Dueling Pianos to Direct Primary Care: What It Actually Took for Dr. Brian Juan to Open Metronome Family Medicine
By Maryal Concepcion, MD, FAAFP | Published September 19, 2026 | Updated September 19, 2026 | 8 min read
Dr. Brian Juan toured with rock bands and played dueling piano bars for more than a decade before he became a family doctor. Three months into Metronome Family Medicine, his solo Direct Primary Care practice in Longmont, Colorado, he talks about what it actually took to make the leap.
He opened on June 1, 2026. When we first sat down together at the DPC Summit in New Orleans in July, he was one month in. By the time we recorded this episode, he was at 114 members, and four of those had signed up that same morning.
But the number is not the interesting part of this story. The interesting part is everything that had to happen in his life before the number was possible.
Growing up in a basement medical practice in rural New Jersey
Dr. Juan's parents came to the United States shortly after the Hart-Celler Act. His father was a physician, his mother a chemist, and they met at the University of Santo Tomas in Manila. His grandfather, a judge, had gone down the line of his seven children assigning careers: lawyer, doctor, lawyer, doctor.
They considered both coasts and chose New Jersey over California because California had earthquakes. His father found a small town called Vernon, surrounded by cornfields, and put an office into the mother-in-law suite of the family house. Two exam rooms, a little waiting room, a secretary's area.
Patients came Monday through Saturday, sometimes Sunday. When the Juan kids had a sore throat, they went down to the basement to get swabbed. When they had a wart, their dad cauterized it downstairs while they cried through the lidocaine.
By kindergarten, most of the kids in his class were connected to the practice somehow. His father would run into patients at the grocery store and they would hand him bottles of wine.
"I'd be like, 'Who's that?' Just a patient. Just a patient. They're just patients. It's patients."
His father is 84 now and still practicing, doing non-surgical diet medicine in North Jersey.
Choosing a band when doctor was the only acceptable answer
The expectation was set early. Dr. Juan and his sister were both going to medical school. It was not presented as a choice.
His mother made him practice piano for half an hour a day starting in kindergarten, then an hour a day. He would listen for the oven timer and cry when he was not allowed to go play until he was done.
"She forced me to practice piano every day from the ages of six to 12, and then she spent the next 20 years begging me to do anything else with my life."
High school is where it turned. He discovered that playing piano got you into a rock band, and that people liked people in rock bands. He joined one. One of the guys from that band now plays guitar for Tim McGraw and writes country hits out of Nashville.
He agreed to finish a bachelor's degree because that was non-negotiable. The day he was done, he moved to Boulder to play music full time. Medical school was the furthest thing from his mind. He had already decided it was too much school for him and that it was never going to happen.
The 2007 phone call that sent him back to school
Dr. Juan spent his 20s touring with rock and jam bands, making around $200 a week on the road. After his daughter was born, he stopped touring, worked as a booking agent, and then landed a gig playing dueling pianos in a bar.
It was the best job he had ever had. All requests, all comedy, four nights a week, $200 a night, no travel and no setup. He did it for four years and learned more about playing and singing than he had in the decade before it.
He also lived in constant fear of the bar closing. In 2007, on a Saturday, just as he was getting ready to go to work, it did.
"Don't come in today, we're changing concepts. Do you want to buy the pianos?"
He said no. They said see you later, it is not really our problem what you do next.
He went therapy shopping at Best Buy, stood in front of a display computer, and looked up what you need to do to go to medical school. He was 33.
He started chemistry a month and a half later and had to drop it the next day because it was too hard. He could not do stoichiometry. So he took intro to chem first, got through the prerequisites in two and a half years, and went to the University of Colorado School of Medicine.
His first day of residency landed on his 40th birthday.
Why he stayed in corporate medicine for nine years
This is the part of the story that matters most for anyone doing this math right now.
Dr. Juan finished residency with zero dollars in savings and a suitcase full of student loans he had used to the absolute max. During medical school he separated from his daughter's mother. His house was foreclosed on. He declared bankruptcy in his first year of residency.
His daughter started high school two months after he graduated.
"I felt pressure to deliver for my kid the experience that my parents delivered to me. That's that child of immigrants sort of thing. That's the cross that we bear."
So he took the best paying job he could get. He asked about the retirement plan at every single interview, and the large corporate system was the only place that had one he could take with him when he left.
He had heard of Direct Primary Care back in 2014 at Colorado Academy of Family Physicians meetings. He had met DPC physicians. They all seemed happy. It also seemed completely unreachable financially.
So he stayed, and he was good at it. He won teaching awards. He became clinical liaison in family medicine for CU's Longitudinal Integrated Curriculum, the largest program of its kind in the country. He became his clinic's technical lead.
And every year he was a little more tired.
The savings buckets system that finally made leaving possible
What changed was not a raise and not a sudden opportunity. It was household financial clarity.
Toward the end of 2025, Dr. Juan and his wife hired a woman to help them get their finances in order. He had never heard of savings buckets before. Money set aside for the cars. Money set aside for the day the plumbing fails.
The system broke a cycle he describes as making all this money, then spending all this money, then still using credit.
"That's not connected at all to my three top values of creativity, relationship, and health and wellness."
A couple of months after the financial reset, he asked his wife what it would look like if he quit and started his own business. She said she thought they could do it. He had more doubts than she did. He usually does.
One phone call and a three-hour pro forma
Dr. Juan listened to the My DPC Story podcast at 1.25 speed, trying to get through every episode before he opened. The thing that stuck was the one line that runs through the entire show: if you have seen one DPC, you have seen one DPC.
"That was really comforting to me because I've always felt like I do things just a little bit differently, and I always felt like I needed room to take big swings and make huge mistakes and accidentally buy $1,000 worth of lidocaine with epinephrine and stick it in a closet somewhere."
The day he listened to the episode with Dr. Luke Pitman, he called Dr. Pitman's clinic. Dr. Pitman answered the phone himself and offered to meet the next night. They spent three and a half hours building a pro forma, which Dr. Juan had no idea how to do.
With that document in hand he applied for a small business loan and got it.
He has not touched a dollar of it.
What the first three months actually looked like
Roughly 30 to 40 percent of his members are patients who followed him from his old practice, and they are still trickling in. Some of them reached out months after he opened.
He joined the Chamber of Commerce. He joined BNI. After five years of living in Longmont, he realized he did not actually know anybody in town except other corporate doctors standing in a circle telling each other they were doing a good job.
He is physically in the office Monday, Tuesday, and Thursday.
He outsourced his bookkeeping the week before we recorded, which is the kind of decision that comes up constantly in a first year. Every task on the business side now gets sorted into one of two piles: the things only he can do, and the things somebody else should be doing.
He also has not paused his panel or started a waitlist. Some days he thinks about it. Not every day.
Ninety-minute new patient visits and an InBody scanner
Dr. Juan started with one hour for new patients and moved to 90 minutes about a month in, because an hour was not enough.
He is not using intake forms yet, because he does not want patients writing everything down and then telling him all of it again. Instead he walks through it conversationally. What conditions do you have, what medicines do you take, what is your family history, tell me about your parents, tell me about your kids.
Because a lot of people finding him are focused on midlife vitality and longevity, he uses the time to talk through the labs he associates with that work and what the wholesale prices actually are. If they ask about compounded GLP-1s, they have a real conversation about sourcing and cost.
Then they walk to the back and he puts them on the InBody scanner for a body composition reading. Most people have never had one.
He also relearned how to take a manual blood pressure, because he no longer has a nurse doing it for him.
And he is buying a wall clock, because he has been checking his phone to track the time and he
does not want to do that in front of a patient anymore.
What nine years of AI documentation taught him
In one of the early AI scribe pilots, his corporate system picked ten doctors and asked them to try the software a few times that month. The other nine ran about ten notes each.
Dr. Juan ran 500. Every single encounter that month, because he wanted to know exactly how it worked and exactly where it failed.
What he found was that the tool did not integrate cleanly with the EHR. Instead of typing, he was copying, pasting, and editing. Roughly the same amount of work, in a different shape.
That experience is now shaping how he builds his own stack. He goes to trade shows, meets the people actually making the software, asks the questions he wants answered, and walks away from anything he does not need.
"It's just about trying to find information with as little friction as possible, so I can stop worrying about the info and just worry about being a doctor."
Even at 110 patients, he says, you forget what someone was dealing with a month ago. The whole point of his system is jogging his own brain back to that place before he walks into the room.
Teaching medical students what Direct Primary Care is
At his old job, Dr. Juan recruited and supported 15 family medicine preceptors for CU's Longitudinal Integrated Curriculum, and precepted a student himself.
When he left, the community program in Longmont needed a liaison. He stepped sideways into the same role with five students instead of 15.
Rather than precepting one student all year, all five will spend two to four days with him across the year. Each of them gets to see what a Direct Primary Care practice actually looks like from the inside.
"I can't believe we still live in a time when people haven't heard of this. Whenever someone's like, 'What's that? Is it concierge?' I just want to shout it from the rooftops."
The guardrails that keep it sustainable
Phones off at 5:00 p.m. Dr. Juan tells patients he will attempt to return any call or text made before 5:00 p.m. on a weekday that same day. If he does not, it means he was busy, and they can bug him about it tomorrow. He does not answer on weekends. He credits Dr. Jade Norris with showing him this was even allowed. His patients' response has been that if he does not take care of himself, nobody is going to be there to take care of them.
Timed messages instead of 2:00 a.m. replies. When he writes a response late at night, he schedules it to send at 8:00 the next morning. Nobody needs to know he was awake.
Wednesday mornings at Rocky Mountain National Park. Wednesday at 8:00 a.m. used to be the day he had to be in the office early. Now it is the morning he and his wife are at a trailhead at 7:45, starting a route they have never done. They did a dozen new trails this past summer, in a park an hour from a house he has lived in for five years.
Scheduled creative time. Half an hour in the journal. Twelve minutes writing a song, and if it is any good, twelve more. He closes the laptop with QuickBooks on it and opens the one with the studio.
A wife who tells him when it is time to stop. His words: she lets him know when he is too far up his own butt with a social media post, and when it is hangout time.
"Autonomy means me being in control of my own life and my own destiny. Just remembering not to let the practice control me, because it so easily could."
What patients notice that nobody expects
One of Dr. Juan's patients of eight years walked into the new office, looked at the wall, saw the photo of his family, and said she did not know he had kids.
Another one saw the piano and said she did not know he played music. That was all he did for years.
"After I say how are you and they tell me, then they say, 'Well, how are you?' And that's a crazy thing, to have a conversation with them about life like a normal person."
He hands out CDs. If you do not like it, he says, it makes a great coaster.
Frequently asked questions
What is Metronome Family Medicine?
Metronome Family Medicine is a solo Direct Primary Care practice in Longmont, Colorado, founded by Dr. Brian Juan and opened on June 1, 2026. The practice is built around midlife vitality and longevity and runs on a monthly membership model with no insurance billing. Dr. Juan sees patients in the office on Mondays, Tuesdays, and Thursdays, and reached 114 members within the first three months.
How many patients does a new Direct Primary Care practice sign up in the first year?
Dr. Juan reached 114 members in three months, with 30 to 40 percent of those coming from his previous employed panel. Growth varies enormously depending on how long a physician has practiced in the community, whether they can bring former patients, how visible they are locally, and what the market looks like. Treat any single number as one data point rather than a benchmark. What is more useful is his approach to community integration: joining the Chamber of Commerce and BNI, and deliberately building relationships outside of medicine in a town where he had lived for five years without knowing many people.
Do you need a loan to open a Direct Primary Care practice?
Dr. Juan secured a small business loan before opening and has not drawn on any of it. The loan required a pro forma, which he built in a single evening with another DPC physician who volunteered the time. Having approved financing sitting untouched functioned as a psychological safety net rather than a debt burden. Startup costs vary widely depending on whether you lease or build out space, what equipment you buy, and how long you plan to go without income. The pro
forma is the document that turns those unknowns into a number you can actually look at.
How long should new patient visits be in Direct Primary Care?
Dr. Juan started with 60 minutes and moved to 90 minutes about a month after opening because an hour was not enough for the depth of conversation he wanted. His 90-minute intake includes medical and family history covered conversationally rather than through forms, a discussion of relevant labs and wholesale pricing, a body composition scan, a manual blood pressure check, and a cardiac exam. Many DPC physicians land somewhere between 60 and 90 minutes for intakes, and the right answer depends on your patient population and how much of the visit you want to spend on prevention and goal setting.
Can a Direct Primary Care doctor set limits on after-hours availability?
Yes, and Dr. Juan is direct with his patients about it. He tells them that any call or text before 5:00 p.m. on a weekday will get a same-day attempt at a response, and that weekends are off. He believed for a long time that constant availability was a requirement of the model, and learned from Dr. Jade Norris that it is not. His patients have responded well, in part because they understand that a doctor who burns out is a doctor who is no longer there.
Is Direct Primary Care the same as concierge medicine?
No. In Direct Primary Care, the patient pays a monthly membership directly to the practice and the practice does not bill insurance. Concierge practices typically charge a retainer fee on top of continuing to bill insurance for visits. This distinction comes up constantly for new DPC doctors explaining the model in their own communities, and it is worth having a clean one-sentence answer ready.
Is it too late to open a practice if you started medicine later in life?
Dr. Juan enrolled in chemistry prerequisites at 33, started residency on his 40th birthday, spent nine years employed, and opened his own practice after that. His experience suggests the real constraint is rarely age. It is financial clarity, a written plan, and a support system at home. The financial reset he and his wife did came before the decision, not after it.
Can medical students rotate through a Direct Primary Care clinic?
Yes. Dr. Juan precepts five University of Colorado School of Medicine students through the Longitudinal Integrated Curriculum, each spending two to four days in his Direct Primary Care practice across the year. If you want students in your clinic, the path usually runs through your state medical school's community preceptor program, and most of them are actively looking for family medicine sites.
The part that applies to you
Fear and planning are not the same thing. Dr. Juan is clear that overpreparing from a place of fear is what keeps physicians stuck. Planning is different. Planning is a list you start crossing things off of. His start date was January 1.
Every piece you do not plan gets planned for you. That is his line, and it is the best argument for sitting down with a planner and sketching the whole thing before you are in it.
Call the DPC doctor whose episode you just listened to. Dr. Pitman answered his own phone and gave three and a half hours to a stranger. That is how this community works, and most physicians in it will do the same for you.
The business skills may already be in you. Dr. Juan credits the music business with teaching him how to run a business. Whatever you did before medicine is not wasted.
Build the off switch before you need it. Closing hours, scheduled sends, standing appointments with the people you love, and protected creative time. These are not rewards for later. They are part of the design.
More Resources From My DPC Story
The DPC Directory. Find a Direct Primary Care physician near you, or add your own practice to the map, at thedpcdirectory.com.
The free DPC startup checklist. The first concrete steps to take if you are in the thinking-about-it stage. Available at mydpcstory.com.
The Physician Owner's Planner. Built to organize the business side of a Direct Primary Care practice, including the daily planning work Dr. Juan describes doing from January 1 forward.
The Toolkit Magazine. Where the EHR comparisons and support stack breakdowns live, the ones Dr. Juan read before walking into trade shows to evaluate software himself.
Leave a voice message. Record your question, your stuck point, or your win at mydpcstory.com/contact and it may be featured on a future episode.
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