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Why Financial Sustainability Is the Foundation of Every Successful DPC Practice

Your clinical training got you here. But running a thriving Direct Primary Care practice takes more than excellent medicine.



You went to medical school to take care of patients. Not to reconcile payroll reports, chase down unpaid invoices, or stare at a profit-and-loss statement wondering if you're actually making money.

And yet, here you are.


If you've opened a Direct Primary Care practice, or you're seriously considering it, the clinical side probably isn't what keeps you up at night. You can diagnose, treat, and build relationships with patients. That part, as hard as it was to learn, is now the easy part.


What's harder? Building a business that can sustain itself, pay you what you're worth, and still be standing in five years.


Financial sustainability isn't a nice-to-have for DPC practices. It's the foundation everything else is built on. Without it, you can't serve your patients. You can't hire support. You can't grow. And eventually, you can't keep the lights on.


This piece is about what financial sustainability actually looks like in DPC, why so many practices struggle with it silently, and what you can do right now to get ahead of it.



The DPC Paradox: You Escaped One System and Built Another One That Can Break You

One of the central promises of Direct Primary Care is freedom. Freedom from prior authorizations, from insurance bureaucracy, from the treadmill of 30-patient days. And DPC delivers on that promise clinically.


But many physicians who open DPC practices discover something uncomfortable within the first year or two: the business side of medicine doesn't disappear just because you left fee-for-service. It just looks different now.


Instead of fighting with payers, you're managing membership pricing, payroll platforms, monthly reconciliations, and the slow creep of operating expenses that compound quietly in the background. And unlike employed medicine, there's no billing department, no hospital CFO, and no finance team to absorb those problems. It's you.


"Most physicians we are finding in Direct Primary Care are not struggling with the clinical side of opening a practice anymore. That is the easy part. The things that we are as a community needing more help with, to make sure our clinics are sustainable, are things we were never trained for." — Dr. Maryal Concepcion


This is the DPC paradox. You built something designed to give you your life back. But without financial systems in place, the business itself becomes the new source of burnout.



The Two Financial Problems That Show Up in Almost Every DPC Practice

After working with physician-owned practices across the country, a clear pattern emerges. Two problems show up consistently, regardless of practice size or how long the physician has been in DPC.


1. Time: The Hidden Cost of Doing It Yourself

Early on, doing your own bookkeeping, running payroll, and managing vendor invoices seems manageable. You've got a handful of patients, a short list of expenses, and you tell yourself you'll get the hang of QuickBooks eventually.


But here's what happens as your panel grows: every system you bootstrapped in month one starts to crack under its own weight.


Payroll that took 20 minutes with one employee takes 2 hours with four. Accounts payable that was simple when you had five vendors becomes a weekly task when you have fifteen. The spreadsheet that worked when you were pre-revenue doesn't give you the insight you need now that you're managing a real business.


And the cost isn't just time. It's what that time is not being spent on. Every hour you spend troubleshooting a payroll platform or deciphering a balance sheet is an hour you're not spending on patient care, on community outreach, on building the practice you actually set out to build.


"What's going to grow your business is working ON the business. How can we get more patients in the door, how can we improve patient outcomes. Spending time calling QuickBooks or looking over a P&L that your cousin Jimmy put together is not a great use of time." — Tom Squire, Osprey CFO


2. Confidence: Not Knowing If You're Actually Okay

The second problem is quieter, but it might be more dangerous. Many DPC physicians have an accountant. They get financials occasionally. But when those reports land in their inbox, they're not sure what they're looking at, or more importantly, what it means for the future of their practice.


They don't have a plan. They don't have a budget. They're managing the bank account and calling that financial management. And when they look at their numbers, they can't tell if they're on track, falling behind, or about to have a problem they don't see coming.


This is not a personal failing. Physicians are not trained in financial management. But the absence of financial clarity creates a specific kind of anxiety: a low-grade uncertainty about whether the thing you built is actually going to last.


The Sustainability Equation: Revenue, Expenses, and the Salary You Keep Skipping

Let's talk about what financial sustainability actually requires. At its core, it comes down to three things: your revenue needs to cover your expenses, leave margin for growth, and pay you a salary you can live on.


That last part is where a lot of DPC practices quietly get into trouble.

In the early days, not drawing a salary feels responsible. You're building something. You're investing in the practice. You'll pay yourself next month, or the month after, once the panel grows a little more.


But "next month" has a way of becoming six months, and then a year, and then the practice is doing fine on paper but you're personally depleted, and you're not sure how much longer you can sustain it.


"If you continue down the road of 'we'll take a salary next month,' you're probably not gonna be in business for that long — and you're not going to be able to serve your patients anymore." — Tom Squire, Osprey CFO


The solution isn't to pay yourself recklessly before the practice can support it. The solution is to have a plan, a real one, that maps out when you'll start drawing a salary, what revenue milestone triggers that, and what the path looks like between now and then.

Sustainability isn't an accident. It's a decision, made in advance, with a clear-eyed view of your numbers.



Pricing: The Lever Most DPC Physicians Underuse

Here's something that comes up consistently in financial reviews with DPC practices: the revenue problem is often a pricing problem.


Practices hit their patient panel goals. Membership is growing. Patients are happy. But the revenue isn't where it needs to be to cover expenses and pay a sustainable salary.

Why? Because pricing hasn't kept pace with the cost of running the practice and because pricing conversations feel uncomfortable for physicians who didn't go into medicine to sell anything.


But pricing is a business decision, not a moral one. And the math matters.

Even a $5 increase per member, applied across a panel of several hundred patients, generates meaningful additional revenue, revenue that goes directly to your bottom line, because your overhead doesn't change.


The physicians who are most financially stable in DPC aren't necessarily the ones with the biggest panels. They're the ones who priced intentionally from the start, review their pricing annually, and aren't afraid to adjust it when the numbers require it.


That doesn't mean raising prices carelessly or without communication. It means treating pricing as part of your financial strategy, not something you set once in year one and never revisit.



What a Real Financial Partner Actually Does for Your Practice

Most DPC physicians who've had a bookkeeper describe a similar experience: they get a report, they don't fully understand it, and no one explains what it means for the health of the business.

That's bookkeeping. That's not financial partnership.


A real financial partner for a DPC practice does something different. They help you build a plan for the year like specific goals, a budget that reflects those goals, and regular check-ins to see how you're tracking. When something's off, they flag it and help you course-correct. When you have a question at 2pm on a Tuesday, you can call a real person who knows your practice.


They also take things off your plate that you shouldn't be doing in the first place. Payroll. Accounts payable. Reconciliations. The tasks that compound and eat your time as your practice grows.

The question to ask isn't whether outsourcing has a cost. It does. The question is what it costs you not to.


"Yes, there is a cost with doing it. But what is the opportunity cost of you not doing it?"

— Tom Squire, Osprey CFO


When you stop spending 10 hours a month on financial administration, those hours go somewhere else. They go into patient care. Into community building. Into the things that actually grow your practice and bring you the satisfaction you opened a DPC to find.



The Private Equity Threat: Why Financial Strength Is Also Protection

There's a bigger picture here that doesn't get talked about enough.

Private equity is coming to DPC. It's already happening in adjacent spaces, consolidating independent practices, rolling up clinical operations, adding administrative layers that slowly shift the model away from the physician-patient relationship that makes DPC work.

The best protection against that pressure is a financially strong, independently sustainable practice.

When your numbers are solid, when you're profitable, when you have a real financial plan and a team helping you execute it, you're not desperate. You don't have to consider offers you'd otherwise turn down. You can say no to arrangements that would compromise what you built.

Financial sustainability isn't just about keeping the lights on. It's about protecting your autonomy as a physician.



Where to Start: Three Things to Do This Month

If you're reading this and recognizing your own practice in what's described above, here's where to start.

  • Get clear on whether you have a plan. Not a vague intention, but an actual financial plan with a budget, revenue targets, and a clear picture of when you'll reach your salary goal. If you don't have one, that's the first thing to build.

  • Review your pricing. When did you last look at your membership rates? Are they covering your costs with margin to spare? A simple analysis of your revenue per member versus your per-member cost of operations will tell you a lot.

  • Audit your time. Track how many hours per month you spend on financial administration tasks. Then ask honestly: is that the highest and best use of your time as a physician and practice owner?


If the answers to those questions make you uncomfortable, that's useful information. It means there's something to address, and the earlier you address it, the easier it is to fix.



Resources from My DPC Story

This blog post was inspired by a conversation between Dr. Maryal Concepcion and Tom Squire of Osprey CFO on the My DPC Story podcast. If you want to go deeper, here's where to start:


Financial sustainability is not the glamorous part of DPC. But it is the part that makes everything else possible from the patient relationships, the clinical autonomy, the freedom from the system you left (or will leave soon) behind.


Build it intentionally. Get help where you need it. And don't wait until the pressure is already on.


WATCH HERE


LISTEN HERE


My DPC Story

mydpcstory.com  |  @mydpcstory  |  Created and hosted by Dr. Maryal Concepcion

 
 
 

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