Opening your business as a direct care practice

Opening a new medical practice can be intimidating. Opening as direct care does remove some of the hassle.

Apprehension about opening a business is the major obstacle for physicians interested in opening a practice. While it may seem daunting, remember that thousands of people start small businesses every day—and you can too! The good news is that by taking insurance factors out of the equation, running a direct care business is way easier than running a conventional medical practice.

Let’s start with the fun stuff: coming up with a name, logo, and website for your practice.

Selecting a name

To make it easy for prospective patients seeking this type of practice to find you, you may want to start by incorporating ‘direct care’ or ‘DPC’ in your name. Some physicians with an established presence in the community choose to use their own last names to help patients find them. However, if you hope to eventually expand your practice to incorporate other physicians, using your name may not be practical.

Many doctors use their location in the name. This can be a specific neighborhood or town or a more general geographic area. Other docs use variations on themes of health and wellness or imagery of nature, freedom, and positive emotions. As you consider your options, practice answering the phone or telling others the name of your practice. Does the name roll off your tongue? Is it easy understand and to spell? Is it memorable? Does the name suggest an image that can be used in a logo?

Next, make sure that the name is not already in use. Do a general web search and then a Fictitious Name search through your state’s business website. Check to see if a domain name incorporating your practice name is available, ideally using a “.com” address. A shorter name is usually easiest for patients to use but remember that you can buy multiple domains that route to the same website. For example, the name ‘GulfCoastDPC.com’ routes directly to my website ‘GulfCoastDirectPrimaryCare.com.’

If you find the perfect name at a low cost, buy the domain right away—you can always create the website down the road. Names that are not currently owned by others are usually very inexpensive, running about $10 per year.

Cultivate your image

Next, you need an internet presence. A website is essential, but the more sites that you create (Facebook, LinkedIn, Google Business, Instagram, etc.), the more likely that search engines will help patients to find you. You will want to create social media pages for your business anywhere you want patients to find you but start by building a website.

As you may have gathered by now, I’m a big fan of saving money and ‘do-it-yourself’ projects, and in my opinion, there is no need to spend big bucks on a website developer. Current website builders make DIY so easy, even for a non-computer expert. I created my website using wix.com for just $4 per month. Other online services include SquareSpace, Weebly, and GoDaddy—just do a web search for ‘easiest website developer’ and see which you like the best. If you don’t have the time or the desire to create your website, there are loads of professionals offering this service.

You’ll need an email address just for your practice. Most website programs allow you to create personalized email addresses for your business based on your domain name for a small extra fee. This is the most professional, but I’ll admit that I still use Gmail because it’s free.

Next, create a logo. Your website program may offer this, or you can use an online DIY logo creator or hire a designer. You can pick an image that represents your practice or use a special font with your practice name. Make sure to keep your logo simple and easy to read. I don’t trust my graphic design skills, so I hired a designer I found by querying my social media contacts. You can also find a graphic designer using an online service like Fiverr or 99designs.

Determine your business structure and legalities

Most direct practices operate as an LLC or S corporation, which has tax benefits over sole proprietorships. You can learn more about choosing a business structure through the U.S. Small Business Association, but this is an area where it makes sense to hire an attorney or accountant. If you wish to use your business structure to operate other ventures, like contract work, then you can establish a ‘DBA’ (doing business as) for your practice, which must be registered as a fictitious name in your state.

Register your business per the requirements of your state, which can be found on their website. For example, my state of Florida requires registration with the Division of Corporations and the Department of Revenue. You also need to check your county and city laws. My county required a business license and business tax, as well as a certificate of occupancy for my executive suite; again, this is found on your county’s business website. Always make sure you are reviewing official state websites, which end in .gov, as scammers often try to mimic business registration sites.

You must register with the IRS and obtain an employer identification number (EIN). Open a business bank account and get set up for payroll, tax withholding, and unemployment tax through your accountant. Get a business credit card through your bank or a private company. You may want to consider business insurance, property insurance, and/or an umbrella insurance policy.

You will need to obtain Workman’s Compensation insurance for staff members in case of accidents or injuries on the job as required by your state. Check the Department of Labor for required workplace posters, including the OSHA poster on workplace safety. For more compliance information, obtain the Manual of Policies and Procedures for Direct Primary Care, or consult your attorney.

Medical requirements

Make sure that you change your address with your state medical board, and if dispensing medication is allowed in your state, obtain a dispensing practitioner license. Check to see if your state requires that you register with AHCA—in Florida, practices that are 100% physician-owned do not need to register. You’ll need to obtain a CLIA waiver so that you can perform office procedures like urinalyses, pregnancy tests, and strep tests.

You must comply with your state Department of Health's process for medical waste disposal. Sharps containers and biomedical waste pickup is handled through companies that are licensed by the health department and are usually inexpensive. Your state may require that you and your staff have completed training on the proper disposal of waste, usually available on their website.

Of course, you’ll need malpractice insurance, but another benefit to direct care is that malpractice is usually less expensive because it’s based on risk. Since direct care doctors have smaller panels and lower patient volume, they incur less risk, and tend to have lower premiums. Be sure that your insurance representative understands the practice model (if they don’t know about direct care, they understand concierge, which is usually priced at a similar rate).

Did I miss anything? Probably. Other logistical resources include the AtlasMD Start-Up KitStart-Up DPC website, DPC StartUp handbook, and DPC Frontier legal checklist, and of course, always consult with your attorney or accountant for state-specific advice.

In the next article, we’ll start marketing to patients and discuss the pros and cons of opting out of Medicare and hybrid practices.

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.