The editors at The Direct Primary Care Journal asked some of the industry’s new and innovative leading physicians and medical practice business owners an important question:
What are the necessary traits of a doc-preneur or direct-pay physician business owner?
From the onset, the idea of starting or even moving your medical practice into this marketplace seems inspiring but also intimidating. Scholars, physicians, business experts and venture capitalists say direct primary care is a growing industry. But, as we’ve learned over the years, the best doctors share a collection of characteristics, from the ability to tolerate risk, treating 5 to 9 patients per day, keeping their price point under $100 per month, risking reputation over reward to passion and self-belief in a niche-industry.
To begin, physicians explained this process as a marathon, not a race. More of an ultra-marathon really, dependent upon which individuals you might talk to. Nonetheless, you have to be able to live with uncertainty and push through a crucible of challenges and obstacles for a couple of years.
“I received a phone call the other day from a physician in Winter Park Florida,” says Tiffany Sizemore-Ruiz, D.O. of Choice Physicians of South Florida. “She was calling just to thank me for answering her questions about [this industry] a few months ago, and encouraging her to start her own practice. Today, her practice is thriving and she said that ‘she is happy with her schedule, her life, and being able to practice medicine that way it is meant to be practiced.’ I was so happy to hear that I helped a fellow physician and colleague, and even more happy to hear that she was doing so well!”
“The conversion process is not an easy one,” said Jeffrey S. Gorodetsky, M.D. of Stuart, FL. “My staff and I are cognizant of the fact that we must consistently communicate the benefits of this choice in care, with the challenge to increase my [memberships] numbers and convert other patients.”
“If you possess excellent communication skills, around the clock dedication and the desire to promote optimal health in pursuit of excellent medicine, then concierge medicine is for you. It’s the best career choice I’ve ever made.” –Brian Thornburg, MSM, DO, PA, FAAP Innovative Pediatrics
Second, it’s commonly presumed that doctors who enter direct primary care must disconnect from all insurance and payer relationships. What most doctors who’ve been there and done that will tell you is this: ‘I’m fueled by a passion to help my patients. I’m now allowed the opportunity to problem-solve and make life a little easier, better and cheaper for my patients.’
Third, the ability to successfully manage fear. Risk-taking goes with the territory when you talk about direct primary care with most physicians, consultants and staff. ‘I don’t think my patients are going to like this,’ most say. But your ability to withstand the pressure and overcome the obstacles of uncertainty and potential failure and see the other side before others do is what makes a successful direct primary care physician, notes one industry consultant. He sees the ability for doctors to control their doubt and fear as the most important trait of all.
“In selecting only a small population of clients and providing dedicated counseling sessions, sometimes as often as weekly, allows clients to actively participate in their care plan and to move goals forward at a real-time pace. This enables all of us to realize that healthcare can be a positive experience.” –Dr. Carrie Bordinko of Consolaré Primary Care in Paradise Valley, AZ
Physicians who’ve traveled down this path over the past 15 years imagine another world free from insurance burdens and heavy administrative overhead. They envision spending more time with patients and enjoying the practice of medicine again. Oftentimes, these physicians and medical practice business owners will find themselves facing naysayers, says one doctors in New York. ‘We often see the future before it plays out. We have to be prepared to be several steps ahead of the market.’
If you’ve planned appropriately, conducted enough analysis and have sufficient research that you can provide the level of service you envision for your medical practices future to ameliorate the risk, you’re ready to take the next step.
“I remember when I started my direct-access, home-based primary care practice in 2009,” says Raymond Zakhari, NP and CEO of Metro Medical Direct. “Patients were skeptical and reluctant because of how accessible and convenient the service was. They expected to be kept waiting on hold. Some seemed puzzled by the fact that when they called I answered the phone and knew who they were. One patient even inquired as to how come they only had one form to fill out. Direct-access primary care patients who have been referred post hospital discharge, have not been readmitted to the hospital in the last 4 years because I can see them without delay or red tape. In NYC, despite the high number of physicians per patient, particularly on the upper east side of Manhattan, direct-access primary care can still be a viable practice solution for patients and providers. It helps patients cut through the red tape that has become expected in accessing health care.”
In a new book, The Marketing MD, I’ve spent a lot of time talking with successful physicians [and unsuccessful ones, too] addressing the challenges and importance of planning before you move into direct primary care or start a direct-pay membership program alongside your insured patient visits in a practice.
What most direct primary care physicians will tell you is that it’s likely your final service or product offering won’t look anything like what you started with. Planning ahead, being flexible and being willing to defy conventional wisdom will help you respond to changes in the economy, insurance and market forces that seem to dislike your current operation. You have to be able to pivot when necessary.
“One of the most difficult occurrences is when patients who does not understand the program or who philosophically disagrees with the membership fees accuse the physician of abandoning them,” says one former Transition Manager in Arizona. “Direct primary care is all about behavior modification accompanied by simple answers to difficult and at times, confusing questions. Sometimes patients can be very vocal about their opinion of this and at times, be quite rude. This is very disheartening to most doctors, at least in the early stages of the transition process. ‘Saying goodbye’ to some long-term patients is one of the reasons many Physicians are reluctant to convert [to a hybrid model].”
“Instead of viewing the status quo PCP model as the center of the universe. Maybe we should take some plays from the Retail Clinic playbook before we become obsolete.” -Direct-Pay Physician, Dr. Robert Nelson of Cumming, GA.
Even the thought of starting a direct-pay medical practice or membership medicine program in your local community defies conventional wisdom according to many people in the healthcare marketplace. If you consider the fact that 13 percent of Americans are engaged in a start-up businesses, according to a Babson College report, then plunging into this start-up world makes you a risk-taker.
This post comes from our content partnership with The Direct Primary Care Journal.
Tetreault currently serves as the Editor-in-Chief of The DPC Journal and Concierge Medicine Today. He is a faculty member and Physician Mentor at The Docpreneur Institute (DPI) in Atlanta, GA, and serves as the Director of Marketing at Soteria Healthcare, an ancillary services managed care organization (MCO). He has also authored such books as: The Patient's Guide To Concierge Medicine, The DPC Consumer Guide, Branding Concierge Medicine and The Marketing MD. He recently co-authored The Doctor's Guide To Concierge Medicine.
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