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How to Start a DPC Practice and Grow a Multi-Doctor Clinic

Updated: 2 days ago

How Dr. Paul Thomas started his DPC practice in Detroit

Launching a DPC practice straight out of residency

The first house call that started Plum Health DPC



Dr. Paul Thomas of Plum Health
Dr. Paul Thomas of Plum Health

How to Start a DPC Practice and Grow a Multi-Doctor Clinic


Originally published: September 20, 2020. Updated: June 28, 2026.

If you are a physician wondering how to start a DPC practice, the story of Dr. Paul Thomas is one of the clearest road maps you will find. He opened Plum Health DPC in Detroit in November 2016, just months out of residency, with a website, a handful of blog posts, and a willingness to make a house call on day one. From there he grew to a full panel, brought on two more physicians, opened a second location, and wrote a book to teach other doctors how to do the same.

In this episode of My DPC Story, Dr. Paul Thomas sat down with Dr. Maryal Concepcion to walk through every step. Below you will find a written summary of the key lessons, the tools and resources he recommends, and the full episode transcript.


Show notes: what you will learn from Dr. Paul Thomas

This conversation covers the practical work of starting and growing a direct primary care practice in a real city with real obstacles. Here is what Dr. Thomas breaks down:

  • How he launched Plum Health DPC in November 2016, just months after finishing residency

  • Why his first patient was a house call to deliver sertraline

  • How he marketed the practice with blogging and social media before he had any patients

  • His honest take on whether any community is truly "perfect" for DPC

  • How to get comfortable on camera and improve your public speaking

  • When and how he added Dr. Raquel Orlich and Dr. Jamie Qualls to the practice

  • Why he opened a second location in Farmington Hills

  • How he protects his family life and takes real vacations

  • How he wrote his DPC business plan and what it should include

  • The one tool he loves for scheduling

  • His best piece of advice for anyone on the fence


How Dr. Paul Thomas started Plum Health DPC in Detroit

Dr. Thomas finished residency on June 30, 2016. He spent that July taking business classes and working out the details of his launch, then opened the doors in November 2016.

Launching out of residency in November 2016

He did not wait for everything to be perfect. He had built his website back in February or March of 2016 with help from his friend Tommy, who designed the logo. The site sat there collecting a few sign-ups while he wrote blog posts about why he chose the name Plum Health and what he believed in.

The first house call and the first patient

What actually pushed him to start was a phone call. One of his first sign-ups, one of about seven people, called and asked if this was a real thing. He told them yes. The patient said he had just taken his last pill of sertraline and needed more. Dr. Thomas ordered it, it arrived the next day, and he made a house call to deliver it and start caring for the patient. That was his very first patient.

Patients often do not realize physicians still make house calls. That moment set the tone for the kind of care Plum Health DPC would deliver.


How to market a new DPC practice

Marketing was a slow build, not an overnight win. Dr. Thomas leaned on two things in those early days: a website with a blog, and social media.

Building a website and blog before you launch

He emailed each early sign-up honestly, telling them he was testing the waters and planned to launch in late 2016 or early 2017. That transparency built trust. Most of those first patients had never met him. They were simply people searching for primary care in Detroit who found his website.

Using social media as infotainment

Dr. Thomas spends about an hour each week creating content. He usually starts with a photo from the previous week, writes a story around it on Instagram, then reshares it on LinkedIn, Facebook, and his blog in slightly different ways. On LinkedIn he uses hashtags like health care and Detroit to help posts trend locally and nationally, then backlinks to a blog post.

His real edge is engagement after the post goes live. When someone left a comment calling his mask "stupid" on a house call post, he replied calmly that the mask helped protect himself, his patients, and his community. That single comment earned over 100 likes and went viral on LinkedIn. As he puts it, following up makes you a real person with depth, not a polished one-dimensional version of yourself.


Is your community right for DPC?

Dr. Thomas pushed back on the idea that any community is a perfect fit for direct primary care. Every market has its own challenges and opportunities.

In Detroit, many people carry a blue collar mentality around health insurance. Workers at Ford, Chrysler, and GM have coverage built into their contracts, so they rarely want to pay a dollar above their premiums for better care. Educating people about health care outside of insurance was a real challenge. A rural community might have a smaller pool of patients. A suburban community might have nearly universal coverage already. There is always some battle to prove how valuable your service is.

The way Plum Health DPC wins that battle is education. Dr. Thomas teaches relevant health topics through videos and long-form posts, blending information with entertainment so people actually pay attention.


How to improve your public speaking and media presence

Dr. Thomas has done 50 to 100 podcasts, been on TV a handful of times, and made well over 200 videos. He is now a regular medical correspondent on The Daily Detroit. None of that came naturally. It came from practice.

His advice is simple and concrete:

  • Hand your phone to your medical assistant and film yourself talking about a health topic that matters to your community.

  • Do it every day for 100 days.

  • Watch yourself back, even when it makes you cringe.

  • Learn, adjust, and try again.

You will accelerate your growth fast, and you will be far better than when you started.


How to add doctors to a DPC practice

Dr. Thomas started solo and grew into a multi-doctor group on purpose, when the numbers made sense.

Knowing when you are full and ready to hire

He opened in November 2016 and was essentially full by January 2019, reaching around 525 patients by June 2019. He wanted to serve more people, and he knew he could do that more effectively with another physician.

Bringing on Dr. Raquel Orlick and Dr. Jamie Qualls

Dr. Raquel Orlick joined on July 1, 2019, straight out of residency. Within about 14 months she had grown to roughly 380 patients. When Dr. Orlick came on, Dr. Thomas simply emailed his panel and offered patients the option to see a female physician if they preferred.

Dr. Jamie Qualls also came straight out of residency, but she wanted to practice in her home area of Oakland County.

Opening a second location in Farmington Hills

Because Dr. Qualls wanted to serve her home community, Plum Health DPC opened a second office in Farmington Hills. The two offices sit about 15 to 20 miles apart, roughly 25 minutes of driving. Patients in northern and western Oakland County find Farmington Hills more convenient, while patients across Wayne County prefer the Detroit office. Dr. Thomas plans to keep adding physicians as capital allows.


Work-life balance in a DPC practice

One of the biggest draws of this model is the chance to work during working hours and be present at home the rest of the time.

Getting your work done in the office

Dr. Thomas finishes his notes in the office. Sometimes a patient texts after hours and he handles a refill, but the bulk of his at-home work is building the brand and recruiting physicians. His partners get nearly all their work done in the office, seeing 5 to 10 patients a day, working 9 to 5, and earning a strong salary. He plans his weeks around his wife Amanda, a veterinarian, shifting his lighter and heavier days to match her schedule so their days off together stay protected.

Taking real vacations and covering your panel

Dr. Thomas takes genuine vacations, which he loves about DPC. In August 2018, with around 375 to 400 patients, he spent two weeks in Italy. He emailed his patients four times before leaving, offering to handle school physicals, refills, and exams ahead of time. While away, he checked email each morning and called in a few simple medications. Only one patient needed urgent care, for pneumonia, and he followed up on return.

Now that he has partners, coverage is even simpler. If a patient needs something, the office calls and Dr. Orlick or Dr. Qualls takes care of it.


How to write a DPC business plan

Dr. Thomas wrote his business plan in March 2016, about six months before launch, and has refined it ever since. He took two business classes after residency, each eight weeks and around $500, covering branding, marketing, law, finance, writing a business plan, and pitching to banks and investors.

A good business plan acts as your road map. It clarifies how you will start, how much you will spend, your projected monthly expenses, and your expected revenue. It also gives you the runway to bring on enough patients to make the practice work in those first six months.

He has packaged that knowledge into his courses, and the feedback has surprised him, including from doctors who bought the course and never opened it but still found it valuable.


How Dr. Thomas chose the Plum Health name and brand

The name Plum Health rolls off the tongue and is easy to understand. It is 10 letters, simple and clear. The plum itself is two overlapping circles, which Dr. Thomas thinks of as the doctor patient relationship, with far more overlap than you find at a typical health center. The purple color also represents the minority and LGBT community members who are often left out of typical insurance coverage in a city like Detroit.


Tools Dr. Thomas uses to run Plum Health

Dr. Thomas keeps his tech stack simple. His favorite tool is Calendly, which he describes as a calendar with the "ar" swapped for "ly." When a patient requests an appointment, he texts them a link and they pick an open slot. It syncs with his Google Calendar, and since the whole team works in Google, everyone can see who is coming in. He does not use the EHR for scheduling because he finds it clunky.


His best advice for starting DPC: it is not the decisions, it is the decisiveness

Dr. Thomas heard a line in a Stanford lecture series that stuck with him: it is not the decisions, it is the decisiveness.

In medicine, we are trained to leave no stone unturned and we are punished for mistakes on rounds. That instinct serves you as a clinician. When you start a business, you have to set it aside and make fast decisions. Which EHR, which email platform, which website service. Many of these choices are six in one, half a dozen in the other. The quicker you decide, the faster you grow.


Resources

Where to start your own DPC journey

Dr. Paul Thomas proves you do not need a perfect community or a flawless plan to start a DPC practice. You need a website, a willingness to teach your community, a solid business plan, and the decisiveness to keep moving. Start small, serve people well, and grow when the numbers tell you it is time.


If you are exploring DPC and want more stories like Dr. Paul Thomas's, check out the START HERE page at mydpcstory.com.




Full episode transcript

Dr. Maryal Concepcion [00:00:08]:

Direct primary care is an innovative alternative path to insurance driven health care. Typically, patients pay their doctor a low monthly membership and in return build a lasting relationship with their doctor and have their doctor available at their fingertips.


Dr. Paul Thomas [00:01:00]:

Hey, everybody. My name is doctor Paul Thomas. And for me, direct primary care means delivering affordable and accessible health care to my community here in Detroit and beyond. Thanks for joining us today, and this is my DPC story.


Dr. Maryal Concepcion [00:01:21]:

Today, I am honored to interview one of the most dynamic speakers there is in the DPC universe. Ironically, he learned about DPC through a friend who advised him to listen to a podcast. Doctor Paul Thomas grew up near Corktown, Detroit where his practice, Plum Health DPC, is the first of its kind in Detroit and Wayne Counties. His mission is to deliver affordable, accessible health care services in Detroit and beyond. He has been featured on WDIV TV channel 4, WXYZ channel 7, Crain's Detroit Business, and CBS Radio. He has also been a speaker at TEDx Detroit and is a graduate and clinical assistant professor at Wayne State University School of Medicine. Recently, he published his second book entitled startup DPC, how to start and grow your direct primary care practice, available in both paper and Kindle formats on Amazon.


Dr. Maryal Concepcion [00:02:18]:

He has been in practice since 2016 and now has DPC doctors working under his vision, Plum Health DPC. Welcome, doctor Paul, to the podcast. Thank you so much for joining us today. I wanted to start with the opening of Plumb Health. Now you finished residency in July of 2016 and then opened your doors soon after in November of the same year.


Dr. Paul Thomas [00:02:55]:

Yeah. That's how we did it. I finished residency in June 2016 June 30th, to be exact. And then that July, I spent some time taking some classes, in business and then also, you know, hammering out the details for how it was gonna launch. And then I launched November 2016. I started making house calls, which was wild. You know, I I don't think I ever would have started until, one of our patients called me. He had signed up, and I had, like, 7 or so people sign up.


Dr. Paul Thomas [00:03:30]:

And he had said, you know, is this a real thing or or what? And I said, yeah. It's real. He's like, well, I just took my last pill of sertraline, and I am now officially out, and I need some. So I ordered some. It arrived the next day, and I made a house call the next day to, deliver it to him and start taking care of him. And that was my very first patient.


Dr. Maryal Concepcion [00:03:54]:

That is such a cool story and something that I think patients might not realize that doctors still do house calls to these days. I wanted to ask when you, had those first seven patients sign up, how did you market yourself and the practice in those first few days?


Dr. Paul Thomas [00:04:14]:

Well, I really launched my website in, like, February or March of, 2016. So my friend Tommy helped me design a logo. We built this website together, and it was just there. And I was writing some blog posts. I I wrote some blog posts about, like, why I picked Plum Health and a lot of things like that, and gradually, I had a few people sign up. And as I signed up, I just emailed them and said, you know, I'm really just testing the waters here and seeing how many people will sign up. I may or may not do this, but, thank you so much for signing up, and we should be launching in late 2016, early 2017. But like I said, I started in November because that one patient called me out and was like, I really need your help today.


Dr. Paul Thomas [00:04:58]:

So, that kinda pushed me into getting started. So it was kinda like a combination of blogging and posting on social media that got those first few people to sign up.


Dr. Maryal Concepcion [00:05:09]:

And your first few people, were they former patients that you had during residency, or were they, completely unknown to you prior to signing up?


Dr. Paul Thomas [00:05:20]:

Well, one person was in a business class that I was taking, and the rest of them, I had not met before. They were just kinda people who were searching for primary care in Detroit, and they found our website.


Dr. Maryal Concepcion [00:05:31]:

That's fantastic to hear. When you started out in February March with an online presence, and then eventually in November when you saw that first patient, going into the early days in into the next year, 2017, when you finally had a physical location, did you have any moments that you second guessed your DPC decision or ever thought or or ever told by others that this might not work?


Dr. Paul Thomas [00:06:01]:

No. I I always thought that it always felt really good starting it because, you know, at that time, during the last half of my residency for, like, a year and a half, I was working in urgent care. And then that year and a half coming out of residency, I kept on working in urgent care just to, like, cover my bills and, you know, pay my mortgage and my car payment and things like that. And I absolutely hated working in the system. I I hated working in urgent care. I was seeing, like, 60 patients on a weekday. I would work a 12 hour shift, and I would be seeing, you know, 4 to 5 patients an hour, and it was just soul crushing. And so it was so good and so nice to be in a space or make a house call where I could sit with somebody for 30 minutes or an hour, really go over their full history and and be instrumental in helping them, like, take the step next step in their health journey and helping them in their processes.


Dr. Paul Thomas [00:06:54]:

And, that's just something I couldn't do in in urgent care, and it didn't really feel like I could do that in an employed fee for service practice. And so every time I met with a new patient, every time I helped somebody in my DPC practice, it just felt so good, and I knew that I was on the right path to, you know, helping people with their medical issues.


Dr. Maryal Concepcion [00:07:16]:

What a wonderful story to hear in terms of you not second guessing your decision. For some people it might be a scary decision from a financial perspective or a time perspective. And for you to have had this vision and to have stuck with it and now to be so successful, that's absolutely wonderful to hear. Now given that you are well established in your community, I wanna go back to the fact that you are a native of the Detroit area. And you have all people can see how the Detroit area is evolving and how it's a perfect community for DPC. I wanted to ask, how are you and Plumb Health involved in Detroit with regards to


Dr. Paul Thomas [00:07:55]:

community engagement and outreach now and in


Dr. Maryal Concepcion [00:07:55]:

the future? Yeah. I I guess I'd wanna outreach now and in the future?


Dr. Paul Thomas [00:08:00]:

Yeah. I I guess I'd wanna correct something there. I I don't think Detroit's a perfect community for DPC, and I don't think there are any perfect communities for DPC. I think every community has its own challenges and opportunities. And in Detroit, a lot of people have, like, this, blue collar mentality around health insurance, and what I mean by that is, like, a lot of people who work for Ford, Chrysler, GM, they always have health insurance included in their contracts, so they never really wanna pay a dollar over and above their health insurance premiums for, like, quote, unquote, better care or direct primary care. And so that was a huge challenge. Educating people on what health care is outside of health insurance was a giant challenge in my marketplace, and it made starting this a difficult process. And so I don't really think Detroit is a perfect community for a DPC, but, you know, in other communities, like, say, you're in a rural community, you're gonna have less people or fewer people in your community, so your pool of patients might be smaller.


Dr. Paul Thomas [00:09:03]:

It's not to say you can't do it there. Or maybe you're in a suburban community where, you know, 90% of the populations has health insurance coverage. You know, they may have more money, but perhaps everybody has insurance coverage all already. So there's always gonna be some kind of battle when you're starting your direct primary care practice with you having to prove how valuable your service is. With that being said, the things that we do in Detroit to really engage with people is I spend a lot of time teaching people about health topics that are relevant, and my preferred medium is making, like, videos and putting those on YouTube or on, Facebook or on or I just make long form posts on Facebook and Instagram and LinkedIn that are kinda fun but educational. It's kinda like infotainment. I'm trying to educate my community about important health topics while entertaining them at the same time and being engaging.


Dr. Maryal Concepcion [00:10:02]:

And you definitely did a wonderful job throughout the start of the coronavirus, pandemic, especially where you were posting about what the current situation is, in the Detroit area in Michigan. Those were extremely informative. I was drawn in by watching what you had to present and how you presented it.


Dr. Paul Thomas [00:10:19]:

Yeah. Totally. I I really try to stay level headed, even keel, and just stick to the facts of, like, okay. This is how many cases we're having. This is why you think it's happening, and this is how you can protect yourself and your family and the greater community by taking these actions. It was kinda something tangible, relatable, easy to understand, easy to digest, and we try to make it fun and entertaining as well. I think the video medium is, like, a good way to communicate that kind of information.


Dr. Maryal Concepcion [00:10:50]:

Stay with us. We'll be right back. Have you tried an AI scribe in your clinic? Well, I've tried so many. And I can say, Heidi Health is the best AI scribe I have come across thus far. With Heidi Health, I can create unlimited, customizable templates for my notes to help me truly cut down on the time I'm spending charting. Template for pediatric well child check, done. Template for weight loss management, done. Some of my favorite things I've built into my AI template beyond the general soap note are having a list of actionables for our team to take after a patient visit, having the diagnoses listed, and creating an after visit summary for our patients.


Dr. Maryal Concepcion [00:11:29]:

Not only have I found Heidi Health to be the most helpful, customizable AI scribe so far, it's also more affordable than most out there. So try Heidi Health today and see how you can harness the power of an AI scribe for your practice. To get an entire month of Heidi pro free, go to the homepage of my dpcstory.com and click on the Heidi Health ad.


Dr. Maryal Concepcion [00:11:53]:

Absolutely. Especially these days where you might not be able to meet someone in person without a mask on. And so for someone to watch you and see your your face, even though it might not be in person, it's it's somewhat more personable than masks can be these days. With that said, you are obviously very much a public figure in your local community as well as in the DPC community. And even recently on the DPC docs Facebook page, there's been 2 or 3 posts that I've read just within this past week about others interested in making, public speeches or being featured on TV spots or radio spots. For those who might feel a little uncomfortable or unsure, venturing out into that, area of the media, do you have any tips on improving one's public speaking abilities or how they present to the public about DPC in their clinics?


Dr. Paul Thomas [00:12:50]:

Sure. I think it comes down to practice. And, you know, I've maybe I've done 50 to a 100 podcasts at this point. I've been on TV a handful of times, and I've made a lot of videos, like, for YouTube to maybe 200 or more at this point. And so, you know, part of why people see me on different media channels and speaking clearly and eloquently is because I've practiced, and I've practiced this art so many times that it becomes such second nature at some point. And so my advice to you is if you want to be featured on TV, well, start handing your phone to your medical assistant and have them film you talking about medical topics that are important to you and relevant for your community. And you do that every single day for a 100 days, and you're gonna be really good at it, or at least a lot better than when you started. And you'll see yourself.


Dr. Paul Thomas [00:13:46]:

You'll watch yourself on these videos, and you'll feel a little bit of an embarrassment because, oh, man. I wish I would've not moved my hand like that, or I wish I wouldn't have had that expression on my face or whatever. But you'll learn from watching yourself over and over and again and and trying again and again to improve yourself, and you'll, really accelerate your growth. And, likewise, I do a lot of these podcasts, so I've I take as many of these as I can because it's a good practice for being on the radio and also just getting the word out about direct primary care. These end up reaching a lot of people, so it's nice to speak with, you know, fellow doctors like yourself or, people who are in the public. And and kinda through my podcasting, I've been invited to be a regular guest on what's called The Daily Detroit here in Detroit. It's a newscast that happens every day, and they've invited me to be, like, their medical correspondent. So that's been a lot of fun kind of polishing my approach and seeing it pay off over time.


Dr. Maryal Concepcion [00:14:49]:

Definitely. And it reinforces how powerful social media can be. I wanted to ask about how much time each week do you dedicate to social media?


Dr. Paul Thomas [00:15:00]:

Oh, man. I usually spend about 1 hour, you know, taking a photo that I've taken from the previous week, thinking about that content, and writing a story about it. And I usually start with Instagram because I like how they have the filters, and you can write a long form story. And I essentially take that content from Instagram, and I share it on different platforms just in a different way. So, you know, on LinkedIn, I'll use the hashtag health care and Detroit because those help it to trend in my local community and nationally, and then I'll backlink it to a blog post. And then oftentimes, I'll take embed that one of the posts either, like, the Instagram or LinkedIn post. I'll embed that on my blog and then go into further detail about why it's important and maybe link some other studies. So all that takes me about an hour or sometimes 2 hours, to do initially.


Dr. Paul Thomas [00:15:57]:

And then throughout the week, periodically, I'll check-in on, you know, comments or likes and engage with people. I think, one thing doctors might do is just post something and then let it go. I think it's really powerful when you engage with people after the fact, especially when they respond positively and wanna give you feedback or when they, you know, wanna talk smack about you and say, you're doing it wrong. It's really fun to engage with people and kinda share your objective, perspective. For example, I made a post about, doing a house call, and one of the guys came on to that LinkedIn post and said, you know, stupid mask or something like that. And I responded by saying, you know, it's not a stupid mask. This mask is helping me to protect myself, protect my patients, protect my community, and I wear this mask proudly because I believe in its ability to reduce the spread of coronavirus. And that actually garnered a ton of engagement.


Dr. Paul Thomas [00:16:57]:

Like, I think over a 100 people liked that one comment on that recent post that went viral on LinkedIn. So I think it's really important to follow-up on your post and engage with people after the fact because it goes a long way into, you know, enforcing yourself as a real person with depth more than just like a one dimensional kinda like, polished version of yourself.


Dr. Maryal Concepcion [00:17:20]:

And just saying that, it really goes back to your focus about how you spoken about how important relationships are in starting and maintaining, a business, your your, patient care. I I wanna go and touch on relationships, with regards to the fact that you have now 2 partners, doctor Raquel Orlick and doctor Jamie Qualls. I wanted to ask specifically for those listeners who might be, thinking into the future about potentially having a partner or more than one partner, join them in their in their vision and their DPC. How did you decide that the time was right to add additional doctors to Plum Health?


Dr. Paul Thomas [00:18:06]:

Sure. So let's see. I started the practice in November 2016, and then around, you know, January of 2019, I was getting full. I was basically full at that point. So maybe 2, two and a half years later, I'm pretty much full with patients, and I got to around 525 in June 2019, right before doctor Raquel came on. So she started July 1, 2019, if I'm doing this correctly in my mind. And, she's been with us for, like, 12, 13 months, and now she's nearly full. She's at around 380 patients in that 14 month period, which has been great.


Dr. Paul Thomas [00:18:52]:

So, you know, to answer your question, I was full, and I wanted to serve more people and take care of more people and give more value to my community. And I knew that I could do that more effectively with another doctor in my group. So I hired doctor Raquel, and she, was eager to join us. She thought this was a great model. And then for doctor Jamie Qualls, she came out of residency and really wanted to join us as well, just like doctor Raquel Orlick. They both came straight out of residency and our practice, but doctor Jamie Qualls wanted to do it in a different location. She's from the Oakland County area and wanted to have a practice in Oakland County, so we decided that it'd be advantageous to open a second location up in Farmington Hills, which is in Oakland County. And now we're serving more patients in that geographic area, and that's feels like home for her, and so she's become an asset for her home community, which I love.


Dr. Paul Thomas [00:19:48]:

I love that story of her, you know, going to medical school, going through residency, and wanting to come back and serve her home community. So I'm really proud of her and what she's building up in Oakland County.


Dr. Maryal Concepcion [00:20:00]:

In terms of geographic distance, how far is Oakland County from the Plum Health location in Corktown?


Dr. Paul Thomas [00:20:07]:

Yeah. So, we're in Detroit, and we're pretty close to downtown Detroit. It's about 8 miles north is the border of Oakland County. And if you've seen the movie 8 Miles, M and M, that's, like, the historic 8 mile that they're talking about in the movie. But, that's the dividing line between Detroit and Oakland County. Our offices are about, I think, it's, like, 15 to 20 miles apart. It's about, 25 minutes driving between the two offices. So there's a little bit of geographic overlap between the two, but most folks in Northern, Western, and, yeah, northern and western Oakland County would find the Farmington Hills office more convenient.


Dr. Paul Thomas [00:20:50]:

Some people in southern Oakland County would be, like, the same driving distance to the 2, and pretty much in everyone in Wayne County would find our Detroit office more convenient. Detroit's in Wayne County.


Dr. Maryal Concepcion [00:21:02]:

When you were looking and just before doctor Raquel Orlick came on, did you have some kind of wait list given that you were expecting a new doctor to join you and you and your practice was full?


Dr. Paul Thomas [00:21:17]:

No. I just kept on adding patients, and I got up to around 525 patients. And then when she came on, I just sent an email to all my patients and offered that if they'd like to have a female physician as their primary care doctor, that doctor Raquel would be doctor Raquel Orlick would be joining our practice, and she'd be happy to take them on. And I'd be happy to, you know, allow them to see her, if they felt more comfortable.


Dr. Maryal Concepcion [00:21:42]:

I wanna go back to, relationships. How do you balance work and family?


Dr. Paul Thomas [00:21:49]:

Yeah. I think the direct primary care model offers you an opportunity to, you know, work during the working hours and be home when you're not at your direct primary care practice. You know, it really depends on how large you want to grow. Like, for me, if I stuck at 450, 500 patients, even 550 patients and remained a solo doctor, things would run really smoothly, and I would probably not take any work home with me. And right now, I don't really take too much patient care work home with me. I finish all of my notes in the office. And sometimes I'll have patients text me after hours, and I'll follow-up on a refill here or, you know, call in a medication there. Most of the time, I work outside the office, would be on building the brand and bringing on other doctors.


Dr. Paul Thomas [00:22:41]:

You know, we're we're gonna try and bring on a 4th doctor here in February. So I'm doing a little bit more than the typical direct primary care doctor. But speaking for the other doctors in my practice, they're getting basically all of their work done in the office and working from 9 to 5, seeing 5 to 10 patients a day, and earning a really good salary while doing it. So, you know, if you start a practice, you might have a few more responsibilities that, quote, unquote, keep you up at night. But for let's say you're an employed doctor, the vast majority of your work is done in the office, and you're not really taking that much home with you. So to speak to your question, you can have a really strong family life in this model. And and for me, you know, I've always made decisions with my wife, Amanda. She's a veterinarian.


Dr. Paul Thomas [00:23:30]:

She works. So I try to like, on Thursdays, she works later. So I try to, you know, do a little bit more work Thursday evening. And then she's off on Mondays Tuesdays, so I really don't bring any work home on those days. And then sometimes she'll pick up a Saturday shift, and when she's working on Saturday. Likewise, I'll do work for my business on that Saturday that she's working, when she has Saturdays and, sun when we have Sundays off together, I really don't do any work for my business so that I can focus on, you know, spending time together with her or visiting our family and having, like, family dinner with our extended family and things like that. The other thing that I've been able to do is take vacations, and, I love that about my DPC practices. I can really easily email all of my patients and let them know when and sometimes where I'm going, you know, and say, listen.


Dr. Paul Thomas [00:24:21]:

My phone's not gonna be on because I'm gonna be in another continent. You know, I'll be in Europe for 2 weeks or something like that. And, and, I'll see you when I get back. Call my partner while I'm away. Let me know if I can take care of anything for you before I go. And that's really allowed me to have really high quality vacation time, which has been phenomenal.


Dr. Maryal Concepcion [00:24:45]:

Absolutely. Especially when when all of us deserve to have some time off, that is is protected. When you were in solo practice prior to doctor Raquel Orlick joining you, what would your coverage be? Would you have another DPC doc cover you, by doing telephone visits for your patients if they needed something while you were away?


Dr. Paul Thomas [00:25:07]:

Sure. So let's say it was August 2018. Every August, we go on a 2 week trip to get out of the country and, you know, recharge. That's our anniversary time in late August. So, I had about 375, 400 patients at that time in August 2018, and we did a 2 week trip to Italy. And I emailed all my patients about 4 times before I left and let them know that I was going abroad and that I would be happy to take care of any school physicals, any med refills, any physical exams, anything that they needed while I was, here in the office, but I would be going out of town. And, if they needed something while I was out of town, they could always send me an email as I might be able to answer that while away if I had good Wi Fi, or they could go to the urgent care. And that's what I did.


Dr. Paul Thomas [00:26:00]:

I had one person go to the urgent care because they had, pneumonia, and they were given a Z Pak, and we followed I followed up with them when I came back, and that was the only person who needed something while I was away. You know, when you're talking about having a panel of 500 patients, your patients aren't going to need that much when you're away, as long as you're super proactive about getting people in before you go. So I start emailing people a month before I leave, and I basically email them every single week until I take off. And that really stems any, you know, hard feelings because you're clearly communicating that you're taking a break. And now that I have partners, you know, there's virtually nothing that becomes a problem because if they need anything, my patients need anything, they call the office, and doctor Raquel Orlick or doctor Jamie Qualls takes care of it. And it's just that easy.


Dr. Maryal Concepcion [00:26:51]:

That's phenomenal. And just speaking from a person who's currently still in fee for service, I I can't even email my patients because that's not a feature of, of our, services that we offer. And so, you know, just the fact that you, reached out 4 times before you left, that you had only one patient who really had a serious issue that they had to go to the urgent care for, that that's phenomenal to hear.


Dr. Paul Thomas [00:27:17]:

Yeah. And then, you know, while I was away, I checked my email, every morning. My wife tends to sleep in a little bit longer than I do. I'm usually, like, an early riser. So, yeah, I just checked my email, answered a few questions. I, you know, definitely called in a couple meds, you know, for, like, a pink eye here or something like that there, and that would be helpful to kinda streamline things for when I get back. But, you know, when I went up like, this year, I went up north, and I really didn't have to do too much for my patients while I was away because my partners took care of it.


Dr. Maryal Concepcion [00:27:52]:

I have become a huge fan of podcasts. Ever since Sarah Koenig hosted the first season of Serial, I was hooked. Now creating this podcast has become part of my daily life. While it is an exciting new hobby, I also see it as a privilege that I get to interview so many DPC and direct care doctors. If you are interested in starting a podcast, let me tell you a little bit about Anchor. First of all, it's free. There are creation tools that allow you to record and edit your podcast right from your phone or computer. Anchor will distribute your podcast for you so it can be heard on Spotify, Apple Podcasts, and many more.


Dr. Maryal Concepcion [00:28:29]:

You can make money from your podcast as well with no minimum listenership. It's basically everything you need to make a podcast all in one place. Download the free Anchor app or go to anchor.fm to get started. I want to shift gears a little bit with regards to, how you learned the business side of your practice and how you developed your business plan.


Dr. Paul Thomas [00:28:55]:

Yeah. So, I wrote my business plan in March of, 2016, so about 6 months before I launched. And then I've been continuously continuously refining it, so I've been working on it throughout. And I took a couple business classes when I finished residency, And, they were each 8 weeks. They were each about $500, and I learned a ton about, you know, branding, marketing, law, finance, you know, how to write a business plan, how to perfect it, how to pitch to banks and, venture capitals, etcetera. And so I know this can be a really difficult process for doctors, and that's why I tried to distill all of that knowledge and put it into one of my courses online. So on my website, start up dpc.com, I have a couple courses where I teach doctors the fundamentals of how to start and grow a direct primary care practice, and that's one of the key resources that a lot of doctors have been using. I've been actually shocked how many people have bought that course, didn't use that course, and given me great feedback on it because there isn't really a great resource for doctors who wanna write a business plan and start their own practice this way.


Dr. Paul Thomas [00:30:08]:

And so it's been really cool to see all the positive feedback I've gotten on it. And it's nice having a good business plan because it is a road map for your business, and it's important on it's important for, like, how you're gonna start, how much money you're gonna spend, how much you're going to project that you're going to spend for your monthly, expenditures, and how much money you're going to expect to bring in for your revenue side so that business plan can be instrumental in making sure you have a good launch point and a good, you know, 6 months when you start. And that will give you enough time to have what what's called runway where you can bring on enough patients to make it all work.


Dr. Maryal Concepcion [00:30:49]:

When you look at your business plan and how you're constantly going back to it, I want to ask about what do you see for Plumb Health in the future? You already mentioned adding another doctor come February.


Dr. Paul Thomas [00:31:02]:

Yeah. So, like, one thing I didn't have in my business plan was, like, setting up a 401 k, but I did that this year because it was important for myself and my employees. Like, I wanna give my employees a lot of good benefits so that they, you know, love working here and and earn a really good income both, like, you know, for their investment side and for their daily expenses. So it was really important me to put that together. So, like, that's something I've added. And then I didn't really see us starting a second office until we had maybe 3 doctors at this office and kinda worked out all the kinks with 3 doctors in one office and then launched a second spot. But, doctor Jamie Qualls was so adamant about serving her home community up in Oakland County, so I was really excited to partner with her and and work to launch Plum Health in a second location, perhaps before I would have been ready to, but I'm really glad that I did because I think it's working out really well so far. And I think we're gonna continue to add doctors as time goes on, as capital allows.


Dr. Paul Thomas [00:32:07]:

And so, you know, what I'm working on right now is, like, how can I leverage capital to bring out all the doctors who wanna join our practice, and how can we serve more patients in our community with affordable and accessible health care?


Dr. Maryal Concepcion [00:32:20]:

For those who might not know about those early blog posts, when you were creating your brand, how did you decide on Plum Health and your logo?


Dr. Paul Thomas [00:32:30]:

Yeah. I think Plum Health just sounds great. Like, it just rolls off the tongue. I think it's easy to understand. I think you know that I'm talking about a medical clinic. Some people sound say it sounds like an insurance company, which is fine. And, you know, it's it's really simple. It's 10 letters, Plum Health, and, it's purple.


Dr. Paul Thomas [00:32:51]:

It's round. If you draw out a plum, it's 2 overlapping circles, and we think of that as a doctor patient relationship. And we have a lot more overlap in this clinic than you would at any other health care center. So, you know, that's the basis of our brand and why we selected that and what it means to me. And then it also is purple. You know, it represents a lot of the minority and LGBT community folks that are left out of the typical insurance coverage, especially in a city like Detroit. So, you know, that's important for me to have, like, that representation, in our branding that we're serving all comers.


Dr. Maryal Concepcion [00:33:29]:

Given your success, you've you've definitely achieved that. I want to ask if you have any tech or tools that you, doctor Raquel, or doctor Jamie use and love in your practice.


Dr. Paul Thomas [00:33:42]:

Yeah. I use Calendly, and I absolutely love it. It's, like, like, calendar, but take off the a r and add an l y, Calendly. And, basically, if a patient requests an appointment with me, I can just text them, and they can pick a an appointment slot that's available. It syncs with my Google Calendar, and it's one of my favorite tools.


Dr. Maryal Concepcion [00:34:03]:

And does it also sync with your EMR?


Dr. Paul Thomas [00:34:06]:

We don't use our EMR for scheduling because it's clunky. I prefer using the Calendly and Google Calendar for all scheduling. And then we're all on a Google, background, so all of our team members can see the Google Calendar and see who we have coming in. And like our medical assistants, if if we get a call into the office, our medical assistant answers, somebody wants an appointment, I give him the green light, just on his own to schedule them, put them on my schedule, or put them on Raquel's schedule so we can serve our patients, you know, on their terms. And the Calendly really allows people to select any time that they want across my calendar times.


Dr. Maryal Concepcion [00:34:47]:

With regards to, a a potential resource or resources that you would recommend highly to others, Can you can you suggest, 1 or more than 1?


Dr. Paul Thomas [00:34:57]:

Yeah. I mean, I'm gonna shout myself out here because I think the start up d PC book is phenomenal. If you haven't picked up a copy, it's on Amazon in Kindle and paper book, paperback format. If you want me to send you a signed copy, just send me an email, paul@plumeltpc.com. I'll send you one. I'll just charge you the cost of the book plus shipping. And then, you know, if you wanna check out our courses on start up d p c dot com, I've gotten so much good feedback about our business plan course and about our sales funnel course, really about how to attract new patients to your practice. And I'm really excited that I'm gonna be launching a course on how to hire another doctor because just as you asked in this interview, I've been getting so many questions.


Dr. Paul Thomas [00:35:43]:

I get a question about every week on how we hired a new doctor, so I'm really gonna lay it out. I'm gonna include some of our contracts and some of my strategies around getting great doctors to be a part of my practice. So I'm really excited to launch, though, that, course coming up here in the next couple weeks.


Dr. Maryal Concepcion [00:36:00]:

For those who are right at the point of jumping into DPC or they're thinking about it, What is something that you might tell them to give them a little bit of inspiration?


Dr. Paul Thomas [00:36:11]:

Yeah. It's not the decisions. It's the decisiveness. I I heard this on a it was like a Stanford lecture series that I listened to. And one of the guest speakers said it's not the decisions, it's the decisiveness. And so, a lot of times in medicine, we're discouraged from making mistakes. We often say, no stone unturned, and, you know, and mistakes are often punished on rounds in in in the clinical setting. And so I think on one side of your brain, you can do that as a clinician, but you have to absolutely leave that behind when you're starting a business and use the other side of your brain to really, really make fast decisions.


Dr. Paul Thomas [00:36:54]:

And don't be afraid to fail, you know, in terms of selecting this EMR, that EMR, using this email platform or that email platform, using, this website service or that website service, you're gonna be confronted with a ton of different, like, you know, 6 in 1, half a dozen the other choices. And the quicker you can make those decisions, the further you're going to get and the faster you're gonna grow in this direct primary care model.


Dr. Maryal Concepcion [00:37:21]:

Paul, I want to ask, if you can repeat your contact information so if people are wanting to reach out to you, they know how to get a hold of you.


Dr. Paul Thomas [00:37:30]:

Yeah. Drop me a email, paul@plumhealthdpc.com, and that DPC stands for direct primary care. Or you can call our office at 313-444 5630. Be happy to answer any of your questions and help you along your journey.


Dr. Maryal Concepcion [00:37:47]:

For those who might still be in training or those who are just looking to actually see the model, do you accept people to, quote, unquote, rotate in your clinics?


Dr. Paul Thomas [00:38:00]:

Yeah. We do accept some people for a short amount of time, and it really depends on how busy I am. I I'm a clinical assistant professor at Wayne State, so I'm teaching students virtually year round, by having them rotate through our clinic. And then I also take some residents from my home program and some, medical students on, like, a continuity clinic basis. So it really depends. I really have no problem, having somebody here for, like, a half day or something if they wanna see something. But, like, if you're doing an extended rotation, it is a little bit more difficult. It has happened.


Dr. Paul Thomas [00:38:35]:

I've had students, for an extended period, but just as long as it doesn't overlap with my Wayne State students.


Dr. Maryal Concepcion [00:38:42]:

I want to, also make sure that people are aware that you will be speaking at the upcoming hint two d summit


Dr. Paul Thomas [00:38:50]:

Yes.


Dr. Maryal Concepcion [00:38:50]:

This September 24th to 25th.


Dr. Paul Thomas [00:38:53]:

Yeah. I'm excited for that. It's gonna be rad.


Dr. Maryal Concepcion [00:38:55]:

Absolutely. It's my favorite conference of all of the DPC conferences. You can find more information out about the hint summit at summit.hint.com, and more information will be on the website, blog post accompanying doctor Paul's interview. Registration for the 2 day online summit is a $149 and free to residents and students.


Dr. Paul Thomas [00:39:18]:

That's really cool that you're making it free for residents and students. I think that's phenomenal. I'll be there, speaking on Friday at, 3:30 EST. I think that's, like, 1:30 MST and 12:30 PST. So I'm really excited about that because I'll be sharing the stage with people like z dawgmd and one of my, favorite DPC pioneers, Jay Parkinson, also Clint Flanagan, doctor Julie Gunther, Zach Holdsworth. It's gonna be a really cool conference, a meeting of the minds, if you will. And I'm excited for some of the interactive features of their platform. They're gonna have some, like, roundtable type discussions as well as some, like, I guess, like, random chat room meetups so you can get, like, randomly paired with another doctor and talk for a couple minutes and then move on to the next one.


Dr. Paul Thomas [00:40:14]:

So it'll be kinda cool to see what their mixer situation is like.


Dr. Maryal Concepcion [00:40:19]:

On that note, I just wanted to say thank you so much, doctor Paul, for joining us today, and we highly look forward to hearing you at the Hint Summit and in the future.


Dr. Paul Thomas [00:40:27]:

Hey. Thank you so much for having me on. It's been an absolute pleasure, and everybody who's listening to this and who's starting their direct primary care practice or growing their DPC practice, you can do it. It's a great journey, and it's so fulfilling in the process.


Dr. Maryal Concepcion [00:40:48]:

Next week, look forward to hearing from doctor Marga Zarraga of Genera Health Direct. Until then, this is Mariel Concepcion. For more information on this episode and much


Dr. Maryal Concepcion [00:41:02]:

more, please visit my dpctory.wixsite.comforward/mysite. That's my dpctory. Dotwixsite.comforward/mysite.


RESOURCES





See Dr. Thomas in action: 1/2018 Detroit TedX Presentation



Dr. Paul Thomas makes a house call on the West Side of Detroit. This post has since gone viral on LinkedIn.

Dr. Paul Thomas of Plum Health in Detroit, MI.

Dr. Paul Thomas and Dr. Raquel Orlich at their Corktown office in Detroit, MI.

Dr. Paul Thomas addresses the media during the ribbon cutting ceremony of Plum Health DPC.


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