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Bootstrap FAQ

Quick Summary: Every objection to starting lean, answered. If you're looking for permission to start simple, here it is.

"But Don't I Need..."

An Office?

No.

Options that work: - Telehealth only - Many DPC docs started here, especially during COVID - House calls - You go to them, old-school medicine - Home office - If zoning allows and you have space - Shared space - Rent a room by the hour/day - Sublease - From another physician, PT, chiropractor

When you need dedicated space: When patient volume makes alternatives inefficient. Usually 50-100+ patients.

The office doesn't make the practice. You do.

An EMR?

No.

Paper charts are legal. Google Docs with a BAA works. Even a Word document per patient works.

Physicians practiced medicine for decades without EMRs. Some still do.

When you need an EMR: - E-prescribing becomes essential (especially controlled substances) - Volume makes paper unwieldy (40-50+ patients) - Lab integration would save significant time - Patients expect a portal

Until then: Paper or simple digital docs are fine.

A Website?

Barely.

Google Business Profile is more important than your website. That's what shows up in local search.

Beyond that: - Carrd one-page site ($19/year) is plenty - Clear contact info and basic description - You don't need a blog, resource library, or patient portal

Most patients find DPC through word of mouth, not websites.

When to invest more: When you have money to spend and want to look more established.

Scheduling Software?

No.

A paper calendar works. Google Calendar (free) works.

"But patients expect online booking!" Do they? Ask them. Many are fine with a phone call.

When you need scheduling software: When you're actually so busy that manual scheduling causes errors. That's a great problem to have.

A Staff Member?

No.

You are the staff. Reception, billing, scheduling, MA - all you.

"But I went to medical school, not secretary school." You also have 5 patients, not 500. You're not too busy for this.

When you need staff: When patient volume means you're turning people away or burning out. Usually 150-250+ patients for solo doc.

Business Cards?

Not really.

Your phone number and a memorable conversation matter more.

If you want them: Vistaprint, $20 for 500. Takes 10 minutes.

No.

Your name is your brand. "Dr. Smith Family Medicine" is fine.

If you want one later: Canva (free) or Fiverr ($20-50).

Marketing?

Not paid marketing.

Your first 50 patients come from: - People you already know - People they know - Local word of mouth - Google Business Profile - Free social media

When to spend on marketing: When word of mouth isn't growing you fast enough and you have cash to invest.

CLIA Certification?

Only if doing point-of-care testing.

CLIA waiver ($180/2 years) is needed for: - Rapid strep - Urine dipsticks - Glucose monitoring - Flu tests

Not needed if you're sending all labs out.

Get it when: You want to do in-office testing, not before.

Medication Dispensing?

Not to start.

Dispensing adds complexity: inventory, licensing, DEA requirements.

Start by prescribing. Patient goes to pharmacy. Simple.

Add dispensing when: You want it as a service/differentiator and have volume to justify inventory.

A Business Plan?

Not a formal one.

You need to know: - What you're charging - How many patients to break even - Where patients will come from

You don't need: - 20-page document - Financial projections - Market analysis - Executive summary

Planning is guessing. Start, then adjust.

An Accountant?

Not immediately.

DIY for first year: - Wave (free accounting software) - Separate business bank account - Track income and expenses - Save receipts

Get an accountant when: Tax time approaches and you want help, or finances get complex.

A Lawyer?

For some things.

Worth paying for: - Reviewing your membership agreement (one-time, ~$500-1,000) - Entity formation advice if complex situation - Any partnership agreements

Not needed for: - Basic LLC filing (do it yourself online) - Standard operations - Day-to-day decisions

A Fancy Stethoscope?

No.

Your $150 Littmann works fine. The $400 version doesn't make you a better doctor.

"But What About..."

Looking Professional?

Professionalism is: - Listening to patients - Being available - Providing good care - Following through

Professionalism is not: - Expensive office - Fancy website - Branded everything - Software subscriptions

Patients care about you, not your infrastructure.

Scaling Later?

Scaling is easier when you: - Know your patients (what they actually need) - Know your systems (what actually works) - Have revenue (to fund improvements) - Have experience (to make good decisions)

Starting lean teaches you everything. Starting heavy hides problems behind complexity.

Competition?

Your competition isn't other DPC practices. Your competition is: - Patients not knowing DPC exists - Patients thinking they can't afford it - Inertia (staying with their current doctor)

None of these are solved by having fancier systems than the next DPC doc.

What If I Fail?

Bootstrap failure is cheap.

If you spend $3,000 and get 5 patients before deciding DPC isn't for you: - You lost $3,000 and some time - You learned what doesn't work - You can walk away clean - No debt, no lease, no obligations

If you spend $50,000 and fail: - Major financial hit - Possibly debt - Psychological weight - Harder to walk away

Bootstrap = cheap lessons.

Being Taken Seriously?

By whom?

  • Patients: They care if you help them, not your office size
  • Other doctors: Some will judge; they're not your patients
  • Your family: Show them the bank account, not the infrastructure
  • Yourself: Take yourself seriously by actually starting

The only opinion that matters is your patients'.

Malpractice Risk?

Low-tech doesn't mean low-quality.

Documentation requirements are the same whether you use: - $400/month EMR - Paper charts - Google Docs

Document your care. That's what matters legally.

In fact, DPC's longer visits and better relationships often reduce malpractice risk.

Burning Out Doing Everything?

Monitor this. But:

With 20 patients, "doing everything" means: - A few calls per day - A few visits per week - Some paperwork

That's not burnout-inducing. That's a practice finding its rhythm.

Burnout comes from volume, not from doing your own scheduling.

"Other Doctors Say..."

"You need at least $50K to start"

They're wrong, or they're talking about traditional practices.

DPC with 50 patients at $100/month = $5,000/month revenue. Break-even with minimal overhead = 20-30 patients.

You don't need $50K to get 20 patients.

"Patients won't take you seriously without an office"

Have they tried? Many successful DPC docs started with: - Telehealth only - House calls - Shared space - Home office

Patients take good doctors seriously.

"You'll look desperate"

Starting lean looks smart, not desperate. You're: - Minimizing risk - Validating before investing - Building sustainably - Being a good businessperson

The desperate move is spending $50K before knowing if it'll work.

"I wouldn't do it that way"

Great. They can do it their way. You do it yours.

There's no one right way to start a DPC practice. The only wrong way is to not start at all.

The Meta-Question

"Should I really start this lean?"

If you're asking, probably yes.

The question reveals: - You're cost-conscious (good) - You're questioning assumptions (good) - You're seeking permission (granted)

Start with what you have. Add what you need. Nothing more.

[!TIP] The best answer to most "don't I need" questions is: "Not yet." Get patients first. Add infrastructure second.

Every successful DPC practice started with zero patients. Most started with less than they thought they needed. You have enough to begin.