How to Start a Cash Practice (and Not Fail) | DPC Startup, Leaving Insurance, & Best EMR for Cash Clinics

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It’s time to run your practice instead of it running you.

I’m Doctor J, and today we’re dispelling a fear that’s been a problem for most doctors dreaming about moving to catch practice or DPC, meaning no third parties, no insurance. I’m just going to make it working with a patient and getting paid.

Here’s the question. What if I try this? What if I leave my safe, secure world and I fail at cash practice? I don’t know, I don’t like it, which doesn’t happen, by the way. I mean, unless you hate medicine and have always hated it, you’re going to love it, all right? So you’re going to love it, or I just I just can’t make a living.

I don’t know that I’ve ever seen that happen. In fact, I know I’ve not seen it happen. Within 3 to 6 months, everybody is breaking even or doing better. So it’s not a problem. But the question persists. So how can you be sure that you’re not going to be that, I don’t know, one in 1,000 who actually doesn’t make it?

What if you do fail? How can you be sure you’re headed in the right direction? What if you have a roadblock or questions?

We’re a pretty risk averse bunch. Doctors. I mean, we’ve been taught, about malpractice and the medical board and all the obstacles we have, and we’re pretty careful and understandably, you have a lot of fence sitters.

I’m going to give you some encouragement and, and show you on this podcast ways that you can be as much as this even possible, totally assured. Let’s start with this. The sleeping giants of dissatisfied walk away. Doctors and NP’s are saying, I’m getting out of it. This sucks. I’m so tired of it, I can’t do it.

The giant is waking up and saying, wait a minute, I don’t have to put up with this.

The cash practice movement is gaining steam. I mean, it’s a bulldozer, and docs and MPs are just getting out of the sick care third party system in droves. There’s a lot of retirement going on. I mean, that’s definitely happening.

We have some doctors we worked with, that were almost there and we really turned them at the last minute. And they’ve been in practice now for 3 or 4 more years and enjoying it.

Cash Practice is diverting a lot of those retirements and all by itself with new practices and doctors who are mid-career.They’re saying, hey, you know what? I don’t need to work in the E.R., I can do a cash practice. I don’t need to work in this, primary care system. I can have a cash practice. It’s hot.

Just one problem. Cash practice is completely different than what we were trained to do.

So you can’t do it by yourself. You got to wear a lot of hats. Can you kind of be an accountant and lawyer and a doctor? This is a little scary. So what about technology and taxes and marketing?

When I was training back in the day, we had a fella on the floor, a seventy year old guy with a diabetic foot and gangrene, and they tried all the antibiotics and didn’t work, and he was gonna have to have his foot cut off. It was horrible. At that time, we were residents and our time was reimbursed at $16,000 a year. So it was just time. I wasn’t paying attention to the clock or the hourly. I had days to work out problems. I went to the maker of Cipro, Bayor and received a compassionate use form and I filled it all out. I sent it in and sure enough, it got approved. We received the Cipro within a couple days. I mean, it’s quick. It’s pretty amazing. Saved his foot. Unbelievably cool clinical outcome, but a total business nightmare. It would be disaster to be unreimbursed for two whole days of work with great clinical outcome. You want great outcomes, but you got to get the other part right.

So how do you avoid rookie mistakes?

Talk to people who’ve done it. There’s organizations and communities that are just amazing. I’ve had really good experience with this, just my ability to talk to people and say, “Hey, what do you think?” And they’re willing to share. The DPC Alliance is a great resource. DPCAlliance.org, is one of the largest membership organizations for DPC physicians offering tons of resources.

There’s so many podcasts and videos and conference materials that you can check out for free, and you don’t have to make mistakes on stuff that’s available to you and your time. You can study it and discover if it’s really for you? And it doesn’t cost a thing. There’s a doc, Her name is Maryal Concepcion and, she and I had a conversation, and she straightened me out on some things I didn’t understand. Like, I thought, I’m a fee for service. I’m not a real DPC. And she goes, oh no, by law, you’re DPC. She has guests on all the time, and she’s got great information at her website, the DPC Alliance.

They have an annual meeting that’s really great. And you can kind of, kibbutz with people and get with them and figure out location and stuff like that with doctors who actually have experience doing this. And they’re passionate.

It reminds me of when we were in medical school, and thought I’m going to be a doctor and we’re so excited.

It’s like a rebirth of that. There’s another group called the DPC Frontier, and that’s at DPCFrontier.com. And they provide a lot of regulatory information. The the alliance has a lotmore practical practice stuff. This is much more in the regulatory world. They have a map of DPC practices of the whole country. And you can see the density of different places, which I’ll explain to you in a minute why that’s so important.

It helps you kind of look at your competition. And also potentially where you could find mentors, people who are in your area who they could use a little help with coverage or, you could help with sharing supplies. We do it all the time. But the site also links to academic publications. So you have really good information.

You can rely on policy papers, and all sorts of open access recordings that are about DPC.

I’ve done some work looking into books and paywall articles. I wouldn’t bother. Don’t spend your money on that. You don’t need to. You’ve got free resources that are excellent. You’ve got this podcast, where we have a ton of material to share with you.

This it’s really, really good for free. So you don’t have to pay any money. That’s one of the things with DPC that it’s so good is you can start slow and don’t pay a lot of money, don’t get into a lot of debt. And you can get really far with just the available resources because of the community that’s involved, people who are really excited about.

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What are the top four mistakes? What are the most significant struggles for new DPC clinics?

Location, location, location? Everybody knows that. Real estate people. I mean, that’s the whole thing. When you buy a building, when you rent a building, location is everything, right? So if you launch in a community that’s never been exposed to DPC, it’s going to be a little bit harder, if you’re launching in a community that doesn’t have anybody that’s capable of paying cash for the care, it’s going to be harder. I almost might put it in the impossible category. So you have to be careful about location. I think that’s number one. You don’t want to start out on the wrong foot.

And a really great way to avoid that is to look at the DPC mapper on the frontier site. And you’ll see where if you see a lot of DPC practices, it means that that’s probably a good area.

Burger King used to open up right across from McDonald’s because they saw their all the work they’d done on location. McDonald’s has spent half a million figuring out where the best site was.

Burger King just opened up across the street and saved a half a million bucks. You can do the same with the DPC mapper. Makes great sense. So location, that’s number one. Number two, and this is also a hard one for some people to swallow. It took me, I think, almost five years to say yes to this. The doctor is the brand. I’m Doctor J, the host of your DPC podcast. The Cash

Practice Solution. Right. So how hard is that to say?It’s easy, but to get started was tough.

Now that I’m there, people know me. They stop me in the grocery store. Hey doctor J, I am the brand. A DPC without that is just another doc in the box. I mean, you have to be willing to say you are the practice. You as an individual are the practice.

You may get a few docs and each of them can have their own brand, and that’s great. We have one doc that we work with. Actually she’s a nurse practitioner, and she’s excellent, she’s beautiful she’s bright, she’s talented. She’s got everything going for her. But she was really afraid to put herself out there and be visible.

I told her, you’re a rock star. You should do this. And once she did it, once she embraced it, it just it blew her up. She did so well because people want to be with someone they can identify as someone who’s taking care of them. So get over being concerned about narcissism and promote yourself. It’s okay. You’re allowed.

You’ve worked really hard to be good at what you do. You should just make yourself available to people.

Number three, not having anybody you can talk to, having no backup and trying to make this happen. Well, it’s tough. Make a few friends, develop some relationships. You can do that.

Contact frontier or the Alliance, or you can talk to us.

It’s not hard. If you look at the resources that are available, you’ll find lots of doctors who are absolutely open to having conversations. On the Doximity app I see tons of that. Where people say, if you’re interested in a DPC practice private message me. We can talk about it. It’s available.

You don’t have to pay $5,000 a month or $10,000 a month for a consultant. That’s unnecessary.

So your solution? Find at least one mentor. Find somebody who you can talk to you. Finally, and this is the final obstacle is money. They don’t understand the actual startup costs and how that works. It can be incredibly inexpensive to start a practice. You don’t have to have a beautiful 3000 square foot building with seven exam rooms, you can start with an exam table, a folding massage table, an otoscope. An ophthalmoscope you get off of eBay, a blood pressure cuff from Amazon and a stethoscope you’ve had since the beginning of your career and do a great job. The king thing. It’s the relationship with a patient. If you can get that right, all the other stuff falls into place. It’s so hard to imagine how it would be if the relationship had been elevated from the beginning of our training, and you could really see how it drives marketing.

It drives your outcomes. When patients trust you, they’re healthier. They listen better. They respond better. You enjoy it better. Everything works better. So don’t spend a lot of money to try to make it work. Spend your time and spend your energy on building relationships and just do a great job for your patients. Make a phone call. Look stuff up. Engage, engage, engage. It’s going to make all the difference. Keep your overhead low. Buy used equipment. Use those DPC resources. When your relationship with your patients is really strong, they’ll pull for you to succeed. They’ll tell everybody about you. They’ll say, oh my gosh, she’s beautiful. She’s amazing. He’s great. And they’ll use your brand.They’ll say Doctor J and share your brand. The DPC model creates a completely different chemistry than the detached third party model, which is basically who’s taken my insurance this year? Next, next. It completely eliminates the bond between the patient and the caregiver. I’ve got patients in our practice I’ve been seeing for 20 years. And they still send friends and relatives.

We spend a lot of time saying no. So I mean, it’s a good problem to have. If you’re still on the fence, take me up on some of the resources we’ve mentioned and give it some thought. I think it’s a wave that you’re not going to be able to avoid. I mean, you might as well get on the wave and go.

If you’ve decided already to start a DPC, make a plan to meet your goals with the help of patients, friends and providers who’ve spent some time in the trenches. You know, like me and some others, plan to share the lessons you’re learning and help build back a real health care system where we care about people’s health. And it’s not just about trying to survive, and you can get there.

So for more, follow us on your favorite platform or look us up at the CashPracticeSolution.com.

Thanks for joining us on the Cash Practice Solution, sponsored by Esprē Health. But before signing off, I want to remind you of our keys to lasting success.

Listen to your patients, learn their stories, love them with all your heart, and you will be unstoppable.

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We’ll reconnect in the next episode with more ways to help you succeed.