Hiring Your First Employee¶

Quick Summary: Most DPC practices can operate solo for years. When you do hire, start small - a part-time medical assistant or office manager is usually the right first step. Don't rush this decision.

Do You Actually Need to Hire?¶

Before hiring, ask yourself:

Challenge your assumptions: - Can you handle 400-600 patients solo? Many DPC physicians do (rule of thumb; unsourced). - Is your time constraint real or perceived? - Would systems improvements or technology help more than an employee? - Could you outsource specific tasks instead of hiring?

Signs you might be ready: - Consistently working more hours than sustainable - Turning away patients due to capacity - Administrative tasks preventing patient care - Phone management becoming overwhelming - You want to take a real vacation

Signs you're NOT ready: - Panel under 300 patients (rule of thumb; unsourced) - Not yet profitable or barely breaking even - "It would be nice to have help" (not a business need) - Trying to grow faster than sustainable

First Hire Options¶

Medical Assistant (Part-Time)¶

Best for: Practices with 400+ patients wanting to increase efficiency (rule of thumb; unsourced)

Typical duties: - Room patients, vitals - Prepare for visits - Simple procedures assistance - Phone triage - Prescription refill coordination - Lab result follow-up

Typical cost: $17-29/hour, 15-25 hours/week ≈ $1,100-3,140/month (estimate; the wage range brackets the BLS May 2025 national median of $21.97/hour, 10^th percentile about $17.33)

Office Manager / Administrative Assistant (Part-Time)¶

Best for: Physicians who want to focus purely on clinical work

Typical duties: - Phone management - Scheduling - Membership billing - New patient enrollment - Correspondence - Supply ordering

Typical cost: $18-30/hour, 10-20 hours/week ≈ $780-2,600/month (estimate; local rates vary)

Virtual Assistant (Remote)¶

Best for: Practices wanting minimal overhead and flexibility

Typical duties: - Phone answering - Scheduling - Insurance verification (for patients) - Prior authorizations - Administrative tasks

Typical cost: $15-35/hour, as-needed basis (estimate; unsourced)

The Hiring Process¶

1. Define the Role¶

Write a clear job description including: - Specific duties (be detailed) - Hours and schedule - Required skills and experience - Nice-to-have qualifications - Your practice culture

2. Determine Compensation¶

Research local rates for: - Medical assistants: $17-29/hour (BLS May 2025: median $21.97/hour, 10^th percentile about $17.33) - Office managers: $18-35/hour (estimate; local rates vary) - Consider benefits (or not for part-time)

For part-time staff: No federal law requires a one-employee practice to offer health benefits at any hour count; the employer mandate in 26 USC 4980H applies only to employers with 50 or more full-time-equivalent employees. State paid-sick-leave laws (California, Washington, Arizona, Colorado, New York, Minnesota, Illinois and others) often cover part-time workers, so check your state.

3. Recruit Candidates¶

Sources: - Indeed, ZipRecruiter (broad reach) - Local medical assistant programs - Word of mouth (patients, colleagues) - Local healthcare job boards - Facebook local job groups

Your DPC advantage: Many healthcare workers are burned out. Emphasize: - Small, personal practice - Meaningful work - No insurance hassles - Better work-life balance

4. Interview Process¶

Phone screen (15 minutes): - Basic qualifications - Schedule compatibility - Salary expectations - Why interested in DPC

In-person interview (30-60 minutes): - Detailed experience discussion - Scenario questions - Culture fit assessment - Questions they have

Working interview (2-4 hours, paid): - Actual practice tasks - Interaction with you - See them in action - Best predictor of success

5. Background and References¶

• Reference checks (at least 2)
• Background check if required
• Verify credentials/certifications
• Drug screening if applicable

Employment Basics¶

Employment Type¶

W-2 Employee: - You withhold taxes - You pay employer taxes (FICA match) - You control schedule and methods - Most common for ongoing roles

1099 Independent Contractor: - They handle their own taxes - Limited control over methods - Risk of misclassification - Generally not appropriate for regular staff

Required Documentation¶

• W-4 (employee tax withholding)
• I-9 (employment eligibility): you must complete Section 2 within three business days of the hire date (8 CFR 274a.2(b)(1)(ii)). E-Verify is voluntary under federal law but mandatory in some states
• State tax forms (varies by state)
• Direct deposit authorization
• Employee handbook acknowledgment

Required Postings¶

Four federal posters (FLSA, OSHA, EPPA, USERRA) are required of every employer regardless of size; see the legal checklist below. Separately, check your state requirements for: - State minimum wage poster - Workers' compensation notice - Other state-specific postings

Insurance Considerations¶

Workers' compensation: Required in most states from the first employee, but Texas coverage is elective and several states set thresholds of two to five employees; see the legal checklist below

Employment practices liability: Optional but recommended

Update business insurance: Notify your carrier of employees

Legal Checklist for Your First Hire¶

Federal rules that apply from the first employee, with thresholds as of 2026-09-22:

• EIN and unemployment tax. Get an Employer Identification Number before the first payroll. Federal unemployment tax (FUTA) applies once you pay $1,500 or more in wages in any calendar quarter, or have an employee on any day in each of 20 different weeks of the year (26 USC 3306(a)(1)); file Form 940 annually. Register with your state unemployment-insurance agency as well.
• New-hire reporting. Report the employee's name, address, Social Security number and hire date, plus your name, address and EIN, to your state's new-hire directory within 20 days of hire (42 USC 653a(b)(1)).
• Form I-9. Complete Section 2 within three business days of the hire date (8 CFR 274a.2(b)(1)(ii)). E-Verify is voluntary federally and mandatory in some states.
• Minimum wage and overtime. The federal minimum wage is $7.25/hour (29 USC 206(a)(1)(C)); most states set a higher one. Both roles described above are non-exempt: pay overtime at one and a half times the regular rate for hours over 40 in a workweek. An employee is exempt only if paid a salary of at least $684/week ($35,568/year) and performing exempt duties (29 CFR 541.600). The 2024 rule raising that threshold was vacated in Texas v. DOL on 2024-11-15, and DOL restored the 2019 text effective 2026-05-15 (DOL release). California, New York, Washington and Colorado set higher salary thresholds.
• Federal posters. Every employer must display the FLSA minimum wage poster (29 CFR 516.4), the OSHA "Job Safety and Health" poster (29 CFR 1903.2), the Employee Polygraph Protection Act notice (29 CFR 801.6) and the USERRA notice (38 USC 4334). The EEOC poster applies at 15 employees and the FMLA poster at 50. State posters are separate; the DOL elaws Poster Advisor lists the federal set.
• Workers' compensation. Required in most states from the first employee, but thresholds vary: Texas coverage is elective (Tex. Labor Code § 406.002); Florida requires it at four or more non-construction employees (Fla. Stat. § 440.02(17)(b)2); Alabama, Georgia, Missouri, Mississippi, New Mexico, South Carolina, Tennessee, Virginia, Arkansas, Michigan and Wisconsin set thresholds of two to five employees. Check your state before assuming you are exempt.

Payroll Options¶

DIY Options¶

Gusto: about $49/month + $6/person (as of 2026-03-01, from secondary sources; Gusto's pricing page blocks automated checks, so confirm current pricing on gusto.com) - Easy to use - Handles all filings - Good for small practices

QuickBooks Payroll: bundled accounting-plus-payroll plans at $88, $125 or $203/month plus $6.50-$10 per employee per month (Intuit pricing page, September 2026; promotional pricing changes often) - Integrates with QB accounting - Full service available

Full-Service Payroll¶

ADP, Paychex: More expensive but handle everything - Better for multiple employees - Include HR resources

Accountant-Handled¶

Many small practice accountants will handle payroll - Usually included in monthly fee - Convenient if you already have a relationship

Training Your First Hire¶

Week 1: Orientation¶

• Practice overview and DPC philosophy
• EMR training
• Phone protocols
• HIPAA training
• Basic procedures

Weeks 2-4: Supervised Practice¶

• Shadow you during patient encounters
• Gradual independence on tasks
• Regular feedback
• Adjust training as needed

Ongoing¶

• Weekly check-ins initially
• Clear communication channels
• Performance feedback
• Continued education

Common Mistakes to Avoid¶

1. Hiring too soon - Wait until truly needed
2. Hiring a friend/family member - Professional boundaries matter
3. Not checking references - Always verify
4. Unclear expectations - Document everything
5. Skipping the working interview - Best predictor of fit
6. Overpaying or underpaying - Research local rates
7. No written policies - Create simple employee handbook

When It's Not Working¶

If your hire isn't working out:

1. Address issues early - Don't let problems fester
2. Document concerns - Written warnings if needed
3. Set clear improvement timeline - 30-60 days
4. Know your state laws - Termination requirements vary
5. Consult attorney if unsure - Employment law is complex

Alternatives to Hiring¶

Before hiring, consider:

• Outsourced answering service: $100-300/month (estimate; unsourced)
• Virtual scribes: Per-visit or monthly
• Billing service: If you do any fee-for-service
• Cleaning service: Don't clean your own office
• Technology automation: Reduce administrative burden

Resources¶

• State labor law resources
• I-9 forms and instructions
• OSHA small business resources
• DOL elaws Poster Advisor

Sources checked against primary law and agency guidance on 2026-09-22.

Most successful DPC practices operated solo for years before hiring. There's no rush - hire when you truly need it, not because you think you should.