Why I have ZERO Staff...

ZERO.  None, nobody, nohow.  That's right, seven plus years into practice and our DPC has no staff.  And guess what - we have no need for staff and no plans to hire anyone - ever.  How do we do it?  Why do we do it?  Because it is the best way to have your practice be 100% what you want and to rely on no-one else to get or keep you there.

Costs: this is a no brainer but one of two biggest expenses in a practice is staff (the other is insurance billing and we already know direct care eliminates that).  But not having staff saves not only the cost of their payroll, but also any benefits they might expect and having to pay their social security and medicare FICA taxes.  

Reliability: I have seen far too many practices hire "the perfect MA" only to be let down a couple years later when that person leaves.  Having become dependent on their assistance (and in many cases having had them do many tasks that the doctor now has no idea how to do, makes the doc very reliant on that particular person.  When they leave (which inevitably happens almost everywhere) the doc is left empty handed, uninformed on many office procedures, and desperately searching for a replacement.  So - my advice? - rely on yourself and no one else.

Retirement Bonuses: as a self employed physician (or co-owned practice with other doctors) there are some huge 401k savings benefits.  Physician on Fire (one of my personal favorite financial independence specialists) writes about the many versions of 401k and details midway down the page how having your own business or being an independent contractor allows you to save way more than the standard into your 401k - to the tune of close to $60,000.  If you have employees, this solo 401k option is eliminated and you're back to the standard $19,500 as of 2021.  This is a huge benefit for physician owned small businesses who have no employees (although spouses are allowed to be employed as an interesting caveat!). Obviously, talk to your accountant on this one.

But I hear you still saying "How can I possibly run a practice without staff?"  Here is how we do it:
- Patients arrive and ring a bell in our waiting room; the doctor gets the patient and checks the vitals (imagine that!).
- The doctor reviews medical history directly with the patient and makes notes as he carries on.  Of course he/she does the visit, physical, procedures, etc.  
- The EMR allows the doctor easy access to schedule future visits or enter tasked reminders for next time.
- We block time to be able to spend making needed orders or referrals afterward (there is no magic science to this stuff, it is very simple!). Sure PAs come up here and there but most of the time websites like myevicore.com help make this pretty simple to do quickly and online.
- Texts and emails are responded to in between patients - our voicemail says we are busy seeing patients, so leave a message and we will get back to you - if urgent we will call quickly.  
- Our phone system texts us transcriptions so we can check easily and step out if needed (which is rare).
- We can handle many things that are clinically appropriate remotely which saves in office visit coordination and time.
- Our EMR allows e-rx, our fax is online and integrates directly to our EMR - we can be anywhere and handle all of this things!
- Patients can self schedule online with our EMR.
- We triage our very own patients (no one can decide when/where/how someone is seen but us and we do it the way we like rather than a secretary acting as middle man) - this helps the right patient be seen at the right time for the right duration which simplifies our work flow.

So, what is it you think you cannot do yourself?  
Not enough time? DPC gives ultimate flexibility so block your schedule off for admin hours or buffer before and after patients so you can handle patient and business needs.
Forgot how to do vitals or phlebotomy? Find your local DPC doc - he or she will probably give you a refresher!
Don't know how to answer the phone while seeing patients? Find an EMR or phone system with a service that allows texting the office or use a voicemail system where patients know you will see a transcription and call right back if urgent or get back to them by text/email when you have time for non urgent matters.

Believe in yourself - you are a physician - you completed medical school, residency and maybe even fellowship.  You passed medical steps and boards.  Just because the system has convinced you that you cannot doctor without medical assistants, PAs, secretaries, and billers does not mean that is true.  The only things you truly need are a doctor, a patient, a computer and a few pieces of medical equipment.  You got this!

---