One Month In: What I've Learned Running a Direct Primary Care Practice

One month and change after opening my Direct Primary Care practice, here's what I've learned.

When Something Isn't Working, I Get to Change It

My favorite part of medicine has always been talking to people. Connection and relationship are high on my values list, and the emphasis on knowing patients over time is what drew me to primary care in the first place.

In fee-for-service medicine, we bill for time — 20, 30, and 40-minute codes tell insurers what an appointment costs. That framework has its logic, but it also caps the relationship at whatever the code allows.

When I opened Metronome Family Medicine, I thought I'd break free of that by offering generous 55-minute appointments. I quickly learned I could easily fill an hour and a half getting to know a new patient and building a real plan for them. So I made new patient intakes 90 minutes — and it feels like just enough:)

That's the whole point. When something isn't working, I get to change it. No committee, no billing department, no permission required.

Protecting My Personal Time Is More Important Than Ever

When I commit to something, my instinct is to pour myself into it completely — and if I'm enjoying it, I'll keep going without stopping. The work of building this DPC has been inspiring and taps every creative resource I have. Responding to patients when they text or call feels important to me. So does building the business: the ads, the videos, this blog, the books. All of it runs "always on" in my head.

Which became a problem. One of the goals of this transition was to make more time to be with my wife and family, more time for myself, for music, for nature, for recharging. My patients don't need a doctor who neglects his own life — and that's not the example I want to set for how to approach a vocation. So I built boundaries into the structure itself: same-day responses to texts and calls before 5pm, next-business-day for anything after that or on weekends. It's written into my membership agreement and agreed upon with every new member. And it’s plenty:)

Sometimes I'm still responding into the evening — occasionally walking over to the office at 7pm to check an ear infection or hand someone antibiotics for a UTI. But I also get a hike with my wife every Wednesday. (Until last week, I'd never once seen Lake Isabelle up past Ward, despite living less than an hour away from it for 30 years). I get to take this Thursday afternoon to bring my nephews to Casa Bonita. I also got to unplug completely and enjoy my birthday — I turned 52 last week — and yesterday went to the mountains to visit old friends before coming back to longmont to ride bikes to the town’s excellent Fourth of July celebration and fireworks.

The Pace of Growth Feels Right

I started with 33 members and more than doubled that in the first month, with inquiries continuing to come in from social media and referrals from current and former patients.

Much more than this pace and I wouldn't be able to spend the time I want with each person. But right now, I can get a new member in for a 90-minute intake the same day they email asking about services — and I have. I genuinely believe I can provide this level of care for a few hundred patients as we settle into a rhythm together.

The business is covering its overhead. Startup costs — legal fees, furniture — were front-loaded and won't recur. Ongoing expenses include the tech stack that runs everything (EMR, health records, communication platform), medications (I stock an on-site pharmacy and order compounded GLP-1s, passing wholesale savings to patients), rent and utilities (helped considerably by the acupuncturist who started renting a room this month), and continuing medical education (advanced hormone dosing coursework in August, and my Menopause Society certification textbook just arrived). My savings are covering my salary for now — and that's always been part of the plan:)

There's Still a Ton to Do

I need to get my on-site lab running for strep tests, urinalyses, and blood draws. I accidentally ordered $700 of lidocaine with epinephrine — of which I'll realistically use about $17 worth in the next year, if my current practice is anything like my last.

I've joined the Longmont Chamber of Commerce to introduce myself to the local business community and offer services to employers — especially with open enrollment season approaching and real education to be done about alternatives to traditional insurance. And in two weeks I'll attend the DPC Summit in New Orleans, continuing to learn from mentors and colleagues in this vibrant, slightly underground corner of medicine.

I realized I get to attend this one a notch up from where I was at my last DPC event. I'm officially a "DPC Newbie" now — no longer "DPC Curious," and hopefully on my way to "DPC Veteran."

Still accepting new members in Longmont, Colorado — and always happy to talk through the process with DPC-curious providers anywhere they're waking up to the possibility.

📞 720-856-4058 🔗 www.metronomemd.com/book