Why Wait? I Opened My DPC Practice Right After Residency

The sun shined brightly through my car windows as I drove down a winding road to the beach on an unseasonably warm October day. It felt like summer.

It was 3 p.m. on a Friday. I finished my to-do list and decided to start the weekend early. It had been my first week of practicing medicine in my own direct primary care practice, and I loved the unrushed visits, the time to think deeply and learn, the space to be creative while designing the website and clinic and the autonomy to practice more holistically.

I could finally wake up and live my values on my own terms every day. I felt the culmination of years of training, studying and late night calls. It had all been worth it.

I had never felt more professionally satisfied. My personal life was also on a high. Hence, the 3 p.m. trip to the beach.

As I rounded a curve in the road, the lake came into sight. Being by the water has always had a calming effect on me. I often sought the beach, even in winter, as a place of solace during residency. It was good to get away from the harsh, beeping pagers and endless notes. Today, the nature of my thoughts and beauty of the lake resulted in slow, happy tears curving down my cheeks in a mixture of joy and relief.

I had made it. I owned my own DPC practice.

The journey of starting my own practice, though rewarding, has not been easy.

One of the common concerns I hear residents voice (and one that I had myself) in starting a DPC practice immediately following residency, is financial in nature. Many of us are burdened with hundreds of thousands of dollars in debt from medical training. We may have other family members to provide for (as I did), so our financial decisions are not solely impacting ourselves, but also our families. 

And then there’s the built-up tension of years of delayed gratification throughout school and residency, living on a tight budget and holding out for that attending salary. Many health care systems offer generous sign-on bonuses, further adding to the allure of employment rather than starting a practice from scratch.

As a medical student, I knew I wanted to practice in the DPC model. I had many generous mentors who had shared their practices with me throughout school. I even designed a DPC elective for my fourth year. However, the financial dilemma caused me to pause. Should I work at an employed position until I had saved up some funds or paid back my loans? But the longer I practiced in a large hospital system as a resident, the clearer it became that it was not the setting for me.

I also realized whether I opened immediately after residency or a few years later, I would be making a financial investment. The question was when, not if. Why not make the leap now while I’m already used to a living on a resident’s salary? It would only become more difficult to take off the golden handcuffs later.

Additionally, the cost of my personal and professional happiness became too large to wait. With one more year of training left to go, I decided I would open my own practice after residency.

I began to work on whatever I could. I designed the website, read as many books as I could about DPC, attended events like the Direct Primary Care Summit and filed for my LLC (limited liability corporation), officially founding my practice, Empowered Health.

Thankfully, I had some incredible mentors who guided me on this startup process, one even taking the time to meet with me once a month. At the time, I was moonlighting and serving as the sole caregiver for a severely ill family member. Free time was not abundant.

Starting a DPC practice can be like riding the waves -- and sometimes like being tossed about by them. I spent the summer after residency working a couple of jobs to pay the bills and save for startup costs, planning to open the practice in the fall. This period just a few months before opening and after residency was definitely the most challenging. As some residents will relate, particularly if they have also been caring for others, my savings were not significant at the end of residency.

As I worked one job while waiting for another to start (and for the paychecks to come in) it was a little more financially straining than I had anticipated. Things ultimately worked out, but it was a stressful few months. I often spent free hours at the beach, working on my laptop and worrying about how I was going to make ends meet. The monetary hesitations some residents have about starting a practice right after residency are valid.

One of the other common concerns I hear among physicians considering making the transition to DPC is the lack of business teaching in medical school. The physicians involved in DPC in the early years have truly paved the way and set the cultural tone for strong support among physicians, making an MBA unnecessary (although not unhelpful). Many DPC physicians continue to share their experiences generously, openly and regularly. Truly, I would not have had the business knowledge, nor the confidence to make such a bold move as to open my own practice without the DPC physician community to lean on and learn from. I am incredibly grateful for them. For those just getting started or interested in learning more the DPC Summit hosted by the AAFP along with a few other organizations is a great place to start. Additionally, the DPC Alliance offers Mastermind workshops throughout the year along with options for group discounts on supplies and services.

Empowered Health officially opened in October 2023 in Cleveland. I was able to keep my startup costs to the bare minimum at just a few thousand dollars. My monthly overhead is even less. As a shy person, I’ve been learning how to get out of my comfort zone by networking and building a presence on social media. It has been a joy getting to know the community of other independent clinicians breaking the mold and standing up for innovative, high-quality patient care. I continue to learn more every day about running a business. By January 2024, my practice broke even. It has continued to grow at a wonderful pace.

Recently, I found myself back at the beach on an unusually warm, sunny February day. I wandered along the beach, looking for anything interesting that might have washed up after the winter snow and rain. A simmer of green caught my eye. I picked up a piece of sea glass, the once-rough edges smoothed by time and sand. I smiled as I reflected on my own not so dissimilar journey here.

Lilian White, M.D., is a 2023 graduate of the family medicine residency program at Cleveland Clinic. She opened a direct primary care practice, Empowered Health, this fall in Cleveland.