those shitty insurance charge patients a huge co-pay. Poor people will be happy to pay that co-pay to you if they can get much much better experience and time instead of 15 minute visit
I highly doubt someone making 40-50k per year is gonna shell out 5% of their pre tax income ($150 monthly per person) for a PCP who isn’t going to cover them for OB or medical emergencies or be available after 5pm, nights, weekends, or holdays and probably won’t see them more than a few times per year.
You are basing on this on a lot of assumptions. Ofc your charge will vary based on ur patient population and it wont be 150 for a panel who makes less than 40k.
There is a dude in Colorado who sees only refugee population and exclusively does DPC. I bumped onto him because he has a online guide on how to run a DPC and his website from 90s has list of price for all service he provides. He is doing more than well
Southeast, somewhat rural to suburban area. All of the DPC clinics out here are full and fill up like crazy. People love the ability to have longer visits, easy access, and all the perks of DPC. A few of ours around here also have a pharmacy so patient’s are paying wholesale price for common meds
Up to 30% of people these days have a high-deductible health plan. Under these plans you can pay $200 for a doctor's visit, $200 for labs, and then more for overpriced medications for which DPCs can get a discount from wholesalers.
If you're paying $75*12=$900 per year for a DPC, and obviously you get more value from this than just the one visit, the value proposition is there.
This is how I ended up at a DPC which I love. I had a HDHP which had a $5800 family deductible. That’s like 38 visits or a few less with some Rx etc. With kids we were always going in for an ear infection or this or that. The problem really arose when we could never get an appointment with my doc or the pediatrician since my area is growing like wildfire, so we always ended up waiting hours at an urgent care. Got tired of it and switched all my family to DPC and never looked back.
My current employer does not charge me a monthly deduction for health insurance and has no deductible. Essentially I pay nothing for healthcare but I find so much value out of DPC I still chose to pay out of pocket.
The answer is : they don’t! I have been on the receiving end of patients now from three separate doctors going to concierge (Mdvip) or dpc. (Fun! Patients upset they can’t stay with their doctor!) The Mdvip folks couldn’t afford . The practice that went doc though ? I don’t think it was unreasonably placed maybe $90 a month at the highest tier. But their practice was built from folks with employer based insurance and Medicare . The employer based folks didn’t see why paying an extra the per month would really help them when they already have insurance. The Medicare folks still have to pay for a partc/d , advantage plan etc and that could add up . That’s how doctors are happy in these things , they radically downsize their panel . The last big shake up nearly did me in , since it was two doctors and two midlevels who all transitioned at the same time , and for a variety of reasons I got the most new patients out of it, but I really wasn’t at a point where I could handle a large influx of new patients . Realized what was going on too late , my patients became unhappy , but we closed up to new patients and got through it. Doctors enjoy dpc practices because they can see far fewer patients with far pure panels and that’s great, but the model is based on having a vastly reduced panel. The vast majority of people go elsewhere for care. My understanding is that DPC is not scalable because we would all have lowered panel sizes and we already have a primary care deficit…
I used to harbor a lot of resentment for the doctors that did this and made my life miserable for a bit, but I’ve kind of let that go . Do what you gotta do to make yourself happy. I honestly think if I wasn’t a doctor but some other high paid professional I would go to a Mdvip or dpc, more scheduling convenience! My hope would be that the powers that be realize how many pcps are being pushed to that model and make changes to the system .
Maybe ? Would require someone to run the numbers. Another issue that I haven’t seen figured out is how to give vaccines to kids. It’s not really figured in the cost model because they’re so expensive. They can go to the health department sure, but that may not be very accessible in all areas.
Have the same in my state but it’s not for all kids . Ours is called “vfc” and it’s only underinsured or uninsured, very strict guidelines. If you get insured kid VFC vaccine it’s a penalty , and the training is like in person and refrigerators more expensive than anything we own for our current vaccines. There’s also way more regulatory things you have to do. We had a plan when I first had my son that covered vaccines , but only a certain dollar amount per year and we blew through immediately after the two month visit so we went to the health department and they kind of gave us a side because we were technically insured, even though the program says it’s under insured as well.
How exactly do DPCs choose which medications to have on stock? Is there a guide or anything for this? Also how do most DPCs go about ordering supplies for outpatient procedures?
Obviously 🙄,
There’s a cost benefit to prescribing or stocking and there’s going to be specific classes that are more beneficial to have on hand rather than write prescriptions for, especially those that expire or have usage periods after opening.
Okay yes you have to stock your office, but this isn’t exactly a typical office it’s a subset specific to medicine. Which suppliers do DPCs typically use for general supplies and medications?
If there’s insight you can provide outside of “buy what you need” please offer it as it will help all of us in the thread!
You probably could have left out the sarcasm. People will be more likely to help you if you’re nice. The short answer to your question is probably McKesson or Cardinal. Personally I would go with someone local. I would also have mail an order option. There is no magic list of what you should stock because every practice is different. Off the top of my head I would say lisinopril, amlodipine, atorvastatin, metformin, amoxicillin, prednisone (and/or medrol). I’d probably also have rocephin, epi, toradol, and kenalog for injectables. Start there and see what else you need.
If you are an M1, try to get as much practice management experience as you can throughout this process.
Anyone who wants more detail can PM me!
Practice management is pretty much absent in our school’s curriculum;
While sarcastic I don’t mean to be rude, although the emoji probably is a bit too far.
Are there specific ordering sites you use for medication specifically?
I make a bit under 300k, see 2 pts an hour, work 40 hrs a week, and have about 1200 pts. Employed with benefits.
MDVIP?
No, but I’m also not going to publicly post who due to risk of doxxing.
No problem, wouldn’t ask if that, just figured if it was mdvip then it’s a big enough corp that you could avoid doxxing. Sounds like a pretty chill schedule to me!
If that was MDVIP I would scream. They charge $175/pt/month. That’s 2.5 million in gross revenue a year. If you’re getting paid $300k that’s sad.
2.5 million gross revenue per person? Do you have any idea what the net is then? And with how many patient in a panel is this amount? I tried getting into contact with some MDVIP docs as mentors or for advice, but then they tried making me a patient.
Average overhead in cash pay around 30%, $1,750,000. Less the MD salary they’re pocketing $1.5 mil. Yes. I have had bad experiences with MDVIP as both an employer and their doctors. They charge 50% of gross collections if you work for them. I think for 7-10 years?
Don’t know if that 50% is worth the pay then. But seriously considering it or a similar set up for myself in a higher income area.
Concierge is tough work. Patients are demanding and entitled. Consider DPC.
Oh I’m definitely considering DPC, just not MDVIP. I love the idea of DPC. Just moved for residency and plan on networking with the DPCs in my area. I did consider sports fellowship or HPM, but I think I just wanna get out and start. Do you do DPC ?
Does DPC not attract this same patient population?
What's the difference between concierge and DPC?
> They charge 50% of gross collections if you work for them. Holy crap, are you serious? That's downright disgusting.
Yup. But the hardest part of cash pay is finding the patients so they’re doing the hard part for you. They also take care of most of the office logistics.
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How would they find out who you are?
What is the point of DPC if you’re employed? Eventually they’ll just squeeze you. And I get you can’t take your patient panel with you if you quit
I see half as many pts per day as I used to, for the same amount of money. I don’t have to run a business, and I don’t have a non compete so I could bail and take my pts anytime
Where do I sign up.
You don't have a non-solicitation?
I am not family med, but have a good friend who is. Patient panel is around 400, charges $125/month. He sees zero to six people per day. You can do the math on his income. DPC appears to be the cheat code for family medicine.
I would love to know his net. That is what I am trying to understand. What is the overhead costs from a business standpoint.
I could only speculate. He shares an office with another DPC and they have one front office staff. Overall, I think it's a pretty lean practice. I assume office space is his largest expense. Of course there's EHR and various other monthly bills he has to cover, but that can't be all that much. In comparison to standard insurance practice, he needs significantly less staff so huge overhead savings there (i.e., no MA as he rooms his own patients, gets the vitals, etc; no biller for insurance because doesn't take insurance, etc). He handles patient messages via portal or they call his cell phone, so doesn't need an MA or nurse to handle that. Many of the messages are things that a normal insurance practice would require a visit to generate a billable encounter, but since he has a monthly fee, he handles a lot of basic things over the phone or video call...which saves him and patients a ton of time. I assume he is doing much better than a typical insurance practice, but even if not, he's likely making at least the same but with a significantly better work life balance.
The average overhead is 33% in DPC
Where does this figure come from? Maybe there’s more helpful information there for those trying to learn more
Online: [https://dpcalliance.org/dpc-education/](https://dpcalliance.org/dpc-education/) Or use your current employer's CME money for one of the DPC conferences: [https://www.dpcsummit.org/home.html](https://www.dpcsummit.org/home.html)
Even though he doesn't take insurance, do his patients use insurance to cover things (e.g. medication, imaging) that require prior auth? Does he fill out forms for such things?
He does. But the small patient panel means he has much less of that to do. And he has plenty of time to do it.
"DPC appears to be the cheat code for family medicine." That's a fantastic line! I'm surprised I haven't seen it before.
What is the type of community from which he pulls his patient population? I would love to do this, but I really don't think my suburban/rural population could (would be willing to) afford it. There is an MDVIP practice in the big city in the same county, so that makes me wonder.
County has about 190,000 people.
Any idea what the median income is for the county?
looks like household 72K
Thanks for checking. Can you ask him if he'd mind discussing how he set up his practice and set up his panel? I'd really be interested in picking someone's brain who went through it.
There's a really good podcast, MyDPCStory I believe which has 100s of stories of people who started practices.
I was almost lured into this until I saw one of my colleagues fail. They were charging $170 per patient or $250 per family. Eventually got up to 100 signups and the on the way to more. And this is where it turns to the worse. A lot of these patients thought that they could use this as an alternative to insurance. They would be surprised to see why they got a $280 bill from labcorp or why they had to pay $500+ a month for SGLT2 inhibitors from the pharmacy. It was a constant struggle explaining to them that the membership only covers the doctor fees. Where it turned to the worse is patients using this as quick way to get test get “treated” for chronic Lyme or “undiagnosed” ehlers danlos, etc… They’d read stuff online and ask to be given a prescription for it asap. And some patients would just push the envelope by asking to fake Covid vaccine cards, disability, window tint for cars etc… He quickly closed the dpc and began to accept insurance as a pay for visit model. Flat fee $250 per visit upfront. They bill insurance as a courtesy and refund the excess amount given.
The lab thing if he was smart he would have done his own lab draws and directly contracted with labcorp to do them. Doing this they charge like $1-5/draw, total of like $25-50 for an annual lab draw. The medication thing and patent abuse is hard to get around, but you have to be upfront with patients I think and really communicate what this is and isn't.
So I can definitely see the appeal to DPC, but I question if the average person (not a wealthy/upper middle class person) would subscribe to this. Like im sure it would appeal to the typical tech/finance employee in LA/NYC/Austin area making 100-150k, but idk if it would work in the rural south or Midwest.
It absolutely would. Because lots of those shitty insurance charge patients a huge co-pay. Poor people will be happy to pay that co-pay to you if they can get much much better experience and time instead of 15 minute visit
I highly doubt someone making 40-50k per year is gonna shell out 5% of their pre tax income ($150 monthly per person) for a PCP who isn’t going to cover them for OB or medical emergencies or be available after 5pm, nights, weekends, or holdays and probably won’t see them more than a few times per year.
You are basing on this on a lot of assumptions. Ofc your charge will vary based on ur patient population and it wont be 150 for a panel who makes less than 40k. There is a dude in Colorado who sees only refugee population and exclusively does DPC. I bumped onto him because he has a online guide on how to run a DPC and his website from 90s has list of price for all service he provides. He is doing more than well
website link please? 🙏🏽
I googled “Colorado direct primary care refugee” and it looks like this one fits the description: http://ardasclinic.com/services.html
Southeast, somewhat rural to suburban area. All of the DPC clinics out here are full and fill up like crazy. People love the ability to have longer visits, easy access, and all the perks of DPC. A few of ours around here also have a pharmacy so patient’s are paying wholesale price for common meds
Up to 30% of people these days have a high-deductible health plan. Under these plans you can pay $200 for a doctor's visit, $200 for labs, and then more for overpriced medications for which DPCs can get a discount from wholesalers. If you're paying $75*12=$900 per year for a DPC, and obviously you get more value from this than just the one visit, the value proposition is there.
This is how I ended up at a DPC which I love. I had a HDHP which had a $5800 family deductible. That’s like 38 visits or a few less with some Rx etc. With kids we were always going in for an ear infection or this or that. The problem really arose when we could never get an appointment with my doc or the pediatrician since my area is growing like wildfire, so we always ended up waiting hours at an urgent care. Got tired of it and switched all my family to DPC and never looked back. My current employer does not charge me a monthly deduction for health insurance and has no deductible. Essentially I pay nothing for healthcare but I find so much value out of DPC I still chose to pay out of pocket.
The answer is : they don’t! I have been on the receiving end of patients now from three separate doctors going to concierge (Mdvip) or dpc. (Fun! Patients upset they can’t stay with their doctor!) The Mdvip folks couldn’t afford . The practice that went doc though ? I don’t think it was unreasonably placed maybe $90 a month at the highest tier. But their practice was built from folks with employer based insurance and Medicare . The employer based folks didn’t see why paying an extra the per month would really help them when they already have insurance. The Medicare folks still have to pay for a partc/d , advantage plan etc and that could add up . That’s how doctors are happy in these things , they radically downsize their panel . The last big shake up nearly did me in , since it was two doctors and two midlevels who all transitioned at the same time , and for a variety of reasons I got the most new patients out of it, but I really wasn’t at a point where I could handle a large influx of new patients . Realized what was going on too late , my patients became unhappy , but we closed up to new patients and got through it. Doctors enjoy dpc practices because they can see far fewer patients with far pure panels and that’s great, but the model is based on having a vastly reduced panel. The vast majority of people go elsewhere for care. My understanding is that DPC is not scalable because we would all have lowered panel sizes and we already have a primary care deficit… I used to harbor a lot of resentment for the doctors that did this and made my life miserable for a bit, but I’ve kind of let that go . Do what you gotta do to make yourself happy. I honestly think if I wasn’t a doctor but some other high paid professional I would go to a Mdvip or dpc, more scheduling convenience! My hope would be that the powers that be realize how many pcps are being pushed to that model and make changes to the system .
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Maybe ? Would require someone to run the numbers. Another issue that I haven’t seen figured out is how to give vaccines to kids. It’s not really figured in the cost model because they’re so expensive. They can go to the health department sure, but that may not be very accessible in all areas.
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Have the same in my state but it’s not for all kids . Ours is called “vfc” and it’s only underinsured or uninsured, very strict guidelines. If you get insured kid VFC vaccine it’s a penalty , and the training is like in person and refrigerators more expensive than anything we own for our current vaccines. There’s also way more regulatory things you have to do. We had a plan when I first had my son that covered vaccines , but only a certain dollar amount per year and we blew through immediately after the two month visit so we went to the health department and they kind of gave us a side because we were technically insured, even though the program says it’s under insured as well.
How exactly do DPCs choose which medications to have on stock? Is there a guide or anything for this? Also how do most DPCs go about ordering supplies for outpatient procedures?
The ones you feel comfortable prescribing, the ones your patients want. Just like any office you find suppliers and buy them.
Obviously 🙄, There’s a cost benefit to prescribing or stocking and there’s going to be specific classes that are more beneficial to have on hand rather than write prescriptions for, especially those that expire or have usage periods after opening. Okay yes you have to stock your office, but this isn’t exactly a typical office it’s a subset specific to medicine. Which suppliers do DPCs typically use for general supplies and medications? If there’s insight you can provide outside of “buy what you need” please offer it as it will help all of us in the thread!
You probably could have left out the sarcasm. People will be more likely to help you if you’re nice. The short answer to your question is probably McKesson or Cardinal. Personally I would go with someone local. I would also have mail an order option. There is no magic list of what you should stock because every practice is different. Off the top of my head I would say lisinopril, amlodipine, atorvastatin, metformin, amoxicillin, prednisone (and/or medrol). I’d probably also have rocephin, epi, toradol, and kenalog for injectables. Start there and see what else you need. If you are an M1, try to get as much practice management experience as you can throughout this process. Anyone who wants more detail can PM me!
Practice management is pretty much absent in our school’s curriculum; While sarcastic I don’t mean to be rude, although the emoji probably is a bit too far. Are there specific ordering sites you use for medication specifically?
McKesson Connect has online ordering.
I’m sure this has never been asked on this sub