Growing a Rural DPC Practice in Year 8: How Dr. Jillian Klaucke Built Patient Trust, Avoided Burnout, and Scaled Team-Driven Care
How an Eight-Year Rural Family Medicine Direct Primary Care Practice Actually Works - 8 min read
Dr. Jillian Klaucke has been practicing Direct Primary Care for eight years. She is a board-certified family physician and Fellow of the Academy of Wilderness Medicine at Sandpoint Premier Direct Primary Care in Sandpoint, Idaho. She also happens to be the granddaughter of Dr. John Verby, a pioneer in rural medical education.
Eight years into Direct Primary Care, her story reveals what actually works when you are running a rural family medicine practice without insurance. This is not startup theory. This is what she has learned by doing it.
The Three Pillars That Guide Everything
Dr. Klaucke's practice runs on three pillars. Not because they are trendy. Because they actually work.
Teamwork. Not just how staff works together. Real teamwork means working with patients as partners in their own care. When imaging is ordered, someone follows up to confirm the appointment happened. When results come back, the doctor reviews them with the patient and discusses next steps. A patient texts over the weekend about an abscess? Monday morning someone checks in. It is the opposite of what patients experience in larger systems where things slip through cracks.
Accountability. This is the linchpin. In traditional practice, it is easy to say "That is not my job" and move on. In Direct Primary Care with a small team, accountability is the only thing that keeps patients from falling through cracks. Did the specialist receive the referral? She makes sure. Does the patient have crutches they need? Her team sources them. Is someone not following a treatment plan? They reach out and problem-solve together.
Patient Safety. This sounds obvious until you realize that patient safety depends on the first two pillars. You cannot keep patients safe in high-volume, insurance-driven systems because you literally do not have time to follow up. In Direct Primary Care, follow-up is built in.
These three pillars changed how her team works, who she hires, and what her office can actually accomplish.
Care Management: The Work Insurance Won't Pay For
One of the most powerful things about Direct Primary Care is care management that goes beyond billing codes. Dr. Klaucke's team loans crutches to patients. They source free or low-cost commodes. They help Medicaid patients navigate equipment rentals. They call patients at home to see how recovery is going. They coordinate between specialists to make sure nothing gets missed.
This work cannot be billed to insurance. Insurance companies will not pay for a nurse to call and check if someone got their imaging done. They will not reimburse for loaning equipment. They will not cover the time it takes to confirm a referral went through.
But patients will pay for it. Not because they want to pay more, but because they are tired of falling through cracks. They are tired of ordering tests and never hearing back. They are tired of referrals that go nowhere. They are tired of feeling like a number.
"We have this team who is able to follow up with them and say, 'Hey, were you able to see the doctor? Did you want to borrow our crutches? Oh, you needed to get a commode? Here is a list of places we can get those for you, and you can either rent them or get them for free,'" Dr. Klaucke explains. "We are able to help them, not just, 'Oh, you broke your foot. You need to go see the foot doctor. Great. See you later.'"
This is the medicine that prevents secondary complications. This is the work that keeps people healthy instead of just treating disease.
The Reality of After-Hours Access: What Actually Happens
Every physician considering Direct Primary Care asks the same question: If I give patients my cell phone number, will not I be on call 24/7? Will not they abuse it?
After eight years, the answer is no.
Dr. Klaucke receives approximately three to four calls or text messages per weekend. Most are appropriate and time-sensitive. A patient called last weekend because she was concerned about a complication after a medical procedure. Two text messages were from Dr. Klaucke herself, checking in on patients she was worried about.
Patients do not abuse the system because they trust her. And they trust her because they have known her for three, five, eight years. She knows them medically and as people. She knows what is actually urgent and what is not. That judgment is built on relationship.
"The longer you practice Direct Primary Care, the better you get at triaging what is actually urgent," she says. "That relationship is the whole point."
Building a Practice Culture That Scales
Managing a growing practice while seeing a full patient panel requires more than good intentions. It requires systems, delegation, and vendors you can trust.
Dr. Klaucke's approach is straightforward: automate what you can, find reliable vendors, and pay attention to the details. The dangerous part is not having systems on autopilot. It is neglecting to monitor them. A vendor who drifts on quality. A cleaner who starts billing incorrectly. A detail that slides for months. That is how costs creep up and problems multiply.
She checks in regularly. She is not afraid to switch vendors if something is not working. She works closely with her office manager and her practice partner to divide the load. She leans on staff who have been with her for years and who anticipate problems before they happen.
Work-life balance requires strategy too. Babysitters. Call schedule coordination with her partner. Delegation that your team actually respects and supports. Saying no to things that do not align with her three pillars.
"The balance is pretty tricky," she admits. "But I have really aimed to do is automate things, work with great vendors, lean on my office manager, work with my partner. It is just communication and strategy and planning, and planning in advance."
Healthcare Trauma and Why Trust Takes Time
Many patients come to Direct Primary Care after experiencing healthcare trauma in traditional systems. They have been dismissed. Their questions were brushed aside. A diagnosis was delayed. They felt lost and alone navigating the medical system.
This creates a kind of medical PTSD. Patients become defensive. They do not ask questions. They do not trust their doctors. They cycle through providers because they have been hurt before.
Dr. Klaucke spends time rebuilding that trust. She listens without rushing. She follows through on everything she says she will do. She does not let patients slip through cracks. Gradually, that sense of safety comes back. Patients begin to believe that someone really does have their back.
This emotional healing is as important as the clinical healing. Maybe more so.
When trust is rebuilt, the medicine changes. Instead of putting out fires after heart attacks, you do prevention. Risk stratification. Cardio IQ testing. Real conversations about what matters to the patient. About seeing grandchildren born. About being here for major life moments.
"We are not just putting out fires," Dr. Klaucke says. "We are saying, 'No, we do not want you to have a heart attack. Let us talk about your LP little A and your LDL to ApoB ratio so that we can actually risk stratify you.'"
That is the medicine Direct Primary Care allows.
Mentoring the Next Generation
Residents and early-career physicians are reaching out to Dr. Klaucke asking about Direct Primary Care. She is advising doctors in North Dakota, Idaho, and other states who are considering opening their own practices.
Her advice is honest: you need time in the trenches first. You need to see volume. You need to learn how to triage quickly. You need to figure out your priorities. New grads feel that weight and assume Direct Primary Care is too risky, too uncertain.
But she tells them what she has learned: once you see Direct Primary Care, once you have experienced how different it is to have time with patients, to collaborate with your colleagues, to make decisions together instead of against a clock, it is hard to unsee. The traditional system starts to look dysfunctional by comparison.
"In Direct Primary Care, you do not rush through patients. If your colleague has a question, you check that rash together. If you need a second opinion on a differential diagnosis, you call them after the kids go to bed. That is impossible in Kaiser or big conglomerates," she says. "Once you see that, it is hard to unsee."
The Legacy of Rural Medicine
Dr. Klaucke's grandfather was a pioneer in rural medical education in the 1960s and 70s. He believed rural communities deserved excellent doctors and excellent care. He advocated for rotating medical students and residents through small towns, teaching them that medicine in resource-limited settings sharpens your skills.
She wonders what he would think of her now: a family physician in a rural practice, delivering the kind of care he always believed in, through a practice model that protects it from the insurance system that came later.
"I think he would be proud," she says. "And he would probably be right about what matters. Teamwork. Accountability. Showing up for your patients."
That is rural medicine in 2026.
What Direct Primary Care Looks Like When It Works
Direct Primary Care works when you give it time to grow. When you build a team culture around three pillars instead of chasing volume. When you hire people who want to excel, not just succeed. When you close every loop on referrals and imaging and follow-ups.
It works when patients trust their doctor enough to call after hours, and that trust is so strong that calls are rare and always appropriate. When care management means real care, not billing codes.
It works when a doctor can practice the kind of medicine she always dreamed of, be present for her family, and actually sleep at night.
Dr. Jillian Klaucke's practice is proof that it is possible.
Frequently Asked Questions
How do I balance owning a DPC practice with family responsibilities?
Dr. Klaucke runs her practice while raising two children and being the primary caregiver. The key is building a team you can trust to run systems while you focus on clinical work, setting boundaries on what you will personally handle versus delegate, and choosing a practice model that allows flexibility. Work-life balance requires strategy and honest conversations with your partner and team about what matters.
What should my DPC practice do for patients without access to specialist care?
In rural areas, Dr. Klaucke's team provides care management that keeps patients informed and connected to whatever specialists are available. They coordinate referrals, confirm appointments, and help patients navigate the system so no one falls through cracks. This is not a service you can bill insurance for, but it is exactly why patients choose Direct Primary Care.
Can I really give patients my cell phone number without being overwhelmed?
Yes, with the caveat that it takes years to build the trust that makes it work. New practices will get more calls than established ones. Over time, as patients come to trust you and understand your availability, inappropriate calls decline significantly. The relationship becomes the filter that keeps urgent calls appropriate.
How do I find the right location for my DPC practice?
Dr. Klaucke's checklist included proximity to home, low overhead, room to grow, and a safe neighborhood. The most important factor was keeping rent manageable so she could sleep at night before memberships rolled in. She searched for five months and was patient about waiting for the right space rather than rushing into something that would not work long-term.
How do I staff a DPC practice that actually works?
Hire people who want to excel, not just succeed. Dr. Klaucke's team has been with her for years and anticipates problems before she has to ask. They are aligned with the three pillars: teamwork, accountability, and patient safety. Train them well, treat them well, and they will go above and beyond.
More Resources From My DPC Story
The Physician Owner's Planner: Organize the business side of your DPC practice. Download at mydpcstory.com.
The DPC Directory: Find practicing DPC physicians and learn how they structure their practices. Visit thedpcdirectory.com.
Chief Complaint Coffee: DPC mood in a cup. Visit chiefcomplaintcoffee.com.
My DPC Story Toolkit Magazine: Deep dives into Direct Primary Care topics and operations. Get your copy at mydpcstory.com.
Sandpoint Premier Direct Primary Care: Learn more about Dr. Klaucke's practice at sandpointdpc.com.
Have a question, a challenge, or a win to share? Leave a voicemail at mydpcstory.com/contact and you might hear it featured in a future episode of My DPC Story.
Tags: Direct Primary Care, Rural Medicine, Practice Management, Team Culture, Patient Safety, Physician Burnout, Healthcare Trauma, DPC Growth, Family Medicine
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