How to Start a DPC Practice: A 12-Month Roadmap

Originally published at krasyn.com/blog/how-to-start-dpc-practice-12-month-roadmap

Direct Primary Care has grown from approximately 300 practices in 2010 to over 2,500 in 2026. More than 30 states have enacted DPC-enabling legislation that clarifies the legal status of DPC memberships (not insurance contracts). Employer interest in DPC as a benefit has expanded significantly since 2022 as small and mid-size businesses seek alternatives to rising group health insurance premiums.

The financial case is also clearer than it was five years ago. The DPC model is well-documented: a solo physician with 600 patients at $85/month generates $612,000 in gross membership revenue with lower overhead than a fee-for-service practice. For physicians who feel trapped in a volume-driven, insurance-dependent system, DPC offers a genuine alternative.

This roadmap assumes you are starting from employment or an existing fee-for-service practice. Adjust timelines as needed for your situation.

Months 1-3: Foundation and Legal Structure

Step 1: Verify Your State's DPC Landscape

DPC-enabling legislation exists in 30+ states, but the specifics vary. Some states explicitly exempt DPC membership agreements from insurance regulation; others have no specific DPC statute and require navigating insurance department guidance. Start by:

• Reviewing your state's DPC statute (search your state legislature website for "direct primary care")
• Consulting a healthcare attorney familiar with your state's DPC regulations -- this is a $500-$1,500 investment that can prevent a $50,000+ mistake
• Contacting your state's insurance department if no statute exists -- get a written opinion on whether your proposed membership structure is subject to insurance regulation

Step 2: Choose Your Business Structure

Most DPC practices organize as a Professional Limited Liability Company (PLLC) in states that allow it, or a Professional Corporation (PC). The PLLC structure provides liability protection while allowing pass-through taxation. A solo DPC physician PLLC with no employees can elect S-Corp taxation if profitable enough -- a conversation worth having with your CPA when annual revenue exceeds $150,000.

Step 3: Review Your Employment Contract Non-Competes and IP Assignment

If you are leaving an employed position, review your contract for:

• Non-compete geographic restrictions and duration
• Patient solicitation restrictions (often different from non-compete terms)
• Chart and patient record ownership provisions
• Tail coverage obligations for malpractice

Non-competes in physician contracts are enforceable in most states but increasingly restricted -- verify your state's current law. Budget 90-180 days from resignation to practice opening to honor typical non-compete notice periods.

Step 4: Draft Your Membership Agreement

Your DPC membership agreement is the foundation of your business. It must clearly specify:

• Included services (define explicitly -- list all services covered by the membership fee)
• Excluded services (labs, imaging, specialist care, medications not provided in-office)
• Membership fee, billing cycle, and payment method
• Termination terms (by physician and by patient)
• That the agreement is not health insurance
• HIPAA authorization and privacy practices

Have a healthcare attorney draft or review this document. Do not use a template found online without legal review for your specific state.

Months 4-6: Physical Space, Technology, and Operations

Step 5: Select Your Location

DPC practices require significantly less administrative space than fee-for-service practices. A solo DPC practice can operate from 600-1,200 square feet with 1-2 exam rooms and a front desk. This dramatically reduces overhead compared to traditional practice.

Monthly rent considerations:

• Target rent at 8-12% of projected monthly revenue
• Look for medical office suites with shared reception
• Some DPC physicians start in home office setups with telemedicine-first delivery to minimize startup costs

Step 6: Select Your EMR and Membership Billing Platform

Key EMR requirements for DPC:

• Built-in recurring membership billing (ACH, credit card)
• Membership tier management and panel capacity tracking
• AI ambient documentation (saves 45-90 min/day you cannot afford to lose with a small panel)
• Telehealth integrated (DPC patients expect portal and telehealth access)
• Clean patient portal for messaging, scheduling, and document sharing

Step 7: Credentialing and Licensing

• Verify your medical license is in good standing and renew if within 12 months of expiry
• DEA registration if you plan to prescribe controlled substances
• CLIA waiver if you will perform in-office laboratory testing
• If opting out of Medicare: file opt-out affidavit with your MAC
• Malpractice insurance: obtain occurrence-based or claims-made + tail coverage

Months 7-9: Patient Acquisition and Marketing

Step 8: Build Your Initial Patient List

Most DPC physicians open with 100-200 founding members and grow to 400-600 over 12-18 months. Founding members typically receive a discounted rate ($10-$20/month off) as recognition for their early commitment.

Sources for initial patients:

• Your existing patient panel (subject to non-solicit provisions -- get legal clearance first)
• Employer groups: approach 5-10 small businesses about a group DPC arrangement
• Community outreach: local presentations, farmer's market presence, chamber of commerce membership
• DPC specialty directories: DPC Alliance's provider directory, directprimarycare.com

Step 9: Price Your Membership and Build the Pro Forma

Use this formula to determine the minimum viable membership fee:

• Target annual physician income: $350,000
• Annual overhead (rent, staff, supplies, malpractice, EMR, marketing): $120,000
• Total needed from practice: $470,000
• Target panel: 600 patients
• Required monthly fee: $470,000 / 600 / 12 = $65.28/month minimum

Price above minimum to account for attrition and ramp-up: $75-$85/month for most markets.

Months 10-12: Launch and Stabilization

Step 10: Soft Launch Before Full Capacity

Open to founding members at reduced capacity (100-150 patients). This controlled launch lets you refine your workflows and identify scheduling issues before scaling.

Step 11: Financial Runway Planning

The ramp to break-even for a DPC practice is typically 6-12 months. Minimum recommendation: 6 months of personal and practice expenses in liquid reserves before opening.

Step 12: Build Your Wholesale Lab and Imaging Network

Negotiate direct pricing with Quest or LabCorp. A comprehensive metabolic panel at wholesale may cost $8-$12 vs. $150+ through insurance. Patients see this as a major benefit.

Timeline Summary

Originally published at krasyn.com/blog/how-to-start-dpc-practice-12-month-roadmap