• Revenue Cycle Management
  • COVID-19
  • Reimbursement
  • Diabetes Awareness Month
  • Risk Management
  • Patient Retention
  • Staffing
  • Medical Economics® 100th Anniversary
  • Coding and documentation
  • Business of Endocrinology
  • Telehealth
  • Physicians Financial News
  • Cybersecurity
  • Cardiovascular Clinical Consult
  • Locum Tenens, brought to you by LocumLife®
  • Weight Management
  • Business of Women's Health
  • Practice Efficiency
  • Finance and Wealth
  • EHRs
  • Remote Patient Monitoring
  • Sponsored Webinars
  • Medical Technology
  • Billing and collections
  • Acute Pain Management
  • Exclusive Content
  • Value-based Care
  • Business of Pediatrics
  • Concierge Medicine 2.0 by Castle Connolly Private Health Partners
  • Practice Growth
  • Concierge Medicine
  • Business of Cardiology
  • Implementing the Topcon Ocular Telehealth Platform
  • Malpractice
  • Influenza
  • Sexual Health
  • Chronic Conditions
  • Technology
  • Legal and Policy
  • Money
  • Opinion
  • Vaccines
  • Practice Management
  • Patient Relations
  • Careers

Logistics and marketing your direct care practice


Focusing on details like hiring, supplying and marketing for your practice are key.

After you have established the business basics of opening a direct care practice, it’s time to focus on operational details like hiring staff, supplying your clinic, and marketing.

Hiring staff

Once you’ve found your practice location, they next step is to hire a great staff member, unless you plan to open a micro-practice without any help (which I don’t recommend if you hope to have any sort of work-life balance!).

I recommend hiring and onboarding a staff member to act as your ‘right hand’ from day one. For some physicians, the idea of paying for a staff member before earning any income is hard to swallow. But remember, you are becoming a business owner—the business isn’t supposed to own you! Having a staff member onsite during business hours frees you up to be elsewhere when you aren’t actively seeing patients. For example, you will need time to focus on entrepreneurial responsibilities, like attending community events to recruit new patients. Having staff also allows you the flexibility to moonlight or spend time on other interests.

Since payroll is one of the largest expenses of running a medical practice, consider hiring just one staff member to assist with both clerical and clinical responsibilities. This could be a medical staff member like a medical assistant or nurse trained to perform clerical duties, or conversely, a dedicated clerical staff member who can be cross trained to give you a hand when needed. While there are pros and cons to each, I chose to hire an administrative assistant to manage the office, figuring that I could handle all the medical aspects myself, such as taking vital signs, giving injections, doing EKGs, and drawing blood. It turns out that I really enjoy these aspects of hands-on patient care, especially since I have the extra time as a direct care doctor.

The most important part of hiring is to find someone who is reliable, trustworthy, and has a glowing personality that reflects well on your practice. They should fully understand the direct care model to enthusiastically explain it to potential patient callers. I’ve found great staff members through word-of-mouth and through online recruiting sites like Be sure to check references carefully and don’t ignore any red flags when hiring.

Supplying your practice

Now it’s time to set up all your utilities like electric, water, phone, and internet. Here’s where it comes in handy to have that staff member—you can delegate the responsibility of contacting utility companies and scheduling setup. Your phone line is critically important as most patients start the process of seeking a physician by calling for information. You can install a direct phone line or consider using a voiceover internet provider. Whatever service you use should allow flexibility in forwarding phone calls when you aren’t in the office. Having the best high-speed internet service you can find in your area is a necessity in today’s electronic era.

There are a host of excellent and affordable electronic record keeping systems, many of which also integrate billing services and let you communicate with patients through email and text. Most are cloud-based and cost just a few hundred dollars a month, at most. Because you won’t be reporting information or sending bills to third parties, you won’t need to comply with expensive and burdensome systems that comply with meaningful use.

While you will likely choose an electronic, ‘paperless’ system, medical practices still seem to generate an awful lot of paper. For this reason, I highly recommend investing in an industrial grade copy machine with integrated faxing and scanning, as well as paying a company to pick up and shred your paper waste. My lease-to-own a refurbished copy machine costs about $75 per month and paper shredding runs about $35. You’ll also need to hire a company to pick up your medical waste, per your state health department requirements.

Next, make a list of the office furniture and supplies you will need. The more you can beg, borrow, and virtually steal like from Craigslist and Facebook Marketplace, the better! I bought my exam table from a tattoo shop that was closing and re-covered it and got my EKG machine from a retiring plastic surgeon for pennies on the dollar. You’ll want to open an account with a medical supply company to obtain the basics like point-of-care tests, office medications, and dressings, but don’t forget to check sites like Amazon which are sometimes cheaper.


The best marketing tool for your practice is YOU. Patients are seeking a relationship with a caring physician; all you must do is show them that you are open for business. Make sure that your new practice address is listed with your state Board of Medicine, on Google, and at physician review sites. If you had a previous practice, send letters to your former patients to let them know about your new location. Send a press release to your local newspapers and media outlets.

Don’t spend a fortune on advertising or marketing services—just start by creating a simple website (I made mine on for $4 per month) and develop a social media presence. Make a Facebook business page and start building content with photos of your practice and videos of yourself talking about your new model. Plug your practice on local area groups on social media and look for opportunities to speak with community groups. If you have a special interest or niche for certain patient demographics, seek out those patients and share your model with them. Consider contacting small businesses of less than 50 employees to offer your services to the employer at a discount price. For example, my practice cares for the employees of a landscaping company, chiropractic office, law firm, and insurance company.

Engaging with your community and sharing your practice model is a great way to recruit new patients. Refine your ‘elevator pitch,’ a 15 to 20 second blurb about how direct care can help your prospective patients by offering affordable, accessible care and returning to a true physician-patient relationship.

Remember, not everyone will see the value of the direct care model—and that’s ok. Be prepared for pushback and even criticism from some patients when they learn that you don’t contract with insurance companies. Stay professional and positive, and don’t get discouraged. Focus on providing the best care you can for the patients who do value what you offer—word-of-mouth from your current patients is one of your best recruiting tools and will help you grow quickly.

Legal issues

As with any medical clinic, you will need to be aware of federal and state-specific legal requirements. For direct care, many states require that patients understand that your clinic is not acting as an insurance plan. Creating a detailed patient agreement that outlines your services, as well as clarifying patient responsibilities is essential. DPC Frontier lists some of the more common legal pitfalls, but it’s important to be aware of any state-specific legislation surrounding medical practice and direct care.

If you want to provide direct care to Medicare-eligible patients, you will need to ‘opt-out’ of accepting payment from Medicare. I’ll have more details about that process in my next article.

Rebekah Bernard MD is a family physician in Fort Myers, FL, and the author of How to Be a Rock Star Doctor and Physician Wellness: The Rock Star Doctor’s Guide.

Related Videos
Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health