Back to Foundations: Lessons from Dr. Edward Williams’ Direct Primary Care Journey in Rural Alabama

Maryal Concepcion
May 25
7 min read

DPC Doctor

For those with an established interest in Direct Primary Care (DPC), the journey of each physician-founder provides valuable, nuanced insights. Dr. Edward Williams’ story, shared on the “My DPC Story Podcast” with Dr. Maryal Concepcion, delivers inspiration and tactical wisdom for physicians seeking to reflect on—or refine—their own DPC path. From rural Alabama roots and frustrating fee-for-service days to boldly launching his own clinic and crafting a system focused on access, care, and family life, Dr. Williams exemplifies both the entrepreneurial spirit and the patient-centered philosophy that anchor the DPC movement.

This post distills Dr. Williams’ strategy, decisions, tools, and personal growth, inviting you to reflect on your unique DPC trajectory and glean fresh ideas for sustainable success.

The Road from Fee-for-Service to DPC: Knowing When Enough Is Enough

Many of us start our careers in traditional, insurance-driven primary care systems. Like so many others, Dr. Williams entered his first post-residency job as an employed physician in his home state—focusing, as he recounts, on "just getting out of residency" and surviving, not strategizing. The insurance model’s frustrations, from arbitrary scheduling to administration-imposed limits on patient communication, quickly became apparent:

“One of the, administrators was like, 'It's not your clinic. It's ours.' ...That was kind of when a light bulb switched. They just want me to work here. I've got no control over who I see and who I can't see.”

Most DPC doctors recognize this emotional turning point—when autonomy is lost, administrative barriers eclipse patient connection, and doctors are reduced to cogs in a billing machine. Dr. Williams’ realization only deepened during the pandemic, with bizarre PPE rules and the absurdity of being reprimanded for efficiently informing patients about normal results by phone. These experiences sharpened his resolve:

“I told my wife, it’s a three year contract. I’ll do this for three years, and then we’ll find something else to do.”

His proactive break came after discovering DPC via virtual conferences during slow pandemic months—proof that a pain point can also become a pivot if you’re open to searching for alternatives. For anyone mulling their own leap, Williams’ advice is honest: Attend conferences, listen to stories, and let your discontent fuel your curiosity and courage.

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Building from Scratch: The Power of Roots and Relationships

Returning to South Alabama, Williams started Foundation DPC in January 2021, blazing a trail as the county’s only DPC. Knowing the region and having both his and his wife’s families nearby proved culturally and emotionally valuable, yet he describes launching his panel as "starting from zero." Few patients followed initially, most preferring to stick with established (if frustrating) models or were unaware of DPC as an option.

So what worked?

1. Blow Minds with Service:Every patient encounter became an opportunity for word-of-mouth growth. As Dr. Williams says:

“If somebody per chance wandered into my clinic, just absolutely blow their mind with the service. And that kinda spidered out the word-of-mouth type of marketing.”

2. Leverage Local Networks—Even as an Introvert:He joined a business roundtable with other small business owners, pitching himself and DPC benefits among peers. For introverted physicians, this is daunting, but Dr. Williams shares candidly, “I would have to sit in my car and, like, psych myself up with music to get out and go introduce myself to strangers.” Authenticity, not slick salesmanship, is what ultimately built trust.

3. Stay Consistent and Patient:Growth wasn't meteoric, but a slow, steady climb—sometimes, “days were pretty slow.” For new DPC physicians, patience and incrementalism are essential. Dr. Williams’ example shows that a strong reputation, community involvement, and genuine caring build a sustainable panel over time.

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Defining Your DPC “Why”: Autonomy and Access

Two themes emerge from Dr. Williams’ story: reclaiming clinical autonomy and expanding patient access.

Clinical Autonomy:From the freedom to set his own schedule, to experimenting with operational tweaks (like cohorting INR or diabetic visits), he now iterates in real time. If something isn’t working, he pivots, unrestrained by an administrator’s dictates.

“The cool thing about this stuff is that we can modify our flow really quickly.”

He also enjoys the latitude to incorporate diagnostic tools (like the Butterfly IQ ultrasound) and embrace creativity in care settings—meeting patients where they are, from their homes to local grocery store parking lots.

Access and Availability:Perhaps most striking is his commitment to a “24-hour response promise,” refusing to let his panel grow past his ability to return every patient communication within a day. For a rural population accustomed to inaccessible, overwhelmed medical offices, this is transformative—and, crucially, scalable as Williams adds trusted providers (like nurse practitioner Wendy) to his team.

“If I can't do that [respond in 24 hours], it means I've gotten too busy... that's when [I add capacity].”

This access-first ethos translates directly into growth: patients cite “accessibility,” “finally being able to reach their doctor,” and “an affordable way to get care” as their top reasons for joining Foundation DPC.

Practical Strategies for Scaling: Team, Tech, and Services

For many DPC founders, the biggest growing pains come from managing success. Dr. Williams is transparent about his early missteps and the need to continually retool operations as his patient panel expanded:

Team Building:He hired a medical assistant (MA) at around 150-200 patients—a move that freed him up for doctoring while Jordan, his MA, handled much of the administrative and patient-facing work. As the practice grew, so did the need to optimize her workflow.

Bringing on nurse practitioner Wendy took careful timing, but because she was already known and trusted, Williams structured her employment as a W-2 with a salary scaled to her panel size—rewarding her for growth, but guaranteeing income during the ramp-up phase.

Tech Stack:Far from overcomplicated, Foundation’s tech stack is lean but powerful. The anchor is a user-friendly EHR, integrated with:

AI Phone Answering Service (with customized avatars and script refinement), which triages calls, routes messages, and frees up hours of MA time, all for a modest monthly cost.
Butterfly IQ POCUS for on-the-spot diagnostics—a value-add patients consistently rave about.
Basic digital communications that integrate scheduling, charting, and secure messaging.

The mantra? Choose tools that cut down clicks, support real-time adaptation, and preserve mental bandwidth.

Broad and Unique Care Offerings:Williams’ rural setting and “show up wherever needed” philosophy mean he provides true full-scope primary care—from home visits and telemedicine to POCUS exams and chronic disease management.

One unique niche he’s seized is men’s health. After noticing persistent untreated issues (like low testosterone) and dangerous mismanagement by online startups, he created a website highlighting men's health expertise, funneling new patients into his DPC and building a word-of-mouth referral pipeline, especially among groups underserved by traditional practices.

“Underpromise, really over deliver ... once you help this guy, they go back to their guy group of friends, and their guys are like, hey. What are you doing? You look amazing.”

Designing Success on Your Own Terms

Dr. Williams’ reflections on work-life balance cut to the core of the DPC movement’s deeper promise: the chance to reclaim not just our professional, but our personal lives.

He recalls fee-for-service days spent rushing to work, coming home after bedtime, and feeling absent from his children’s fleeting childhood. Now, he can block off a random afternoon to experience life’s small joys—like taking his sons to a mid-week matinee.

“That alone is worth all the bad things of all the days that you're wondering if this thing will actually work.”

He’s cautious about defining success in numerical or financial terms. Patient panel size isn’t his yardstick—for Williams, success means:

Delivering meaningful, relationship-driven care
Having the freedom to shape his life around family
Never becoming complacent; striving for continual improvement
Ensuring workflow (and panel size) never compromise his foundational promises

Looking Ahead: Flexibility and Openness

As Foundation DPC matures, Dr. Williams remains open to evolution: adding more providers if the fit and timing are right, opening a satellite location if community need and resources align. He’s learned to avoid rigidity in vision—preserving flexibility as a core entrepreneurial trait.

The secret to sensible, sustainable scaling? Hire for character, attitude, and shared values; iterate on systems based on experience and lived needs; and trust your instincts when something (or someone) just feels right.

Key Takeaways for Your Own DPC Reflection

Whether you are in the early decision stage or actively growing your DPC, Dr. Williams’ story offers timeless principles for reflection:

Start with “Why,” Not “How Many”: Make sure your drive to build DPC is rooted in core values—autonomy, patient service, personal life—rather than panel benchmarks or profit alone.
Grow through Relationships and Service, Not Gimmicks: Genuine, whole-hearted patient care is the best marketing. Consistency beats velocity.
Expect Evolving Challenges: Each new stage (launch, 100 patients, 250, first staff, first provider) will require new workflows, tools, and boundaries. Adaptability is your friend.
Honor Your Promises to Patients—and Yourself: If you set an access or response guarantee, hold to it; don’t overextend for short-term gains.
Balance Technology with Humanity: Use digital tools to streamline, not distract, so both you and your staff can focus on what matters.
Measure Success Holistically: Look at professional satisfaction, patient well-being, and the life you live outside the clinic. The right balance is different for every DPC.

Dr. Williams’ DPC journey is not a formula, but a springboard for reflection. The beauty of DPC lies in its freedom and flexibility—each clinic, and each doctor, can define and pursue their own version of success. If you’re weighing your own strategy or feeling overwhelmed by uncertainty, take heart in this: Sustainable, fulfilling DPC is possible, especially when built on strong roots, authentic service, and the willingness to continually learn and adapt.

As Dr. Williams demonstrates, “foundation” is more than a name—it’s a philosophy. Start with purpose, serve with humility, and let your clinic’s story be one you’re proud to live.

Ready to Reflect or Pivot on Your DPC Journey?Listen to more physician stories on “My DPC Story Podcast” and join the community—because, as Dr. Concepcion reminds us, “if you’ve seen one DPC, you’ve seen one DPC.” Your best version is waiting to be built.

Watch the Episode Here: