My DPC Story

How do you run a community vaccine clinic when your Direct Primary Care (DPC) practice doesn't bill insurance?

Dr. Maryal Concepcion and independent pharmacist Urvish share how Big Trees MD in rural Arnold, California gave 84 vaccines in one day, on a weekend, without billing a single insurance company. Recorded live in the clinic, so you will hear real life in the background.

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Community Vaccine Clinic Playbook LITE: Direct Primary Care Edition

Read the full write-up and 7-step checklist:

In this episode:
- Why a DPC practice that doesn't take insurance runs a vaccine clinic: access
- The model: the physician prescribes, the pharmacy dispenses and bills the vaccine without an administration fee, and the physician gives it at the clinic or at home
- What to bring when you approach a pharmacist, and why to skip the phone line
- How much notice a pharmacy needs (about a week) and how to plan for walk-ups
- How billing sorts by Medi-Cal, Medicare Part B and commercial coverage
- Small orders and 10 dose packs for kids under 3
- The Medicare Part D late enrollment penalty and other open enrollment questions
- How two other DPC practices talk Medicare with patients
- Why 2027 Medi-Cal work rules and six-month renewals make community clinics matter more
- 7 steps to run your first community vaccine clinic

Resources mentioned:

- Big Trees MD: https://bigtreesmd.com

- Halcyon Health Direct Primary Care (Dr. Emilie Scott and Dr. James Gaor)

- Living Well Family Medicine, Lexington, SC (Dr. Feneisha Franklin)

- The Toolkit, Medicare edition (Lean Startup Business Plan, $150 HSA rule, December 1 Medicare opt-out deadline): https://toolkit.mydpcstory.com

- Can Patients Use an HSA for Direct Primary Care? The $150 Rule

- What Is Direct Primary Care?: https://www.mydpcstory.com/post/what-is-direct-primary-care

- Medicare Part D late enrollment penalty: https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html

- Medi-Cal changes for 2027 (DHCS): https://www.dhcs.ca.gov/Medi-Cal/Pages/changes.aspx

- Find a DPC practice: https://caringdirectly.com

- Leave a voice message for the show: https://www.mydpcstory.com/contact

LEARN MORE: My DPC Story WOMEN'S SUMMIT 2027

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Dallas pediatrician Dr. Tonya McDonald was laid off with 21 other physicians and opened Radiance Pediatrics, a house-call direct primary care practice, in 2019. Seven years and hundreds of kids later, she shares how she built it for less than the cost of a used car, how COVID doubled her practice, and how she uses Texas’s free CPAN network for pediatric mental health.

In this episode:

• How her own pediatrician, the first Black pediatrician in Beaumont, Texas, shaped how she talks to kids
• Running a clinic in a Dallas medical desert, and why metrics have to fit the community
• Getting laid off, non-competes, and choosing DPC when every other door closed
• House calls, 90-minute newborn visits, and $225/month pricing in an urban market
• Partnering with midwives, chiropractors and other DPC physicians
• Using CPAN for therapy referrals and psychiatric medication guidance
• Caring for patients to age 26 and coaching their handoff to adult care
• Practical advice for physicians worried about job security

• WEBSITE: Radiance Pediatrics: https://www.radiancepeds.com/
• The Gold Standard Health, Dr. Kelsey Walker: https://www.tgshealth.com/
• Dr. Walker’s My DPC Story episode: https://www.mydpcstory.com/post/launching-the-gold-standard-health-dr-kelsey-walker-s-direct-primary-care-experience
• Paradigm Family Health, Dr. Staci Benson: http://www.paradigmfamilyhealth.com/
• Texas CPAN (for clinicians): https://www.childrens.com/for-healthcare-professionals/refer-a-patient/provider-resources/cpan | 1-888-901-CPAN
• Find a DPC near you: https://thedpcdirectory.com
• Leave a voice message: https://www.mydpcstory.com/contact

Learn more about Hint Summit at: https://go.hint.com/45zknvf

Get $250 off registration at HLTH with code H26MYDPCSTORY - and join Maryal at Healthcare's #1 Innovation Event. Las Vegas Nov 15th-18th.

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Medicare Open Enrollment: A DPC Physician’s Toolkit for 2027 Changes

Today we discuss why Direct Primary Care (DPC) practices still field urgent calls during Medicare open enrollment when patients’ coverage changes affect care outside the DPC clinic.

Host Maryal Concepcion introduces the Fall 2026 Medicare Toolkit and gives a five-question CMS-based quiz covering 2027 updates:

• Find out what the Part D out-of-pocket maximum is with a deductible and an option to spread costs via the Medicare Prescription Payment Plan
• when a Medicare Advantage plan ends, patients have until the end of February to choose a new plan and 63 days after the plan ends to buy Medigap without health questions. See the TOOLKIT for more on this.
• HSA funds - can they pay for Medigap premiums? What happens to your HAS when you are on Medicare.
• More drugs gain negotiated prices (25 total) in 2027

and new plans must honor active treatment for 90 days. Get free patient downloads, quizzes and more at CaringDirectly.com patient resources and clinic map listings.

DOWNLOAD OUR FREE MEDICARE EDITION OF THE TOOLIT, OUR MAGAZINE ALL ABOUT DPC!

00:00 What Is Direct Primary Care
00:53 Open Enrollment Calls Hit DPC
01:54 Toolkit And Medicare Pop Quiz
02:11 Quiz Q1 Part D Costs
02:43 Quiz Q2 Plan Ending Window
03:26 Quiz Q3 HSA And Medigap
03:58 Quiz Q4 Negotiated Drug Prices
04:21 Quiz Q5 Continuity Of Care
04:44 Score Yourself And Get Toolkit
05:37 Survival Guide And Dates
06:07 Patient Resources Caring Directly
07:47 Add Your Clinic To The Map
08:04 Translations Contact And Wrap Up

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Opening a DPC Practice After Training Through COVID: Dr. Nada Farooqui, MD of RAWQ Medicine

Dr. Nada Farooqui, MD trained in family medicine at the height of the pandemic. Her unopposed residency taught her to do everything. Then she sat through job interviews where someone else defined her scope. After a few years in wound care and hyperbarics, one Direct Primary Care summit settled it.

Dr. Farooqui is the founder of RAWQ Medicine, a Direct Primary Care practice opening this fall in Hillsborough, New Jersey. The name comes from an Arabic word for water that has settled and turned clear, which is what she wants her patients to feel about her practice. She joins Maryal with the lease, the membership agreement and the EHR all about to be signed, so you hear the opening stage exactly as it feels.

In this episode:

• Growing up with a mother who still practices full time in the Bronx, and how that old-school family doctor shaped the physician she wants to be
• Training during the pandemic, losing her attending and mentor to COVID, and why she is fighting for physicians as much as for patients
• The moment at her first DPC summit when it clicked: these are my people
• How her family planned the finances: the household budget first, a year of projected cashflow, and where she chose to spend (lawyer, CPA, lease, EHR) versus save (website, headshots, social media)
• Flat-fee wound care for non-members, home visits, and a pay-it-forward fund for sponsored memberships
• Getting the word out before opening day: five nights at the town fair, the library, her mosque, and local physicians and pharmacists who offered to help for free
• Her 60-minute first visit, which opens with, “What are your concerns?” instead of a checklist
• Her advice for the next doctor opening: know your vision first, because it answers every other question

Resources:

• RAWQ Medicine
• Find or add a physician-led Direct Primary Care practice: CARING DIRECTLY
• Free startup checklist and the Physician Owner’s Planner: https://www.mydpcstory.com/

Opening your own practice, or stuck on a step? Leave a voicemail at https://www.mydpcstory.com/contact. Tell Maryal your question, your challenge or the win you are proud of, and you might hear it on a future episode.

Want more stories like this one? Sign up for the My DPC Story newsletter at mydpcstory.com so you are the first to know when the next Toolkit Magazine drops.

If this episode moved you, please leave a five-star review on Apple Podcasts. Follow @mydpcstory and find episodes, free resources and the Toolkit Magazine at https://www.mydpcstory.com/.

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What does a Direct Primary Care practice look like six years after opening? In this annual anniversary episode of My DPC Story, Dr. Maryal Concepcion catches up with Dr. Christina Mutch and Dr. Mutch of Defiant, Dr. Lauren Hughes of Bloom, and Dr. Deepti Mundkur of My Happy Doctor. They all opened their practices in 2020.

These doctors get real about growing a DPC practice. They talk about adding an RN who changed everything, bringing on a fourth physician, and writing SOPs for the first time in year six. They also share what a full panel really means when you stop comparing yourself to averages on social media.

The conversation then turns to medical misinformation. These physicians explain how they talk with patients about vaccines, TikTok wellness trends, and "scamfluencers." The goal is to meet people where they are without talking down to them. They also share why DPC doctors have a unique responsibility to educate their communities.

For any physician worried that the money won't work, this episode gives practical financial advice. Topics include state loan forgiveness programs, starting small with low overhead, raising your prices, and building a financial tech stack. Dr. Mundkur also shares why treating your first year like a "DPC fellowship" can change your mindset.

Finally, each doctor shares what they protect outside of medicine, from Orange Theory and school calendars to jazz saxophone, gardening, parrots, and Italian lessons. Because the goal of Direct Primary Care isn't to build yourself a new cage.

In this episode:

• How adding an RN for triage, refills, and hospital follow-up became a "level unlock"
• Using AI-generated chart prep summaries and a shared inbox to protect clinical time
• Why 150 to 200 patients per physician works for one practice, and why there is no single "right" panel size
• Hiring a fourth physician and creating SOPs six years in
• Running a solo house-call practice and partnering with local pharmacies for exam space
• How to talk to patients about misinformation with authenticity instead of data dumps
• Why nuance isn't clickbait, and how to communicate risk so patients can act on it
• Financial tips: loan forgiveness, low startup overhead, raising prices, and tools like Ramp, Digits, and Gusto
• Setting guardrails so DPC doesn't become your new golden handcuffs

Resources mentioned:

• DPC Mindset Retreat with Dr. Maryal Concepcion and Dr. Deepti Mundkur
• Find a DPC physician: thedpcdirectory.com
• Free startup checklist and the Physician Owner's Planner: mydpcstory.com
• Leave a voice message for the show: mydpcstory.com/contact

If this episode helped you, please leave a five-star review on Apple Podcasts so more physicians can find these stories.

Get $250 off registration at HLTH with code H26MYDPCSTORY - and join Maryal at Healthcare's #1 Innovation Event. Las Vegas Nov 15th-18th.

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Under current Medicare rules, a physician who opts out of Medicare for their DPC practice can't bill Medicare anywhere else. That means no hospitalist shifts, no SNF work and no hospice. AAFP Resolution 504, introduced by the New Mexico chapter, asks the AAFP to advocate for a partial opt-out by practice setting. The Congress of Delegates votes on it in October.

Dr. Shannon Connolly is co-owner of Open Arms Direct Primary Care in Southern California, a past CAFP president and a CAFP delegate to the AAFP. She joins Maryal to explain what the resolution says and why every DPC doctor should pay attention, whether or not you're an AAFP member.

In this episode:

• Why DPC is at a tipping point, with DPC doctors now more than an estimated 11% of AAFP membership
• How the "all-in or all-out" opt-out rule makes DPC doctors choose between their practice and their hospital, SNF or hospice roles, and why that reduces access for patients
• What happens if Resolution 504 passes: from the Congress of Delegates to a commission, the board and the AAFP policy compendium
• Why wording matters, including the "one employment setting" language and why practice owners need a say in it
• How to start advocating even if you're not a health policy expert
• Using the AAFP, the DPC Coalition and your state chapter together
• Dr. Connolly's call to action: advocacy is an investment in the environment your business depends on

Resources:

• Resolution 504 and background on the My DPC Story blog (no AAFP login needed):
• AAFP's July 2026 letter for the record on direct contracting: LINK
• Our earlier episode on Medicare opt-out with Dr. Phil Eskew: LINK
• DPC Coalition: https://dpcare.org Note: The DPC Alliance does not engage in policy as the DPC Coalition does.

Have thoughts on Resolution 504? Leave a voicemail at mydpcstory.com/contact. As chair of the AAFP Direct Primary Care Member Interest Group, Maryal will bring your comments to the AAFP.

Want more Medicare and DPC policy updates? Sign up for the My DPC Story newsletter at mydpcstory.com so you're the first to know when the next Toolkit Magazine drops.

This episode is not sponsored by the AAFP. Follow @mydpcstory and find free resources, the Physician Owner's Planner and more at mydpcstory.com.

Get $250 off registration at HLTH with code H26MYDPCSTORY - and join Maryal at Healthcare's #1 Innovation Event. Las Vegas Nov 15th-18th.

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Today a DPC physician in Iowa, 25 months into her DPC practice, emailed us with three decisions she's weighing, and one challenge: "If there are still spots, convince me to come."

Challenge accepted.

In this mini My DPC Story episode, Drs. Clodagh Ryan and host Maryal Concepcion answer her directly and walk through how the Illinois DPC Summit (open to DPC docs in ALL STATES!) meets each of the three things she's actually asking:

• "Help me look at the books." Friday morning's session, The Business You Have Never Run — Dr. Joel Schumacher and Dr. Clodagh Ryan open their real numbers in front of the room, not a pretty presentation of averages. Then Saturday, the whole room builds a cash rate sheet together including labs, imaging, dispensing. Bring YOUR numbers and leave seeing your practice more clearly!
• "Close the panel or grow?" Saturday's growth clinic. You bring the decision that's stalling you and the room works it with you! There are no formal lectures with slides. ZERO. You sit with physicians who capped, who grew, who did one and then the other, and you get to ask them why.
• "Buy or keep renting?" Not a session title but exactly what the open breakouts are for. Maryal went from telemedicine home visits, to renting, to a lease-to-own she took over in 10 months.

40 physicians. That's the cap. Small groups, a speaker at every table, dinner Friday night at Topgolf. You're not sitting in a row watching someone present at you. Refreshingly, you're talking, for two days, with fellow DPC Physicians who've already made the decisions you're weighing right now.

To the doctor in Iowa: thank you for writing. 25 months of DPC is no easy feat, and you're right at the decisions that shape the next 10 years.

Registration closes September 25. Go to caradirectcare.com/summit to grab one of the last seats. To our DPC colleague in Iowa, we hope to see you in IL!

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Dr. Brian Juan toured with rock bands and played dueling piano bars for more than a decade before he became a family doctor. Three months into Metronome Family Medicine, his solo Direct Primary Care practice in Longmont, Colorado, he talks about what it actually took to make the leap.

Dr. Brian Juan spent most of his 20s and 30s on the road, first touring with rock and jam bands, then playing dueling pianos in bars around Boulder and Denver. His dad was a Filipino immigrant physician who ran a small practice out of the family's basement in rural New Jersey, so medicine was always somewhere in the background. It wasn't until a bar owner called him one day in 2007 and told him not to bother coming in, because they were putting in a mechanical bull instead of pianos, that he actually went back to school. He was 33.

In this episode, host Dr. Maryal Concepcion catches up with Dr. Juan three months into running Metronome Family Medicine, his solo Direct Primary Care practice in Longmont, Colorado, built around midlife vitality and longevity. They get into what actually kept him at his corporate job for nine years, and it wasn't inertia, it was real financial fear. They cover the savings buckets system that finally got him to leave, the pro forma he built in one night with another DPC physician, and how his years as his old clinic's go-to guy for AI documentation tools are shaping the practice he's building now. And yes, they get into the music too.

In this episode:

• Growing up inside a Filipino immigrant physician's basement practice in rural New Jersey, throat swabs, wart removals, the whole deal
• Choosing a band over med school when "doctor" was basically the only acceptable answer growing up
• A decade-plus on the road, rock and jam bands in his 20s, then years as a dueling pianist around Boulder and Denver
• The 2007 phone call that ended his music career, when the bar replaced the pianos with a mechanical bull
• Going back to school at 33, starting with intro chemistry, then medical school at the University of Colorado
• The student debt, foreclosure, and bankruptcy that shaped every decision that came after
• Nine years in corporate medicine and the real reason he stayed
• What finally made leaving possible: a financial planner and a savings buckets system
• Building the pro forma that got him a small business loan he still hasn't touched
• Running 500 AI scribe notes in a pilot that asked for ten, and what that taught him about his own tech stack
• 90-minute new patient visits, InBody body composition scans, and relearning how to take a manual blood pressure
• Precepting medical students in a Direct Primary Care clinic through CU's Longitudinal Integrated Curriculum
• The boundaries that keep it sustainable: no calls after 5pm, weekly hikes with his wife, actually writing music again
• His 25-year collaboration with Colorado Rock and Roll Hall of Fame bluesman Otis Taylor, and why he still plays with Docs That Rock

Get $250 off registration at HLTH with code H26MYDPCSTORY - and join Maryal at Healthcare's #1 Innovation Event. Las Vegas Nov 15th-18th.

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What should a direct primary care physician actually pay themselves? On this episode of My DPC Story, Dr. Maryal Concepcion sits down with Nate Goodman, CPA, founder of Goodman CPA, the accounting firm that works exclusively with direct primary care and direct specialty care practices.

Nate is also a DPC patient. His family's experience with direct primary care in the Black Mountains of North Carolina is why his firm stopped taking non-direct care clients in 2024.

Together they walk through 10 questions, each with a real number attached, that every DPC owner should be able to answer.

In this episode:

• How to set a DPC membership rate using your household budget and local census income data
• Why most physician owners are 30 to 50 percent underpriced once discounts and free memberships are counted
• Where an enrollment fee should sit (one to two months of membership) and what it funds
• The profit margin to target with employees (about 30 percent) versus a solo micro practice with no payroll (up to 70 percent)
• How many months of cash to hold before raising your own pay
• The Profit First method for DPC: 20 percent to owner's pay and 15 percent to taxes from day one
• What has to be true in your numbers before hiring a second physician, and the marketing signal most owners miss
• The true loaded cost of a hire (1.25 to 1.4 times base salary)
• What a normal annual termination rate looks like and when churn means something is wrong
• LLC versus S corp: the 15.3 percent self-employment tax and where the break-even point sits
• Year-end tax moves to make before December, including the 401(k) setup deadline

Free calculator: Nate and the My DPC Story team built a free DPC financial calculator so you can run your own membership pricing, enrollment fee, owner pay, and hiring numbers. Get it at mydpcstory.com.

Listener offer: My DPC Story listeners get 25 percent off onboarding fees for Goodman CPA's full services, including tax advisory and fractional monthly accounting. Use the links at mydpcstory.com.

Ways to work with Goodman CPA:

• The DPC Circle community with monthly live Q&A ($10/month)
• Launch Pad for physicians opening a new practice ($2,500)
• Fractional accounting and payroll team (starting around $1,250/month)

This episode is sponsored by Goodman CPA. Nothing here is legal or tax advice. Talk with your own CPA about your practice.

Leave a voice message at mydpcstory.com/contact and you might hear your question answered on a future episode.

Follow My DPC Story on social media and find The Toolkit Magazine, free resources, and The Physician Owner's Planner at mydpcstory.com.

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Dr. Jillian Klaucke, MD, FAWM. Board-certified family physician at Sandpoint Premier Direct Primary Care, Idaho. Wilderness medicine fellow.

Eight years into Direct Primary Care, Dr. Klaucke shares what actually works running a rural family medicine practice without insurance. Her practice runs on three pillars: teamwork, accountability, and patient safety.

Teamwork means working with patients as partners. When imaging is needed, someone follows up to confirm it happened. Accountability means closing every loop: a weekend text gets a Monday check-in call. A referral goes out? Her staff confirms scheduling. Care management is where rural DPC shines, loaning crutches, sourcing equipment for Medicaid patients, walking alongside people through the whole process. This work can't be billed to insurance. It's exactly why patients choose DPC.

After eight years, Dr. Klaucke has real data on after-hours access. She gets three to four calls or texts per weekend. Most are appropriate and time-sensitive. Patients don't abuse the privilege because they trust her. The relationship is the whole point.

Managing a practice while seeing a full panel requires strategy. She leans on her office manager, partners with reliable vendors, and divides big tasks with her partner. The risk isn't systems on autopilot—it's neglecting to monitor them. She checks in regularly on vendor performance and catches cost creep before it happens.

Many patients come to DPC after healthcare trauma. Dismissal. Delays. Lost in the system. Dr. Klaucke rebuilds trust by listening and keeping patients from slipping through cracks. This emotional healing matters as much as the medicine. Trust changes how you practice: instead of firefighting, you do prevention. Cardio IQ testing. Risk stratification. Lifestyle conversations. You have time to help people see grandkids born, kids graduate.

Residents and early-career physicians ask Dr. Klaucke about DPC. She advises doctors in other states considering it. She tells them the truth: you need time in the trenches first, seeing volume and learning triage. Then DPC makes sense. In DPC, you collaborate with colleagues, check rashes together, call about differential diagnoses. Once you see that, you can't unsee how dysfunctional big systems are.

Dr. Klaucke's grandfather pioneered rural medical education in the 1960s-70s. She wonders what he'd think of her now, practicing the kind of medicine he believed in, through a model that protects it from the insurance system. She thinks he'd be proud. And he'd probably be right about what matters: teamwork, accountability, showing up for patients.

This is what Direct Primary Care looks like when given time to grow.

Resources: Sandpoint Premier DPC: sandpointdpc.com | (208) 263-3091 | My DPC Story: mydpcstory.com

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Dr. Sarai Ambert-Pompey opened Libélula Primary Care in Boise, Idaho. "Libélula" is Spanish for dragonfly, chosen for transformation. One year in, she joins Dr. Maryal Concepcion to talk about what changed when she left the VA for Direct Primary Care.

Her path is unconventional: CompUSA and GameStop, Sony PlayStation reviewer training, oncology research at OHSU, then internal medicine residency in Boise. At the VA she joined a Primary Care Center of Excellence and helped launch the Boise Clinical Resource Hub, delivering clinic-to-clinic telehealth to rural sites across the Northwest, then trained physicians in telemedicine through the Ada County Medical Society during the pandemic.

In this episode:

Why time is the intervention - patients arrive never having been told their A1C goal, their blood pressure goal, or what their medications are for. Longer visits keep high ER utilizers out of the ER.

Culturally responsive care in Idaho - Boise is predominantly white, but farming communities and employers like Micron bring diversity the traditional system was never built to serve. Healthcare trauma can take several visits to overcome before a patient consents to a blood draw.

Telehealth done right - her top three: screen whether the visit is appropriate, build an emergency protocol and know your state's consent law, and actually perform a physical exam on video. Most clinicians skip that last one.

How to vet an EHR - test customer service response time first, ask about interoperability, run a full patient walkthrough instead of the salesperson's highlight reel, get pricing broken out line by line, ask how an AI scribe stores data, and watch for 12-month contracts.

Community as marketing - she launched a Walk with a Doc chapter before the clinic opened. Chamber involvement, immigration medical exams, and one paid social promo that returned its investment in a week.

Leaving the system - 15 pounds lost, sleep restored, weekends back. "I tell anyone who will listen: I wish I had done it earlier."

Mentioned: IN -PERSON DPC SUMMIT COMING IN OCT 2026! Illinois DPC Summit, first week of October, open to out-of-state physicians - register at caradirectcare.com/summit · Walk with a Doc · Latino Conservation Week · Idaho Hispanic Chamber of Commerce

Free DPC startup checklist, the Physician Owner's Planner, and the DPC Toolkit Magazine: mydpcstory.com

Leave a voice message for the show: mydpcstory.com/contact
Follow @mydpcstory · Leave a 5-star review on Apple Podcasts

Get $250 off registration at HLTH with code H26MYDPCSTORY - and join Maryal at Healthcare's #1 Innovation Event. Las Vegas Nov 15th-18th.

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One month shy of five years. That is how long Big Trees MD ran on the electronic health record it opened with, and this month, that ended. Not because Dr. Maryal Concepcion went looking for something shinier, but because the terms under which her patients' data lived changed, and she could not accept them.

In this solo episode, Dr. Concepcion documents the switch in real time from her rural Direct Primary Care practice in Arnold, California, which she owns with her husband, Dr. Jeremiah Fillo, and runs with a fully virtual team. No vendor names, on purpose. The names change. The framework does not.

Built from The Toolkit's Battle of the EHRs issue, where over 200 DPC EHR users shared what they use and why, this episode walks through how to choose an electronic health record that grows with your practice instead of boxing you in:

• Why an EHR is the memory of your practice, and why the DPC version of this decision is nothing like the fee-for-service version
• The 10 categories to score every EHR on, from membership billing and charting speed to support quality and scalability
• The 5 questions to ask before you switch, starting with "what problem am I really trying to solve?"
• How to run a demo on your terms: build a fake patient, count clicks out loud, ask about migration before features, and ask the question nobody asks, which is "how do I leave you?"
• Why you should research who owns the EHR company, especially as private equity and venture capital creep into Direct Primary Care
• Running the real math: subscription, add-ons, switching costs, and exit costs over a three year horizon, plus what an hour of your life is actually worth
• The hidden costs no spreadsheet captures: patient trust, the emotional weight of change, and the 90 day post-switch reality check

Things have changed since the Summer 2025 issue published, and the second Battle of the EHRs opens for voting in Q1. The only way to vote is through the My DPC Story newsletter, so sign up at mydpcstory.com.

FREE from The Toolkit at mydpcstory.com:

• How to Interview Electronic Health Records comparison worksheet
• Patient handout on choosing healthcare vs. health insurance (perfect for open enrollment season)
• The Lean Startup Business Plan
• The First Year Roadmap
• Every issue of The Toolkit, including the new Battle of the Support Stack

Follow the full switch in real time: demos, migration answers, the four-bucket spreadsheet, and the second guesses, all inside the My DPC Story Patreon community.

Leave a voice message with your question, challenge, or win at mydpcstory.com/contact and you might hear it on a future episode.

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When Dr. Laura Petrescu opened Athena Direct Primary Care & Lifestyle Medicine, she was the only Direct Primary Care physician in the Rochester, NY metropolitan area. Health system leadership thought she was out of her mind. Colleagues told her nobody would pay a membership on top of insurance. The advice everywhere was the same: New York is too restrictive, and DPC will not work here.

Today there are seven or eight DPC practices in the Rochester area, and Dr. Petrescu has founded the New York State Direct Care Physicians Alliance with board members from Buffalo, Syracuse, Hudson Valley, and New York City.

In this episode of My DPC Story, she and Dr. Maryal Concepcion get specific about the mechanics most physicians never hear.

In this episode:

• Why she filed as a 501(c)(6) business league instead of a 501(c)(3), and why the charitable designation would have blocked advocacy entirely
• What the state and IRS filings actually cost, and where the paperwork gets returned
• How reading her contract first led to her health system releasing her from a 10-mile non-compete radius
• How to build a board representing rural, metropolitan, and downstate practices
• Why eight busy physician owners vote on motions by email instead of scheduling Zoom calls
• What New York's lab restrictions mean in practice, and why they are the alliance's top legislative priority
• How California organized, from monthly meetings that fizzled to a state summit with 80 physicians

About the guest: Dr. Laura Petrescu is triple board certified in internal medicine, lifestyle medicine, and menopause medicine, with 25 years in practice. Originally trained as a surgeon in Romania, she is founding president of the New York State Direct Care Physicians Alliance.

Links:

New York State Direct Care Physicians Alliance: nysdirectcare.com
California DPC: calidpc.com

Legal question for My DPC Story State by State with Dr. Phil Eskew? Leave a voicemail at mydpcstory.com/contact

Organizing in your state? Leave a voicemail there too so we can highlight your group

Free startup checklist, The Physician Owner's Planner, The Toolkit Magazine, and every episode: mydpcstory.com

Follow @mydpcstory

Upcoming: Illinois DPC Summit, October 2 to 3, NIU Naperville. California DPC Summit, June 2027, registration open. https://caradirectcare.com/summit

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Direct Primary Care no longer disqualifies patients from HSA eligibility. As of January 1, 2026, DPC membership fees are a qualified HSA expense at or below $150 per month for one person and $300 for a family. Above $150 you are not in violation. You are in the same gray zone DPC lived in for a decade, and the tax position belongs to the patient and their accountant, not to you.

Dr. Phil Eskew (DO, JD, MBA) of DPC Frontier joins Dr. Maryal Concepcion to break down what changed and what it means for your practice, then walks through the Medicare opt-out calendar most physicians discover too late.

KEY NUMBERS AND DATES
$150/month per person, $300 family. Effective January 1, 2026.
Opt-outs take effect only on January 1, April 1, July 1, October 1.
Affidavit must be filed at least 30 days before the effective date.
File by roughly December 1, 2026 to be opted out January 1, 2027.
90-day reversal window, but you must refund every membership dollar collected.

QUESTIONS ANSWERED

Can patients use an HSA to pay for direct primary care?
Yes, as of January 2026. Both old IRS objections were fixed: whether the fee is a medical expense, and whether membership disqualifies HSA contributions.

Should I put "HSA eligible" on my website?
No. Write "We accept HSA cards." Promising eligibility in your marketing or agreement takes on a tax position on your patient's behalf.

How do I get under $150 without losing revenue?
Enrollment fees are not compensation for care. Blood draws, injections, EKGs, and dispensed medications can price separately.

What does the rule exclude?
Prescription drugs other than vaccines, and lab services not typically done in an ambulatory primary care setting.

If I opt out, can I still order labs and referrals?
Yes. Opting out is not disenrollment. You stay credentialed and Medicare pays for labs, imaging, referrals, DME, and prescriptions you order.

Where can I still work while opted out?
VA, Indian Health Service, corrections, and hospice administrative work. Precepting usually requires participation. TRICARE requires Medicare participation. Medicaid uses ORP/OPR status, prohibited in Kentucky and Colorado.

Does opt-out apply to Medicare Advantage?
Yes. Opt-out applies to all Medicare programs nationwide. You cannot opt out selectively.

MENTIONED
DPC Frontier · McCarran-Ferguson Act (1945) · ACA primary care carve-out · bronze and catastrophic plans as HSA-compatible · capacity vs. competency · durable power of attorney · prior authorization escalation strategy

HAVE A QUESTION? WE ANSWER THEM ON AIR.
Leave a voicemail at mydpcstory.com/contact with your name, state, and question.

NEXT EPISODE: ILLINOIS, timed to the Illinois DPC Summit, October 2 and 3, NIU Naperville. Subscribe to the My DPC Story newsletter at mydpcstory.com to know when it drops.

Educational only. Not legal or tax advice. Dr. Eskew is not your attorney.

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Dr. Kyle Rickner heard about Direct Primary Care in a side room at the AAFP National Conference in October 2014 and committed to it 50 minutes later. Today Primary Health Partners cares for employee lives in 30 states, and it started with a patient named Jason who owned a 22 person company and handed Dr. Rickner a check covering every employee for a full year, six weeks after opening.

In this episode, Dr. Rickner talks with Dr. Maryal Concepcion about what it takes to build a DPC practice that serves employers without giving up autonomy. He opened with 198 members on day one after a 15 month runway, a $1,000 equipment haul from a shuttered nursing program, and a lot of honest conversations with patients he wanted to bring with him.

He also gets direct about the mistakes he sees. Enrollment is not engagement. A 375 employee contract can gut a 600 patient panel overnight if that company sells or closes. And overpromising to an employer poisons the well for the next DPC doctor who walks through that door.

What you will hear:

• Why commitment and enthusiasm persuade patients faster than any marketing budget
• The three pillars Primary Health Partners built on before opening the doors
• How to identify a good employer partner, and when to say no
• Utilization differences between retail members and employee members, and why adoption rates range from 10% to 92%
• How he built a 28 doctor affiliate network in three weeks using DPC Mapper
• What he thinks about private equity and venture capital money entering DPC, and the two non-negotiables that protect your practice
• Why passive customer acquisition channels may be how DPC reaches the next tens of thousands of patients
• Lessons on autonomy from practicing inside the Army health system

Find resources and your next step at mydpcstory.com, including the free startup checklist and the Physician Owner's Plannerbuilt for the business side of practice ownership.

Leave a voice message at https://www.mydpcstory.com/contact and your question could be featured on a future episode.

Follow My DPC Story on socials @mydpcstory.

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Two months after opening Amity Creek Primary Care in Duluth, Minnesota, Dr. Nyasha Spears returns to My DPC Story with the real numbers, the real costs, and the parts of a Direct Primary Care startup nobody puts on a slide.

She and her DPC partner Dr. Kristin Lusian hit 130 patients six weeks in, with no advertising beyond a website and word of mouth. As of June they are covering overhead, rent, and debt payback, though they are not paying themselves yet. Meanwhile the non-compete case that made the opening possible is still moving. Her former employer appealed the temporary injunction and filed a motion to stay, so Dr. Spears is funding an appellate defense while building a brand new practice from scratch.

In this episode:

• What a non-compete fight really costs, and what physicians considering the legal path should prepare for financially and emotionally
• Why keeping membership prices low was a boundary decision, not only a pricing decision
• How she handles patients wanting care her practice does not offer, and when "no" beats "yes, with limits"
• The justice and equity case for DPC, and why she is focused on patients who fall through the safety nets rather than on replacing Medicare and Medicaid
• Boring wins worth celebrating: custom patient ringtones so calls stop landing in personal voicemail, decoding hospital lab orders with CPT and ICD codes, and 12 successful blood draws in five weeks
• Two-physician cross coverage, planning the first vacation, and the schedule she rebuilt once her husband started working three days away
• Keeping skills sharp with journal club, procedures, and actually reading again
• Why she says the more DPC the better, even in her own city

Maryal also shares how Big Trees MD partnered with Calaveras County Health so uninsured patients get same-day help, including one patient who went from panicking about medication access to picking up a prescription within eight hours.

If you are weighing a non-compete, pricing your memberships, or wondering whether patients will actually come, this conversation is the honest version.

Resources mentioned:
Amity Creek Primary Care: https://amitycreekclinic.com/
Advocacy with the DPC Coalition: dpcare.org
Big Trees MD: bigtreesmd.com

Find your starting point at mydpcstory.com, from the free startup checklist to the Physician Owner's Planner built for the business side of your practice.

Leave Maryal a voice message at mydpcstory.com/contact. Your question or win could be featured on a future episode.

Follow @mydpcstory and please leave a five star review on Apple Podcasts so more physicians find these stories.

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Recorded LIVE on the floor at the AAFP Co-sponsored DPC Summit in New Orleans, Dr. Angela Andrews of Direct Primary Care of West Michigan and Dr. Nicholas Jones of Clear Health Direct Primary Care in Eugene, Oregon sit down with Dr. Maryal Concepcion for an honest roundtable on what changes between year one and year three of direct primary care practice ownership.

Both opened in November 2023. Both came to New Orleans with a list. What they say out loud is what most physicians only think: the workflows you built on day one and never revisited, the boundaries you are usually the first to cross, and the succession question this movement has not solved yet.

IN THIS EPISODE

Physician owned regional DPC networks, and using them for call coverage, internal locums, and physician funded startup loans instead of banks

Why you do not need a nonprofit to do nonprofit work

Revisiting the workflows you built when you were solo, and what to automate, eliminate, or document

Employers as the next phase of DPC growth, and the arrival of employed DPC positions

Boundaries, moral injury, and why the physician is usually the first one to violate the boundary

How to handle one star reviews and trolls without losing your weekend

Succession planning, and what happens to patients when a DPC physician gets sick or closes

Oregon's corporate practice of medicine law, the non compete ban, and what advocacy looks like when you own your practice

Getting onto your state chapter committees, and why DPC needs representation at AAFP and state academies

Spouses, kids, and the family roles that quietly keep practices running

Choosing an EHR you will not have to leave in three years

MENTIONED IN THIS EPISODE

Dr. Emily Holt, Dr. Esther Khatibi, Dr. Julie Gunther, Dr. Timothy Blain, Dr. Phil Eskew, Dr. Jill Scherer, Dr. Clodagh Ryan, Dr. Neil Douglas, Dr. Hailey Miller, Dr. Amy Tressan, and Shaunna Sanders

RESOURCES

The Toolkit Magazine, including this year's Battle of the Support Stack and last year's Battle of the EHRs: toolkit.mydpcstory.com

The Physician Owner's Planner Limited First Edition Bundle: mydpcstory.com/shop

PHYSICIAN OWNER'S PLANNER BUNDLE

Fifteen available. Each one includes the printed Physician Owner's Planner in a binder, the digital bundle with our Medicare and Medicare Advantage Open Enrollment Guide, the yellow "Insurance is not healthcare" T-shirt, and a personal website review from Dr. Maryal Concepcion and Nathalia Hyland, head of marketing and strategy at My DPC Story. Limited shirt sizes remain. mydpcstory.com/shop

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From physician assistant to DPC physician, Dr. Reid Lancaster took the long road on purpose. In this episode of My DPC Story, he sits down with Dr. Maryal Concepcion to trace his journey from PA to DO and the moment a three-minute news clip about direct primary care planted a "worm in his brain" he couldn't shake.

Dr. Lancaster is the founder of Ethos Modern Medicine in La Quinta, California, just outside Palm Springs in a community as economically diverse as almost anywhere in the country. He shares why he chose to become a physician rather than practice independently as a PA, the honest differences he sees between PA, NP, and physician training, and how residency shaped what he can now do for his patients in primary care.

This conversation is packed with practical wisdom for anyone weighing a DPC of their own. Dr. Lancaster opens up about the naysayers he faced through medical school and residency, the mentors who pushed him to "cash in" on a traditional job, and the wife who kept the dream alive when the doubt crept in. He also reflects on the business side he never trained for, from California compliance surprises to the taxes and systems that fall through the cracks in year one and beyond.

You'll hear the real stories behind the lessons: the AI answering service named Jarvis that tanked his consults by 80 percent, the patients stuck in referral limbo despite having insurance, and the goals he wrote down before opening that he rediscovered in an old drawer. Dr. Lancaster makes the case that mistakes are lessons, that hiring a little earlier than feels comfortable can accelerate growth and protect your quality of life, and that clear boundaries set upfront are what keep DPC sustainable.

Now three and a half years in and effectively full at 600 patients with no marketing, Dr. Lancaster reflects on what growth looks like from here, the working partnership he's exploring with PAs and NPs in the DPC space, and why the local coffee shop model, not the franchise, may be the future of direct primary care.

Whether you're a pre-med student, a resident or a physician eyeing the exit from fee-for-service, or a DPC owner thinking about your next step, this episode is a reminder that you've done hard things before and you can do this too.

Head to mydpcstory.com to find your starting point, and come say hi at the AAFP co-sponsored DPC Summit in New Orleans.

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When Dr. Timothy Blain opened his direct primary care practice in the middle of COVID, he finally felt like a “real doctor” again — after two decades of employed medicine, five-year burnout cycles, and the constant ache of knowing he could help patients but never had the time.

In this honest and moving episode, Dr. Blain shares his full journey: graduating in 2000 as hospitals bought up practices, surviving non-Hodgkin lymphoma at 38, then weathering COVID pneumonia, a heart attack, and adult-onset Still’s disease — all while continuing to care for his patients. He opens up about how DPC helped save his marriage, why empathy is the first thing burnout takes from physicians, and what it truly means to be the patient when you’re also the doctor.

Dr. Concepcion and Dr. Blain dig into:

•The 5-year burnout curve, and why “just take a half day” never works

•Building patient loyalty so deep that almost no one left, even through his hospitalizations

•Practical steps for leaving employed medicine for DPC (including the prepay discount that funded his startup)

•Why DPC doctors may be best positioned to use AI in medicine

•Supplements, home visits, ultrasound, and staying curious as a physician

•How and why he chose to close his practice — the taxes, timing, and grief involved

•Redefining “failure” and finding peace in a one-year sabbatical

Whether you’re burned out and dreaming of a way out, a few years into your own DPC, or simply wondering what a fulfilling end to a medical career can look like, this conversation is a breath of fresh air.

“Failure is in the eye of the beholder.”

— Dr. Timothy Blain

—

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Come say hi at the AAFP co-sponsored DPC Summit in New Orleans!

Explore free tools for every stage of your DPC journey — the 90-day startup checklist, and the Physician Owner’s Planner — at mydpcstory.com.

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What does it look like to build a Direct Primary Care practice that protects your health as fiercely as it protects your patients? In this episode of My DPC Story, Dr. April Soto of Love and Light Integrative Medicine in South Pasadena, California shares how she systematically exited corporate medicine over three years and built an integrative DPC practice rooted in authenticity, boundaries, and healing.

After more than a decade in fee-for-service family medicine and infectious disease, including HIV care, Dr. Soto completed an integrative medicine fellowship, trained in ketamine-assisted therapy, and opened a micropractice designed around her own capacity as a physician living with chronic illness and mast cell activation syndrome (MCAS). Today she receives MCAS referrals from specialists across the country and offers ketamine journeys, transgender care for patients from age three to eighty, and deeply unhurried visits that can run four hours.

In this conversation, Dr. Soto and host Dr. Maryal Concepcion discuss:

• Why she left corporate medicine and how she planned her three-year exit
• Facing fears around money, homelessness, and financial security before opening a DPC
• Pricing as a quality-based practice instead of competing on discounts
• What she learned from giving too many discounts in year one
• How her assistant Natalie supports meet and greets, workflows, and boundaries
• Building an inclusive practice for LGBTQIA+ patients, immigrant communities, and neurodivergent patients
• Caring for patients afraid to seek care because of ICE enforcement
• MCAS diagnosis, testing pitfalls, and why these patients need a different kind of visit
• Ketamine-assisted therapy pricing, informed consent, and managing patient expectations
• Burnout, trauma as a superpower, and why inclusivity has to include the physician
• Her five-year vision: wellness contracts, motivational speaking, and growing her team

Whether you are planning your DPC launch or working to make your existing practice more sustainable, this episode is a masterclass in valuing yourself, honoring your capacity, and practicing medicine on your own terms.

Learn more about Dr. April Soto at Love and Light Integrative Medicine in South Pasadena, CA.

Visit mydpcstory.com for the free 90-Day Startup Checklist, the Physician Owner's Planner, and DPC tools for every stage. Leave a voicemail at mydpcstory.com/contact and you might hear it on a future episode. Support the show on Patreon for commercial-free and extended episodes.

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