How to Start a DPC Practice: A 12-Month Roadmap

Why Now Is a Good Time to Start a DPC Practice

Direct Primary Care has grown from approximately 300 practices in 2010 to over 2,500 in 2026. More than 30 states have enacted DPC-enabling legislation that clarifies the legal status of DPC memberships (not insurance contracts). Employer interest in DPC as a benefit has expanded significantly since 2022 as small and mid-size businesses seek alternatives to rising group health insurance premiums.

The financial case is also clearer than it was five years ago. The DPC model is well-documented: a solo physician with 600 patients at $85/month generates $612,000 in gross membership revenue with lower overhead than a fee-for-service practice. For physicians who feel trapped in a volume-driven, insurance-dependent system, DPC offers a genuine alternative.

This roadmap assumes you are starting from employment or an existing fee-for-service practice. Adjust timelines as needed for your situation.

Months 1–3: Foundation and Legal Structure

Step 1: Verify Your State's DPC Landscape

DPC-enabling legislation exists in 30+ states, but the specifics vary. Some states explicitly exempt DPC membership agreements from insurance regulation; others have no specific DPC statute and require navigating insurance department guidance. Start by:

• Reviewing your state's DPC statute (search your state legislature website for "direct primary care")
• Consulting a healthcare attorney familiar with your state's DPC regulations—this is a $500–$1,500 investment that can prevent a $50,000+ mistake
• Contacting your state's insurance department if no statute exists—get a written opinion on whether your proposed membership structure is subject to insurance regulation

Step 2: Choose Your Business Structure

Most DPC practices organize as a Professional Limited Liability Company (PLLC) in states that allow it, or a Professional Corporation (PC). The PLLC structure provides liability protection while allowing pass-through taxation. A solo DPC physician PLLC with no employees can elect S-Corp taxation if profitable enough—a conversation worth having with your CPA when annual revenue exceeds $150,000.

Step 3: Review Your Employment Contract Non-Competes and IP Assignment

If you are leaving an employed position, review your contract for:

• Non-compete geographic restrictions and duration
• Patient solicitation restrictions (often different from non-compete terms)
• Chart and patient record ownership provisions
• Tail coverage obligations for malpractice

Non-competes in physician contracts are enforceable in most states but increasingly restricted—verify your state's current law. A healthcare attorney can assess your specific contract risk. Budget 90–180 days from resignation to practice opening to honor typical non-compete notice periods.

Step 4: Draft Your Membership Agreement

Your DPC membership agreement is the foundation of your business. It must clearly specify:

• Included services (define explicitly—list all services covered by the membership fee)
• Excluded services (labs, imaging, specialist care, medications not provided in-office)
• Membership fee, billing cycle, and payment method
• Termination terms (by physician and by patient)
• That the agreement is not health insurance
• HIPAA authorization and privacy practices

Have a healthcare attorney draft or review this document. Do not use a template found online without legal review for your specific state.

Months 4–6: Physical Space, Technology, and Operations

Step 5: Select Your Location

DPC practices require significantly less administrative space than fee-for-service practices—no billing staff, no insurance verification team, smaller waiting rooms (because you control scheduling more tightly). A solo DPC practice can operate from 600–1,200 square feet with 1–2 exam rooms and a front desk. This dramatically reduces overhead compared to traditional practice.

Monthly rent considerations:

• Target rent at 8–12% of projected monthly revenue (for a $51,000/month practice, $4,000–$6,000/month in rent)
• Look for medical office suites with shared reception—these often include utilities and janitorial at lower all-in cost
• Some DPC physicians start in home office setups with telemedicine-first delivery to minimize startup costs

Step 6: Select Your EMR and Membership Billing Platform

A DPC practice needs an EMR that handles both clinical documentation AND membership billing. The worst setup is separate systems for each—reconciliation between a clinical EMR and a standalone billing tool creates accounting gaps and administrative work.

Key EMR requirements for DPC:

• Built-in recurring membership billing (ACH, credit card)
• Membership tier management and panel capacity tracking
• AI ambient documentation (saves 45–90 min/day you cannot afford to lose with a small panel)
• Telehealth integrated (DPC patients expect portal and telehealth access)
• Clean patient portal for messaging, scheduling, and document sharing

Krasyn includes all of these. Its DPC module is specifically designed for this model—not adapted from a fee-for-service template. See the DPC feature set.

Step 7: Credentialing and Licensing

• Verify your medical license is in good standing and renew if within 12 months of expiry
• DEA registration if you plan to prescribe controlled substances
• CLIA waiver if you will perform in-office laboratory testing (urine dipstick, point-of-care glucose, strep test, influenza)
• If opting out of Medicare: file opt-out affidavit with your MAC. Opt-out takes effect 30 days after filing.
• Malpractice insurance: obtain occurrence-based or claims-made + tail coverage. DPC-specific malpractice products exist and may be less expensive than traditional coverage—contact DPCARE or your state medical society for referrals.

Months 7–9: Patient Acquisition and Marketing

Step 8: Build Your Initial Patient List

Most DPC physicians open with 100–200 founding members and grow to 400–600 over 12–18 months. Founding members typically receive a discounted rate ($10–$20/month off) as recognition for their early commitment and willingness to absorb the risk of a new practice.

Sources for initial patients:

• Your existing patient panel: patients you have treated who want to follow you (subject to non-solicit provisions in your employment contract—get legal clearance first)
• Employer groups: approach 5–10 small businesses in your area about a group DPC arrangement; a 50-employee company converting to DPC can add 50–100 members at once
• Community outreach: local presentations, farmer's market presence, chamber of commerce membership
• DPC specialty directories: DPC Alliance's provider directory, directprimarycare.com

Step 9: Price Your Membership and Build the Pro Forma

Use this formula to determine the minimum viable membership fee:

• Target annual physician income: $350,000
• Annual overhead (rent, staff, supplies, malpractice, EMR, marketing): $120,000
• Total needed from practice: $470,000
• Target panel: 600 patients
• Required monthly fee: $470,000 ÷ 600 ÷ 12 = $65.28/month minimum

Price above minimum to account for attrition and ramp-up: $75–$85/month for most markets. Research local competition—if there are established DPC practices nearby at $100/month with waitlists, your market can likely support $85–$95.

Months 10–12: Launch and Stabilization

Step 10: Soft Launch Before Full Capacity

Open to founding members at reduced capacity (100–150 patients). This controlled launch lets you refine your workflows, identify scheduling issues, and get comfortable with the membership billing cycle before scaling. Use this period to ask founding members for referrals and testimonials.

Step 11: Financial Runway Planning

The ramp to break-even for a DPC practice is typically 6–12 months. You need financial runway to cover this period. Minimum recommendation: 6 months of personal and practice expenses in liquid reserves before opening. Alternatively, some physicians use a "moonlighting" strategy—maintaining part-time employed work during the first 6 months of DPC growth.

Step 12: Build Your Wholesale Lab and Imaging Network

Negotiate direct pricing with Quest or LabCorp (or regional reference labs). A comprehensive metabolic panel at wholesale may cost $8–$12 vs. $150+ through insurance. Patients see this as a major benefit—document your wholesale pricing list and share it with members so they understand the value.

For imaging: build referral relationships with independent radiology centers willing to offer self-pay rates. Many offer 50–70% off standard charges for direct-pay patients.

Timeline Summary

DPC Practice Launch Timeline

Month	Key Milestones
1–3	Legal structure, state registration, employment contract exit, membership agreement drafting
4–6	Space selection, EMR selection, credentialing, malpractice, CLIA waiver, Medicare opt-out
7–9	Founding member recruitment, employer outreach, pricing finalization, marketing launch
10–12	Soft launch, billing cycle testing, lab network, referral relationship building, scale to target panel