Direct Primary Care Growth Strategies and Practice Management
Today, I had the chance to do a deep-dive consult with a Direct Primary Care (DPC) practice and discuss ways they could refine their growth strategy. DPC operates on a membership-based model, meaning patients pay a monthly fee for unlimited access to care. Because these practices don’t take insurance, they can streamline communication, often handling a large portion of patient interactions via text instead of requiring in-person visits.
One of the main topics we covered was niching down. Most primary care practices try to serve everyone—families with young children, elderly patients, and everyone in between. But when marketing a practice, a broad message often fails to connect. For example, an 80-year-old may be drawn in by discounted prescriptions, while a parent of a newborn is looking for newborn care. A message that tries to speak to both can end up resonating with neither.
This practice was considering a focus on college students since their office is near a university. However, college students aren’t usually the ones making healthcare decisions—their parents are. So, instead of targeting students directly, we brainstormed ways to reach their parents. Some ideas included:
Speaking at new student orientation events where parents are present.
Connecting with sororities and fraternities, as they often host health-related programs and have parents that want their kids to have a medical home while away from home
Emphasizing mental and physical health support for students who need consistent care while away from home.
The next topic we tackled was online appointment scheduling. Many practices still require patients to call for appointments, which can be a major barrier. People are busy, and they don’t want to wait on hold or play phone tag. Instead, they prefer the convenience of self-scheduling, just like they do for haircuts, car services, or even dentist appointments. I emphasized that even if they weren’t ready to allow all visits to be booked online, they should at least offer meet-and-greet appointments through an easy online scheduling system. When potential patients can book instantly, they are far more likely to follow through rather than putting it off indefinitely.
Lastly, we talked about after-hours texting boundaries. Many DPC doctors struggle with the expectation that they should be available 24/7. When patients text at 10 PM asking about vitamins they found on Amazon, it can become overwhelming. While it’s great to be accessible, it’s also essential to set boundaries so the practice remains sustainable.
I recommended implementing an automatic after-hours text response. At 4:30 PM, the system should send a message saying something like:
“We’re currently closed, but we’ll check messages in the morning. If you need to book an appointment, here’s the link. If it’s urgent, call our nurse triage line.”
By setting clear expectations, patients can still reach out, but doctors aren’t constantly on call for non-urgent issues. And surprisingly, this approach increases patient satisfaction—they know they can text whenever they have a question, without feeling like they’re bothering their doctor.
Ultimately, a growing DPC practice needs a combination of clear niche marketing, easy appointment booking, and firm boundaries to remain both successful and sustainable.
Full Transcript Below.
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Full transcript:
I got to do a really cool practice consult today with a Direct Primary Care (DPC) practice.
DPC practices operate mostly outside of insurance, meaning you pay a monthly membership fee—kind of like Netflix or a gym membership. With that, most practices offer unlimited access, meaning unlimited visits. Communication is streamlined because these practices have smaller patient panels. In my practice, for example, 80% of our interactions with parents happen over text message. There are so many things we can handle via text without requiring an in-office visit. Since we don’t need to bring patients in just to bill their insurance, we can offer this level of convenience.
One of the things we discussed during today’s consult was the importance of having a specific niche. Most DPC practices are general primary care, meaning they see everyone—80-year-olds, 8-year-olds, 8-week-olds, and 8-day-olds. The challenge is that when you try to market to everyone, you often end up connecting with no one.
For example, older adults might be drawn to DPC because of lower prescription costs and easier access to care. Parents of young children join because they want fast, reliable access when their child is sick. But the parents of an 8-day-old baby don’t care about discounted prescriptions for seniors. When your message is too broad, it fails to resonate.
In today’s discussion, we talked about this practice’s ideal new patient—college students. But after some brainstorming, we realized that the real target was their parents. Parents are the ones paying the bills and worrying about their kids’ healthcare while they’re away at school.
We explored several ways to market to these parents:
New student enrollment events—places where parents are present.
Sororities and fraternities—especially sororities, since they often host health-related programming.
Positioning the practice as a medical home—offering support for mental, physical, and emotional health, so parents feel reassured that their child has consistent care.
College students love texting, which makes the DPC model especially appealing for them. They don’t have to call an office, wait on hold, or schedule an appointment weeks out—they can just text their doctor and get help quickly.
Of course, focusing on college students doesn’t mean the practice won’t see other patients. It just means they’ll have a clear growth strategy for reaching a specific audience first, then expanding from there. Instead of saying, “We want to grow,” it’s more effective to say, “We want to attract college students—here are three specific ways we’ll do that.” Once that niche is established, they can move on to another, like retirees or families with young children.
The second big topic we covered was online appointment scheduling. This practice wasn’t offering it yet, and we discussed why that was a problem.
People are busy. I used myself as an example—I need to go to the dentist and see my primary care doctor, but I put it off because I don’t want to deal with calling, waiting on hold, and coordinating schedules. Instead, I want to book online when it’s convenient for me—whether that’s at 5 AM, 7 PM, or 11 PM.
Parents love the ability to book online. In my practice, we allow online scheduling for meet-and-greets and sick visits. This eliminates the back-and-forth of phone calls and makes it easier for families to take action. One of the doctors on the call even said she chooses businesses (including her haircuts and oil changes) based on whether she can book online.
If a practice isn’t ready to allow all appointments to be self-scheduled, they should at least offer dedicated time blocks for meet-and-greets, so potential new patients can book instantly without having to wait for a call back.
Finally, we talked about after-hours text messages. Many DPC doctors struggle with work-life boundaries because patients feel like they should always be available. Some people will text at 10 PM asking about a vitamin they found on Amazon, and doctors end up feeling like they have to respond.
At first, this isn’t a big issue in a tiny practice, but as the practice grows, it becomes unsustainable.
I recommended using an automatic after-hours text response. At 4:30 PM, we set up an auto-reply that says:
"We’re currently closed but will check messages in the morning."
"If you need to book an appointment, here’s the link."
"If this is urgent, here’s our after-hours nurse triage line."
I have a nurse triage line because I like my sleep. In three years, I’ve only gotten two after-hours calls from the triage team, meaning this system works.
I also encourage patients to text anytime—even at 2 AM if they’re awake with their baby and have a question. They won’t wake me up, and I’ll respond in the morning. Setting expectations this way reduces stress while still making parents feel supported.
By having these boundaries in place, DPC doctors can prevent burnout while still offering high-quality, accessible care.
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