Two years ago this month, I was sitting in a rented office space with secondhand furniture, a brand-new EMR login I barely knew how to use, and the kind of quiet terror that comes from realizing you have actually done the thing you said you were going to do. Verdant Family Medicine existed on paper, on a lease agreement, and in the anxious knot between my shoulder blades, but it did not yet exist as a real, breathing medical practice with real patients who trusted me with their health. Today, as I write this in the same office, which now has art on the walls and coffee stains on the desk and a waiting room that smells like the lavender diffuser my medical assistant Sarah insisted on, I find myself wanting to reach back through time and talk to that terrified version of myself.
So that is what this post is: a letter to my former self, organized around the things I wish someone had told me plainly before I took the leap. Some of these lessons are practical, some are emotional, and some are the kind of thing you can only learn by living through it, but I want to write them down anyway, because maybe someone reading this is where I was in March 2024, and maybe hearing it from someone who has been through it will help.
The first thing I would tell myself is that the financial anxiety does not disappear when you hit your target panel size; it simply changes shape. I spent my first year obsessing over patient enrollment numbers the way a resident watches their first arterial line tracing, constantly, with a low hum of dread. When I finally reached 320 patients and felt financially stable, I expected the worry to evaporate. It did not. Instead, it morphed into different questions: should I hire another staff member, can I afford better equipment, what happens if a dozen patients leave at once, how much should I be saving for taxes versus reinvesting in the practice. The anxiety is quieter now, more like background music than a fire alarm, but it is still there. What I have learned is that this is simply what it feels like to own something that matters to you. The antidote is not reaching some magic number; it is building enough financial margin that the inevitable fluctuations do not threaten the foundation, and then learning to trust your own competence in managing them.
The second thing I would tell myself is to invest in your technology infrastructure early and generously, because the hours you save compound over time like interest in a retirement account. I started Verdant with the cheapest software options I could find, which felt prudent and turned out to be expensive in the currency that matters most: my time and energy. When I finally switched to Hero EMR about eight months in, the difference was so dramatic that I actually felt angry at myself for not doing it sooner. The ambient AI scribe alone gave me back over an hour every day that I had been spending on documentation after my last patient left. The agentic inbox consolidated the five different communication channels I had been juggling into one prioritized stream. The 98% first-pass claim rate on the billing side meant I stopped losing sleep over rejected claims and coverage denials for the handful of insurance-billed services we provide. If I could go back, I would tell myself to start with the best tools available and treat the cost as an investment in my own sustainability rather than an expense to be minimized.
The third thing, and this one surprised me, is that the loneliness of solo practice is real and it requires deliberate effort to address. In my hospital days, I complained constantly about the bureaucracy, the meetings, the politics, but I also had colleagues I could turn to when a case puzzled me or when I just needed to vent about a difficult day. Running a solo DPC practice, especially in the first year, can feel isolating in a way that catches you off guard. I would tell my former self to join a DPC physician community immediately, not eventually, not when you have time, but on day one. The monthly DPC physician group I joined in my second year has been one of the most valuable things I have done for both my clinical confidence and my mental health. We share cases, swap referral networks, compare technology notes, and remind each other that the struggles of independent practice are universal rather than personal failures.
The fourth lesson is about patients, and it is the one that still moves me when I think about it. I was so worried, in those early months, about whether patients would value DPC enough to pay for it directly. What I did not anticipate is how profoundly the membership model changes the nature of the therapeutic relationship itself. When a patient chooses to pay you directly, when they pick your practice out of all the options available and commit their own money to the relationship, something shifts in the dynamic. They show up differently, more engaged, more honest, more willing to do the work of managing their health. And I show up differently too, because I am not rushing through a fifteen-minute slot with one eye on the schedule and the other on the billing codes. I am sitting with a person who chose me, giving them the time they deserve, practicing the kind of medicine I went to medical school to practice. Two years in, I have patients who text me when they are worried about a symptom and call me by my first name and bring me tomatoes from their garden in August. That is not a business relationship; it is a community, and building it has been the most fulfilling professional experience of my life.
The fifth thing I would tell my former self is that your definition of success will evolve, and you should let it. When I launched Verdant, success meant hitting 300 patients and matching my hospital salary. I have exceeded both of those benchmarks, and while that feels wonderful, the metrics that matter most to me now are completely different. Success, in my second year, looks like the fact that my average appointment is 32 minutes long. It looks like knowing that my patients can reach me when they need me, usually within hours rather than days. It looks like my hemoglobin A1c outcomes for diabetic patients, which are better than the national average because I have the time to actually counsel people about nutrition and exercise and medication adherence rather than just adjusting doses and moving on. It looks like the thank-you notes pinned to my office wall. It looks like leaving work at 5:30 most days and being present for dinner with James.
There are things I still struggle with, and I want to be honest about that because I think the DPC narrative sometimes gets unrealistically rosy. I still have days when the administrative work feels overwhelming, even with Hero EMR handling the heaviest lifting. I still worry about the long-term sustainability of the model as healthcare policy shifts in unpredictable directions. I have lost patients who moved, who lost jobs, who decided the membership was not worth it, and each departure stings more in DPC than it ever did in a system where patients were just names on a panel list. I have moments of doubt, usually late at night, when I wonder what would have happened if I had stayed at Meridian, taken the safe path, accepted the slow erosion of my professional soul in exchange for a predictable paycheck and a retirement plan.
But those moments pass quickly now, because the evidence of my own life contradicts them so thoroughly. I am healthier than I was two years ago. My marriage is stronger. I practice medicine that I am proud of, medicine that my residency mentors would recognize as the kind of care they trained me to deliver. My patients are healthier, happier, and more engaged in their own wellbeing. My staff, small as we are, genuinely enjoys coming to work. These are not abstract benefits; they are the daily, tangible reality of a practice built on a model that puts the physician-patient relationship at the center of everything.
So if you are reading this and you are where I was in March 2024, here is what I would tell you, distilled into the simplest form I can manage: the fear is real but temporary, the financial math works if you plan carefully, the loneliness is solvable, the technology is better than you think, and the medicine, the actual practice of caring for human beings, is everything you hoped it would be. Two years in, I would make the same choice again without hesitation. In fact, the only thing I would change is that I would have done it sooner.
Next month, I am going to write about something I have been putting off discussing publicly: what it looks like to think about scaling a DPC practice, whether that means adding a second provider, expanding services, or simply optimizing what I already have. It is a question I have been turning over for months, and I think it is time to work through it on the page. Until then, thank you for being here, for reading, and for being part of this community. It means more than you know.