I want to be honest about something that I don't see discussed enough in the DPC community: the psychological experience of growing a practice from zero is genuinely one of the hardest things I've ever done. Harder than residency, harder than boards, harder than the buildout. Not because the medicine is difficult, the medicine is actually wonderful, but because the constant uncertainty of "is this going to work?" sits on your chest like a weight that never fully lifts.
Let me give you the numbers first, because I know that's what many of you are here for. As of April 1st, Verdant Family Medicine has 67 enrolled members. My monthly membership revenue is approximately $5,500. My monthly overhead is approximately $10,200. That means I'm still losing about $4,700 per month, which comes out of our savings reserve. At my current growth rate of about 15-20 new patients per month, I should reach breakeven (120 patients) around July or August. That's actually ahead of the projections James and I built, which is encouraging. But "encouraging" and "financially comfortable" are not the same thing, and watching the savings account shrink month after month is its own special form of stress.
The patient growth has come from several sources. About 30% of my patients came from word of mouth, which is the most powerful and also the least controllable marketing channel. People who love their DPC experience tell their friends and family, and those people sign up. I've had patients bring their spouses, their parents, their adult children. One patient brought her book club, which resulted in four new members in a single week. I am considering sending that book club a fruit basket.
Another 25% found me through the DPC mapper and similar directories that list DPC practices by location. About 20% came through my website and local SEO. The remaining 25% came from a mix of sources: a few local physician referrals (two of my former colleagues at Meridian have been quietly referring patients they know want more time with their doctor), a local newspaper article about DPC that mentioned my practice, and social media.
The medicine itself has been profoundly fulfilling. I am seeing twelve to fourteen patients a day, spending thirty to forty minutes with each one, and going home by 5:30 most days. I am not charting at night. That sentence deserves its own paragraph because of how radically it contrasts with my previous life.
I am not charting at night. The ambient scribe drafts my note while I'm still in the room with the patient, and reviewing it takes me two to four minutes. I have not opened my laptop at home for clinical documentation a single time since opening. Not once. After eight years of spending two to three hours every night catching up on charts, this feels like someone removed a tumor I didn't realize I'd been carrying. I don't want to make it sound magical, because it isn't: it still garbles supplement names (it once turned ashwagandha into something unprintable), and I had to spend an evening turning off notification settings that pinged me for every routine portal message. But the unified inbox means I clear messages, results, and refill requests in about twenty minutes each morning instead of the anxious hour it took at Meridian, and the evenings are mine. That trade I will take every single day.
Denise has been incredible. She's taken ownership of the practice operations in a way that goes beyond her job description. She manages the supply ordering, handles the patient scheduling that doesn't go through the automated phone agent, and has become remarkably adept at the EMR. She told me last week that she can't imagine going back to working in an insurance-based practice. "It's like we're actually practicing medicine here," she said. I wanted to put that quote on a billboard.
But here's the emotional reality that I promised I'd be honest about. There are days when the uncertainty is overwhelming. Days when I wake up and calculate how many months of savings we have left. Days when a patient cancels their membership and I take it personally even though I know I shouldn't. Days when I compare my income to what I'd be making at Meridian and feel a wave of doubt about whether this was the right choice.
There was one particular Wednesday in March when I had two cancellations and only eight patients on the schedule, and I sat in my office during a gap and felt the old familiar dread. Not the burnout dread, something different. The fear of failure. The fear of having upended my career and my family's financial security for an idealistic dream that might not work. James talked me through it that night, as he always does, by pulling up the spreadsheets and showing me the trend lines. "You're ahead of projections," he said. "The math works. Trust the math." I'm trying.
If you're in the early months of a DPC practice, or thinking about starting one, I want you to know that the emotional terrain is real and it's challenging. But I also want you to know that on the days when it's hard, the medicine is still good. The patient relationships are still deep. The satisfaction of practicing the way I trained to practice is still there. And that, so far, has been enough to keep going.
Next month I'll have passed the 80-patient mark if growth continues at the current pace. I'll check back in over the summer with a more detailed update on the practice's finances and operations. And I promise I'll write a proper review of my EMR around the six-month mark, because several of you have emailed asking for one, and by then I'll have accumulated enough scar tissue to be fair about it.