It is Sunday morning. James is making pancakes downstairs, the dog is doing that thing where she lies in the one square of sunlight on the kitchen floor and refuses to move, and I am sitting at the desk in our guest room with a spreadsheet open and a cup of coffee that is already going cold. I told myself I would do this months ago. Today is the day I finally audit every single piece of technology in my DPC practice, two years after opening the doors of Verdant Family Medicine, to figure out what earned its place, what quietly drained money without earning it, and what surprised me along the way.
If you are a physician planning or running a DPC practice, I think this kind of exercise is worth doing at least once a year. Technology has a way of accumulating. You sign up for a tool to solve a specific problem, and then six months later the problem has evolved or disappeared entirely, but the subscription keeps charging your credit card because you forgot to cancel it or because canceling feels like admitting a mistake. I am guilty of this. We are all guilty of this. So here is my honest accounting.
What Stayed: The Tools That Earned Their Keep
Let me start with the obvious one. Hero stayed. It is the center of the stack and has been since before opening day, and after two years of daily use my verdict from the six-month review mostly still holds: the scribe and the unified inbox carry the practice, the reporting still makes me sigh, and I still do my monthly chart export because putting everything in one vendor's basket is a bet I renew consciously, not a thing I've stopped noticing.
The scribe has quietly improved over the two years, which I did not expect from software I was already paying for. It handles colloquial symptom descriptions better, it no longer mangles most supplement names (ashwagandha and I both remember the early days), and I correct fewer notes than I used to, though I still read every single one before signing and I always will. The honest accounting is that it saves me a couple of hours of typing on a normal clinic day. I have stopped trying to turn that into an annualized number because the math always comes out sounding like a press release. What I did with those hours is the real ledger: dinners with James, books, sleep, patients who got my whole face instead of my profile.
The inbox continues to be my second favorite thing. Messages, results, faxes, pharmacy notifications, one stream, urgent things first. Mornings take fifteen to twenty minutes. The virtual fax handling deserves special mention because it replaced a separate service I was paying for (more on that embarrassment in a moment): incoming faxes get scanned and matched to the right chart automatically, and the matching is good enough that I now only fish for misfiled documents once in a while instead of daily.
The phone agent stayed too. It books appointments, answers routine questions, and routes urgent calls to me or Denise, and it is the reason a two-person shop can cover a 348-patient panel's phone line. It is not universally loved: I keep a short list of patients, mostly older, who want a human voice and get Denise's direct line instead, and I consider maintaining that list part of running a humane practice rather than a failure of the technology. Two years in, the agent and I have settled into the relationship you have with a very capable employee who occasionally does something baffling and cannot explain why.
My OpenPhone VOIP line stayed. This is a simple one. I pay $15 per month for a dedicated business line that rings on my cell phone. I use it for the rare situations where I need to make a personal call to a patient, a specialist, or a pharmacy and do not want to give out my personal number. It is not fancy. It does not need to be. Fifteen dollars a month for professional call separation is money well spent, and I have never once considered canceling it.
The iPad check-in tablet in our waiting area stayed. We set this up in the first month for patients to confirm their arrival and review their information. It cost $329 for the iPad plus a $49 wall mount plus a $10 per month device management subscription. Patients tap their name, confirm their demographics and medication list are current, and Denise gets a notification that they have arrived. It is simple, it works, and it saves about two minutes per patient check-in, which across a full day adds up to nearly half an hour of Denise's time. The patients seem to like it too. Several have told me it makes the practice feel modern and organized, which matters for a small DPC practice competing for members against the perception that "small practice" means "disorganized."
What I Dropped: The Expensive Lessons
Here is where it gets humbling. In my first year, I signed up for a separate online scheduling tool because I was not yet confident that my EMR's built-in scheduling would be sufficient. I wanted patients to have an easy, polished way to book appointments online, and the scheduling tool I picked had beautiful booking pages and automated reminder texts. It cost $25 per month, which felt negligible at the time. Here is the thing: it was fine. It worked. But it created a parallel scheduling universe. Appointments booked through the external tool had to sync with the EMR's calendar, and while the integration mostly worked, "mostly" is not a word you want associated with your appointment schedule. About once a week, there would be a sync lag or a duplicate entry that Denise had to manually fix. After six months, I realized that the native scheduling, combined with the phone agent that books appointments directly into the system, was handling 90 percent of my scheduling volume without any of the sync headaches. I canceled the external tool in month eight and have not missed it for a single day. That is $200 I spent on a problem that did not actually exist, or at least did not exist once I trusted the tools I already had.
The bigger and more embarrassing cut was the standalone fax service. When I set up the practice, I subscribed to an eFax service at $35 per month because I assumed I needed a dedicated fax solution. Faxing is, incredibly, still a core communication method in healthcare, and I was receiving referral letters, specialist notes, insurance documents, and lab results by fax every day. The eFax service worked, but it dumped everything into my email as PDF attachments with no context, no patient matching, no organization. I was spending fifteen to twenty minutes a day sorting through fax PDFs and manually uploading them to the correct patient charts in the EMR. It was tedious, error-prone, and exactly the kind of mindless administrative work I had left corporate medicine to escape.
Then, about ten months in, my EMR rolled out enhanced virtual fax handling as part of the platform: scanning of incoming documents, automatic patient matching, direct filing into the chart. I was skeptical, because automatic patient matching sounds exactly like the kind of feature that works in a demo and fails on a Tuesday. So I ran it alongside the eFax service for two weeks and kept score on a sticky note. The matching was right far more often than I expected, wrong occasionally in ways that were easy to catch, and the whole workflow was faster than my sorting-PDFs ritual even accounting for the corrections. I canceled the eFax the next day. Over fourteen months, I had spent about $490 on a fax service doing a job my existing subscription learned to do better. Not a fortune, but it stings, because the lesson is so clear in hindsight: before you buy a separate tool, check whether the platform you already pay for does the thing.
What Surprised Me
Two things genuinely surprised me in this audit, and I think they are worth sharing because they challenge assumptions I held strongly at the start.
The first surprise was that the software kept changing under me, mostly for the better. I assumed the scribe would plateau at "good enough" and stay there, the way every other medical software I've used stayed exactly as annoying as the day it was installed. Instead it kept picking up small competencies, like flagging a medication interaction in the draft note, that it didn't have at the start. I want to be balanced about this, because continuous change cuts both ways: twice this year an interface update moved a button I use forty times a day, and I grumbled about it to Denise for a full week both times. But on net, buying software that improves without my involvement has been a better deal than I understood when I signed up.
The second surprise was how readily my patients adapted to the patient portal. I was genuinely worried about this. My panel includes patients ranging from their early twenties to their mid-eighties, and I assumed the older patients would resist using a digital portal for messaging, lab results, and appointment management. I was wrong. It took some initial hand-holding, absolutely. Denise spent a lot of time in the first few months walking patients through the portal on that waiting room iPad, showing them how to send a message and how to find their lab results. But once they got the hang of it, even my most technology-resistant patients embraced it. I have a 78-year-old patient named Arthur who now sends me portal messages about his blood pressure readings with the enthusiasm of a teenager texting his friends. He signs every message "Regards, Arthur J. Whitfield" with full punctuation, and it is the most charming thing in my inbox every week. As of today, 89 percent of my patients use the portal regularly, which is far higher than the 60 percent I projected. The portal has become one of the invisible load-bearing walls of my practice: it quietly handles a huge volume of communication that would otherwise come through phone calls, and it gives patients the feeling of access and connection that is so central to the DPC value proposition.
The Money: Where I Ended Up Versus Where I Thought I Would Be
When I was building out my technology budget in 2024, I projected a monthly technology spend of $400 to $500. Here is what I am actually spending today: Hero EMR at $299, OpenPhone at $15, iPad management subscription at $10, website hosting at $29, and a few small tools for accounting and practice analytics that total about $45. My total monthly technology spend is approximately $398. That is about $100 per month less than the high end of my original projection, but more importantly, it is roughly $500 per month less than what I was spending during the chaotic first six months when I had the separate scheduling tool, the standalone fax service, a patient communication app I have not even mentioned because it lasted exactly seven weeks, and a couple of other experimental subscriptions that did not survive contact with reality. Annualized, my current technology stack costs about $4,776 per year. The savings from consolidating onto one platform and dropping redundant tools amounts to roughly $6,000 per year compared to my peak spending, or about $500 per month. For a solo DPC practice where margins matter, that is not trivial.
But the subscription line items are the least interesting part of the audit. The real currency is time, mine and Denise's, and I have made a deliberate decision to stop publishing dollar conversions of it. James has a tab that does exactly that math, and every time I read it, it sounds like an advertisement for my own life, which is a genre I distrust. So here is the unquantified version: my notes are done when I leave, Denise spends her day on patients instead of phones, and the two of us run a panel that would have required twice the staff in my old world. Some months that feels miraculous. Other months the printer jams, the WiFi sulks, an update moves my buttons, and I remember that no stack of technology removes the part where you run a small business with your own two hands.
What I Would Tell a New DPC Doctor About Technology
If I could sit down with a physician who is six months from opening a DPC practice, which is a thing I now do fairly regularly through the DPC physician group I belong to, I would tell them three things about technology.
First, do not overbuy at the start. I know this is counterintuitive, because when you are in the planning phase, every shiny tool looks like the thing that will make your practice work. You will be tempted to sign up for a scheduling platform, a separate patient messaging app, a virtual receptionist service, a standalone fax solution, and three other tools that each solve one specific problem really well. Resist that temptation. Start with one comprehensive platform that handles the core workflows, ideally an EMR with built-in communication, scheduling, and documentation tools, and let your actual daily experience reveal the gaps. Some of those gaps will be real and will require additional tools. Many of them will not. You cannot know which is which until you have lived inside the workflow for a few months.
Second, invest in the tools that save you time, not the ones that save you money. A cheaper EMR that costs $150 per month but requires you to spend an extra hour charting every day is not saving you anything. It is costing you 250 hours per year, which at any reasonable calculation of your time's value is far more expensive than the $150 per month you thought you were saving. The best technology investments in a DPC practice are the ones that give you back time, because time is the entire foundation of the model. More time per patient, more time for yourself, more time to build the kind of practice you actually want to run.
Third, let your needs reveal themselves. Your practice at month twelve will look nothing like your practice at month one. The workflows you think you need, the tools you think are essential, the problems you think are urgent will all shift as you accumulate patients and experience. Build your technology stack iteratively, not all at once. Add tools when a genuine need becomes clear, not when a vendor's marketing email creates an artificial sense of urgency. And audit your stack regularly, at least once a year, to make sure everything you are paying for is still earning its place.
I am glad I did this audit. It forced me to look clearly at what is working, what was not, and where the money is really going. If you are a DPC physician reading this, I would encourage you to do the same exercise. Open a spreadsheet, list every piece of technology you pay for, and ask yourself honestly: is this tool earning its keep? The answers might surprise you. They certainly surprised me.
Now if you will excuse me, the pancakes are ready, and my coffee is completely cold, and the dog has moved from the sunlit square on the floor to the couch, which she is absolutely not allowed on but which she occupies with the confidence of someone who knows she will not be removed. Some things technology cannot solve. Happy Sunday.