Building Your Team 

Any venture worth doing is worth doing with someone else. As you are building your business vision and laying out a plan for your start-up, ask yourself: who is your business team? 

DOMESTIC PARTNER 

When considering DPC, physicians with a domestic partner should involve their partner in the decision to switch. Working together to realize your dreams can bring you closer or apart, depending on how invested your partner is in your DPC dream. Whether you have a partner who can hold down the fort at home, provide income and health insurance, offer design/graphic device, help with keeping the books, do the billing, run your office or just enjoy dinners while you ramble on about all of your ideas and needs, a supportive partner is a critical component to business success. 

LOCAL INDEPENDENT PHYSICIANS 

Seek out like-minded entrepreneurial independent physicians of all specialties. Most are intrigued by the Direct Primary Care model and are eager to work with our cash-paying patients as less billing means less overhead. You may develop a local network of supportive specialists, not only with patient care but also with physician entrepreneurship, which can sustain you through difficult or lonely times. 

LOCAL BUSINESS NETWORKING GROUPS 

There are business networking groups that can be very helpful in introducing you and your business to your local business community. Be prepared to join as a member and go to meetings and events to network with other small business owners. Be aware that networking takes TIME and many conversations but eventually as you and your DPC model become well known and trusted, you will begin to get referrals. 

• “BNI”- Business Networking International. 
• Chamber of Commerce/Local Business Associations 
• Faith community (if that applies to you) Consider offering to give presentations on medical topics (not DPC) to increase exposure in your community 
• One Million Cups 
• Meetup.com (look for entrepreneurial groups) 
• Civic groups like Rotary International and Lions Clubs can all help you establish connections and useful business relationships. They may not bring in a substantial number of patients but they will help with your business acumen and word of mouth knowledge in your community. 

Other members of your team worth considering include: 

• Accountant 
• Lawyer 
• Business mentor. Use your business networking meetings to learn tips for running a business from other entrepreneurs. 

LOCAL AND NATIONAL DPC PHYSICIANS 

Call or email your local established DPC physicians. Most will be happy to hear from you and help you along the way. Some are less interested in being part of a wider DPC community – don’t take it personally! The national DPC community is full of physicians willing to help you get off the ground. Check out the DPC Alliance member directory, send an email, and ask for help.  

How to Find Your DPC Mentor 

One of the greatest benefits of the DPC movement is the collaboration among DPC physicians. Most independent physicians want to help other physicians be successful. Mentorship and the culture of “rising tides raise all ships” has been fundamental to medical education throughout the history of medicine. A good mentor is someone who is enthusiastically willing to share their knowledge and expertise, provides guidance and constructive feedback, and is successful in their own DPC practice. 

Resources for Finding a Mentor 

Below are two websites which have DPC mappers. Search for DPC clinics in your state and close to you. 

• DPC Alliance directory: DPC Alliance Members- physician only 
• DPC Frontier mapper: Includes physicians and mid-level (NP/PA), Concierge practices, Corporate DPC practices 

You can also do an internet search for DPC clinics in your state and close to you. 

Social Media: 

DPC Alliance Facebook Group 

Join online DPC social media groups. There are many state or regional DPC Facebook pages which are great resources to find those around you. Use the search option to find posts about the questions that you have. Post your own questions. Use the files tab to access free resources posted by other physicians. Pay it forward by adding your resources as you build them. 

You may find a story from an established DPC physician that resonates with you – for example, a transition practice, a part-time practice, specific practice niches. Do you want to build a practice with mainly uninsured? Mainly employees? Mainly pediatrics? All geriatrics? Do you want a micro practice, without employees? A large practice with multiple sites? Lots of procedures? Find doctors who have built a practice like what you want to do, and reach out to them. Email them and ask to set up a phone call/coffee/lunch date to hear more about their practice. 

DPC Conferences: 

The greatest value of an in-person conference is meeting like-minded physicians and developing relationships that will sustain you in a path less traveled. Virtual conferences are also helpful but it is more difficult to make those connections virtually. Consider signing up for at least one in-person DPC education event. 

• DPC Alliance Masterminds (small group in-person learning with mentors) 
• DPC Summit  
• DPC Nuts and Bolts 
• Hint Summit 

Questions: 

• What should I ask of a DPC mentor? 
  Ask informed questions – do your own research and read all the DPCA University resources before contacting them. Ask to hear their story. DO NOT ask all the basic questions that you can find answers for here – these physicians are glad to help, but they are grateful when a new prospective DPC physician has shown initiative and done basic DPC research prior to contacting them. 

• How should I show appreciation for DPC mentorship? 
  Most DPC physicians are passionate and excited about new DPC physicians jumping ship and starting practices near them. The best way to repay your DPC mentor is to PAY IT FORWARD by mentoring the next generation of DPC docs who start up after you. 

• What can I expect from a long-term DPC mentor/mentee relationship? 
  The DPC mentor-mentee relationship may become a mutually rewarding source of collaboration and support. Be open to sharing tips and tricks with local pricing, vaccines, and supplies, vacation coverage for each other. Be willing to listen when your mentor needs advice and encouragement. 

Hiring Staff 

You’re about to hire someone — maybe for the first time! Here are the first steps.  

Start with a job description. What do you need staff to do? What responsibilities will this employee have? The description lays out the basics like expectations, professionalism, dress, pay, hours, vacation, benefits — and more. Remember that the more highly skilled the position hiring for, the more diligent and detailed you should be. Hiring front desk staff is crucial, but also essentially an unskilled position. As such you have a much larger pool of applicants. Vs hiring a new provider … this pool of applicants is much smaller and can be much more tricky. 

• Determine the lowest level of training a person would need to fulfill that job. 
• Determine the amount you can afford to spend and budget. This also will affect your pool of applicants. Especially the more skilled ones like new providers. 

Create a job posting. There are many vendors available to list your job, each of which has a different price point: 

• Indeed 
• LinkedIn 
• ZipRecruiter 
• Craigslist 
• Community message boards 
• Word of mouth (Broadcast on social! Share over networking!) 
• Word of mouth may also be the best because it’s easier to check references if you get them from people you know 

Interview. Design interview questions that are meaningful to you and your practice. Consider any/all of the following modalities of interview: 

• Telephone: quick! 
• Videoconference: an easy way to screen for tech-savviness 
• In-person: more logistics and time-intensive, but can also be more revealing. Once again the more complex the position you’re hiring for the more in-depth your interviewing should be 

Call references. Again, prepare for this with specific questions in mind. Expect that you can spend up to a week (sometimes indefinitely!) chasing down references. 

Background checks. A quick online search will give you a few vendors to choose from. 

Contract or no? There are different schools of thought; consult your attorney and accountant for guidance. 

Consider ways to avoid a bad hire (and avoid paying costly unemployment): 

• Clearly define a standard trial period of X days; if the hire is not a good fit, you can “not renew” their employment. Make X be a not insignificant amount of time. 2 weeks is NOT long enough. 2 or 3 months would not be unusual 
• Consider a “trial day” or “trial week” to see if you’re a good fit — and pay them for their time without a guarantee for future employment. 

Most of us would suggest that finding a “fit” for your practice is more important than finding the candidate with the most skills or training. To a large extent, you can always train unskilled staff in how you want them to do their job. What you can’t do well is change someone’s personality.  

Employee Benefits 

It is not a requirement to offer benefits, but it can be a great way to show your employees how much you appreciate them. You may also want to consider speaking with your accountant regarding financial strategies for your particular situation.  

Things to consider: 

Retirement savings  

• Talk to your accountant. Options will depend on your tax structure. Also very strict rules on what can be offered to some but not all employees. What you can do for yourself without involving the same for employees. Definitely use your accountant’s expertise here. 

Health insurance  

• You can sign up for traditional PPO small business health insurance at any time. Find a local broker to learn about more options. 
• Consider giving a set cash amount per pay period, month, or year that your employee can put toward their insurance/healthcare. Seek accountant advice again. Some things are taxed vs tax deductible, etc. 

Dental/Vision insurance  

• You can offer the actual insurance, or consider bartering with a local dentist and optometrist to provide annual screening or other discounts for your employees.  

Other insurance  

• Disability, life, etc. 

Profit-sharing  

• Variety of ways you could do this. Consider a bonus if it helps sign up new patients. Or a bonus for every 100 patients enrolled. Get creative. Your staff is a very important part of the business and its growth – help them feel valued as such. 

Vacation  

• You are not required to provide paid vacation time, but it’s a perk to consider. 
• Most full-time employees will expect 1-2wk/yr of paid vacation 
• You do not have to provide PAID vacation, holiday, or sick leave 

Days off  

• You must give time off to serve on a jury and perform military service. You may have to give time off to vote (state by state requirement) 
• Consider calling them “Earned Time Off” or “Personal Days” as your staff may have children and need to take time off for them, not just their own sick days. 

Flexibility  

• Many DPC docs love the flexibility that this model provides them in terms of their work schedule. Your staff can also benefit. They can still answer the phone from home when they have to leave early to pick up a sick kid. Again, get creative and find ways to allow your staff to have some flexibility too. But don’t let your staff abuse this. 

You must:  

• Give time off to vote (state by state), serve on a jury, and perform military service. 
• Comply with workers’ comp (see your state laws) 
• Withhold FICA taxes (see your accountant for specifics) 
• Pay state and federal unemployment taxes 
• Company with Federal Family and Medical Leave (FMLA) 
• Contribute to any other state programs such as short-term disability (talk to your accountant)