Texas DPC: Funding a Clinic With Historic Tax Credits

Featuring Dr. Manuel Vogt of Texas DPC on the My DPC Story podcast

Dr. Manuel Vogt photo: Voyage San Antonio

A Texas physician couple built two Direct Primary Care clinics, funded a historic renovation with tax credits, and grew to a full panel. Here is how.

When Dr. Manuel Vogt talks about leaving the insurance system, he keeps coming back to one word: renovation. Not the kind with paint and permits, although there was plenty of that too, but the larger project of taking what already works in medicine and rebuilding it into something better for patients and physicians alike.

In this episode of the My DPC Story podcast, Dr. Vogt of Texas DPC sits down with host Dr. Maryal Concepcion to walk through how he and his wife built two separate Direct Primary Care practices in San Antonio, how they used historic preservation tax credits to fund a clinic renovation, and the financial tools that made the leap not just possible but more profitable than fee-for-service ever was.

If you have ever wondered whether the numbers in Direct Primary Care can really work, especially as a physician family carrying student loan debt and no employer match, this conversation is for you.

From Germany to Brooklyn to a Physician-Friendly Texas

Dr. Vogt's path to Direct Primary Care started long before the model had a name he recognized. Originally from Germany, he moved to the United States in the early 1990s when his father took a contract with Bosch. He went on to college and osteopathic medical school in Kentucky, then completed residency in Brooklyn, New York, where he met his wife, also a DO.

The couple discovered Direct Primary Care during residency when they attended an early DPC Summit. As Dr. Vogt remembers it, the event was a fraction of its current size, and the contrast with today's packed exhibit halls says a lot about how fast the movement has grown.

When training ended, Texas was the obvious landing spot. Tort reform, no state income tax, and family already in San Antonio made it, in his words, a more physician-friendly state. That combination of professional autonomy and family support became the foundation for everything that followed.

Two Doctors, Two Clinics, One Family

One of the most practical takeaways from this episode is that a physician couple does not have to share a single practice to build something powerful together.

Dr. Vogt's wife opened her Direct Primary Care clinic first, around the end of 2021 into 2022, with a focus on women's health. Dr. Vogt followed roughly a year later, leaving a medical group he co-owned with several physicians and nurse practitioners.

They deliberately kept the two clinics as separate entities. His wife wanted full control over her own practice and patient experience. Dr. Vogt was drawn to growth, a larger panel, and the business side of expansion. Keeping the clinics distinct let each of them run the model their own way while still supporting one another behind the scenes.

For physicians weighing a shared practice against parallel ones, that is the lesson: separation can protect autonomy without sacrificing partnership.

A Pre-Enrollment List of 220 Patients on Opening Day

Dr. Vogt's launch is a case study in why relationships travel with the physician.

Because he negotiated his way out of his non-compete and non-solicitation clauses, he was able to invite his existing patients to pre-register before he opened. He walked into his first day with around 220 patients already enrolled, then saw exponential growth over the following six months.

If you are navigating a non-compete of your own, listen to our earlier episode with Dr. Nyasha Spears, who shares her ongoing legal fight over hers.

He also points out a pattern many DPC physicians will recognize. Some patients who could easily afford the membership chose not to join right away. Others who had to budget carefully made it a line item in their monthly spending. And years later, he still gets about one call a month from a former patient ready to come back.

Funding a Clinic Renovation With Historic Tax Credits

This is the part of the conversation that most DPC physicians have never heard before, and it is worth slowing down for.

Dr. Vogt's wife's clinic is an old house that had been rezoned commercially and once belonged to a local artist, sitting inside a nationally designated historic neighborhood. That designation unlocked a stack of incentives most clinic owners never explore.

Here is how the financial picture came together in their case:

• Federal historic tax credits of roughly 25 percent of qualifying restoration costs, paid out over a five year period

• State historic tax credits of about 20 percent, which they sold to larger corporations for around 93 cents on the dollar since Texas has no state income tax to offset

• ADA accessibility credits, including a 50 percent credit on a wheelchair ramp

• Additional credits for installing a solar charging carport behind the clinic

For their project, the state credits worked out to roughly 106,000 dollars, and the federal credits came to about 18,000 dollars per year across five years. The property itself cost around 400,000 dollars and sits on a quarter acre.

Their accessibility ramp deserves a footnote of its own. Because the historic review board did not want it obscuring the front of the building, it was built long and tucked into the back. The work was done so well that the city now uses it as an example of how to do a compliant rehabilitation ramp.

How to Pursue Historic Tax Credits Without Getting Lost

Two pieces of advice stand out for any physician considering a historic property.

First, hire a specialist. Dr. Vogt's team used a firm called Post Oak Preservation, which handled the applications and knew exactly what would and would not be approved. That guidance cost around 10,000 dollars and, in his view, was well worth it.

Second, vet your contractor carefully. He got lucky with a contractor named Mike, whose wife is an architect and who shares a genuine passion for historic preservation. On a different project, the couple was ghosted by contractors entirely, a reminder that the right partner matters as much as the right building.

He also made a smart switch on the accounting side, moving to a Direct Primary Care focused accountant, Jonathan Apgar, who charges a flat monthly membership rather than billing per visit. For a family deep in tax strategy and credit applications, that pricing model mirrors DPC itself.

Subleasing as a Built-In Overhead Strategy

Dr. Vogt's own clinic is a roughly 1,000 square foot medical condo he bought down the street from where he started, renovated in a month or two. He uses one room for himself and subleases the other three.

His tenants include a pediatric DPC physician, a urologist offering cash-pay vasectomies, and a nutritionist. Together, those leases cover his entire overhead, including insurance, as reliable passive income.

The arrangement does more than pay the bills. It creates a built-in referral network. Dr. Vogt does not see young children, so he sends those families to the pediatrician on site. With the surge in GLP-1 prescriptions, he refers heavily to the nutritionist, because, as he puts it, a medication is a tool and not a replacement for real lifestyle change.

The San Antonio DPC Umbrella and Marketing to Employers

To reach local employers, Dr. Vogt and his wife teamed up with another practice, Tailored MD, to create an umbrella group originally called San Antonio Direct Primary Care, now expanding under the Texas DPC banner.

The umbrella covers four clinic locations across the partner practices, which lets them pitch employers a simple message: your employees can choose whichever clinic is most convenient. They marketed to small restaurants, breweries, physical therapy offices, and other businesses, and the effort jump-started his wife's panel with at least 40 patients.

The structure works because it keeps costs low and preserves autonomy. There is no shared staff beyond the founders, and each physician still runs an independent practice. It started, fittingly, with one phone call and a conversation between two doctors who became friends.

A Workaround for Texas Dispensing Laws

Texas does not yet allow Direct Primary Care physicians to dispense medications in office the way many other states do, a fight the DPC community is actively pushing on. Until that changes, Dr. Vogt built a workaround into his employer plans.

Through a partner company, his employer agreements give patients access to local and mail-order medications, plus the in-office testing DPC patients expect, including strep, flu, COVID, and urine dips. On labs, he uses a large wholesale lab, rounds the cost up to the next 5 or 10 dollar increment to cover processing, and offers annual panels for around 25 to 30 dollars.

A note for physicians in other states: rules vary widely. In California, for example, pass-through lab billing is not allowed, so patients are billed the exact lab cost. Always confirm your own state's regulations before building a pricing structure.

What Better Diabetes Care Actually Looks Like

Dr. Vogt's clinical focus is diabetes, and the difference between the two models shows up most clearly here.

He describes a new patient who arrived with an A1C of at least 11. He spent more than an hour with them, placed a continuous glucose monitor right there in the office, and now monitors their numbers on an app and texts adjustments throughout the week. That is a world away from the rushed 10 to 15 minute visit, and it is exactly the kind of care that keeps patients loyal enough to follow him across state lines. His furthest patient is currently on a military base in the United Kingdom.

Designing a Care Space That Does Not Feel Like a Doctor's Office

Both Vogt clinics were intentionally designed to throw out everything patients expect from a medical office. The waiting rooms are cozy, full of live plants, and modeled loosely on the family doctor's home office Dr. Vogt remembers from Germany, the Hausarzt whose practice was simply part of his house.

The most telling detail: patients rarely wait at all. The design signals pride and care, and patients notice immediately.

The Lifestyle Math: 500 Patients and a Daily 5K

Dr. Vogt found his sweet spot at around 500 patients, the panel size that lets him deliver excellent care and still live the life he wants. He drops his kids at school every morning, often sees his first patient at 8:30 or 9:00, and is frequently done by early afternoon.

On pricing, he started at 100 dollars per member per month, raised new memberships to 120 and then 150, and grandfathered existing patients at their original rate. Some patients, recognizing the value, have asked to be moved up to the highest tier voluntarily.

The result is a schedule that supports both his family and his health. He has run a 5K every day this month, something that was nearly impossible in the insurance world.

What Is Next for DPC in Texas

Texas remains one of the friendliest states for Direct Primary Care, and the number of practices has grown dramatically over the past three years. Dr. Vogt credits the openness of the DPC community, where physicians freely share what is working and even cover one another's practices. He is heading to Germany for two and a half weeks with coverage handled by another local clinic at no cost.

Two policy priorities sit at the top of his list: in-office dispensing and FSA eligibility for DPC memberships. The HSA language was clarified at the federal level last July, but FSA coverage remains a gray area worth advocating for.

If those issues matter to you, the Direct Primary Care Coalition at dpcare.org is the place built for this movement, where longtime advocates have worked for years to move the needle on exactly these questions.

Listen to the Full Episode

Dr. Vogt's full conversation, including more on contracts, expansion planning, and the day-to-day tools he relies on, is available now on the My DPC Story podcast. The accompanying blog includes photos of both clinics and the historic renovation.

While you are here, cast your vote in our Battle of the Support Stack at mydpcstory.com to help the community find the communication, billing, and legal tools that work best.

And if you want to go deeper into the movement, consider joining the My DPC Story Patreon community for exclusive content and additional interview topics.

Frequently Asked Questions

Can a physician couple run two separate Direct Primary Care practices? Yes. Dr. Manuel Vogt and his wife run two distinct DPC clinics in San Antonio, each as its own entity. Keeping them separate lets each physician maintain full autonomy while still supporting one another on finances, marketing, and coverage.

What are historic tax credits and can they help fund a clinic? Historic tax credits are federal and state incentives for restoring buildings in designated historic areas to certain standards. In Dr. Vogt's case, they covered a significant share of a clinic renovation through a combination of federal credits paid over five years, sellable state credits, ADA accessibility credits, and credits for a solar carport.

Is Direct Primary Care financially viable for physicians with student loan debt? Dr. Vogt reports earning more in Direct Primary Care than he did in private practice, even while carrying significant student debt. The model removes insurance overhead and lets physicians design lean, profitable practices, often supplemented by strategies like subleasing space.

How can DPC physicians work around state dispensing restrictions? In states like Texas where in-office dispensing is limited, physicians can partner with medication access companies and build that benefit into employer plans, alongside in-office testing and deeply discounted wholesale labs. Always confirm your own state's rules first.

What panel size supports a sustainable DPC lifestyle? For Dr. Vogt, around 500 patients is the sweet spot that balances excellent patient care with personal time, including daily exercise and family commitments. The ideal number varies by physician, pricing, and practice style.

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