Starting a DPC Practice Right Out of Residency: The Realistic Guide

Yes — and a growing number of physicians are doing exactly that. Starting a Direct Primary Care practice straight out of residency is not only possible, it may actually be easier than transitioning later. You have no insurance contracts to unwind, no existing panel tied to a fee-for-service system, and you're already used to living on a resident's salary.

The honest financial picture

Let's address the elephant in the room: you probably have $200K+ in student loans (the Class of 2025 average is $223,130) and you're looking at employed starting salaries of $275K+. A DPC practice won't match that in year one.

DPC income trajectory

| Timeline | Patients | Estimated Gross Revenue | Take-Home (after 30-40% overhead) | |---|---|---|---| | Months 1-6 | 50-200 | $36K-$144K/yr rate | Supplemented by moonlighting | | Months 7-12 | 200-400 | $144K-$288K/yr rate | Approaching break-even | | Year 2 | 400-600 | $288K-$432K/yr | $170K-$300K | | Year 3+ | 500-600+ | $360K-$650K/yr | $250K-$450K+ |

Based on $60-$90/month average membership fee. Your numbers will vary by market and pricing.

At maturity, DPC physician compensation is competitive with or above the median employed family medicine salary ($315K) — with dramatically better working conditions, clinical autonomy, and practice ownership equity.

The moonlighting bridge

The most common strategy for new graduates: work urgent care or locum shifts during the first 6-12 months while building your panel. Many physicians work 40-60 hours/week in supplemental clinical work while spending 20 hours/week on practice building. It's intense but temporary.

Student loans and DPC — what you need to know

PSLF does NOT apply. DPC practices are private businesses, not 501(c)(3) nonprofits or government employers. If you were counting on Public Service Loan Forgiveness, DPC takes you off that path. This is a real tradeoff worth calculating.

Income-driven repayment works in your favor during ramp-up. Plans like IBR and PAYE cap payments at 5-10% of discretionary income. During your low-income first year, payments could be very small — even $0 depending on your situation. Interest accrues, but the breathing room is real.

The long game favors ownership. An employed physician earning $275K makes roughly the same every year with modest raises. A DPC practice owner at maturity earns $250-$450K+ and builds equity in a business they can eventually sell or bring on partners.

Startup costs

You don't need $200K to open a practice:

• Lean/virtual start: $5,000-$10,000 (shared space, minimal equipment, basic EHR)
• Traditional office: $50,000-$100,000 (lease, equipment, build-out, operating capital)
• Key expenses: Office lease, malpractice insurance, EHR system ($100-$300/month for DPC-specific platforms like Atlas.md or Elation), legal setup (LLC/PLLC), and marketing

Some physicians start with a micro-practice model — a single exam room in shared space — and scale up as their panel grows.

Should you get experience first?

There's no single right answer. Both paths work.

Case for starting immediately:

• No insurance contracts to unwind
• You're already living lean on a resident's budget
• Clean start with no legacy patient expectations
• Dr. Paul Thomas's advice: "It is better to start a DPC practice right out of residency than to wait until you have established fee-for-service patients or established insurance-based contracts."

Case for working employed 2-3 years first:

• Build clinical speed and confidence beyond residency
• Save $50-$100K for startup capital and personal runway
• Pay down some student debt at a higher salary
• Build local reputation and referral relationships
• Less financial stress during the startup phase

Physicians who did it straight out of residency

Dr. Paul Thomas — Plum Health DPC (Detroit, MI) Started in 2016 right out of residency with $100K+ in student loans. Had 7 patients in month one. Grew to 700+ patients, hired staff and a second physician, was named Detroit Vanguard Entrepreneur of the Year, gave a TEDxDetroit talk, and wrote three books including Startup DPC.

Dr. Lilian White — Empowered Health DPC (Cleveland, OH) 2023 Cleveland Clinic FM residency graduate. Moonlighted through the summer to save startup capital, opened her practice in October 2023. She wrote: "The period between residency and opening was the most challenging" — but she did it.

What to do NOW while you're still in residency

1. Join the DPC Alliance (free for residents) — access mentorship, education, and peer networking. Membership extends 6 months post-graduation. dpcalliance.org

2. Set up a DPC elective rotation — arrange 1-4 weeks at a local DPC practice. Startup DPC has a published curriculum template if your program doesn't have one.

3. Attend the DPC Summit — apply for the resident scholarship. The annual conference (co-hosted by AAFP, ACOFP, DPC Alliance) is the single best networking event for DPC. dpcsummit.org

4. Listen to My DPC Story podcast — 300+ episodes of DPC physicians sharing their startup journeys. Free mentorship in audio form.

5. Find a DPC mentor — the community is remarkably open. The DPC Alliance connects interested physicians with practicing DPC docs.

6. Write your business plan — startup costs, monthly operating expenses, target patient volume, and break-even math. Do this during residency so you're ready to move.

7. Model your student loan strategy — run the numbers on IDR payments during ramp-up vs. aggressive repayment on an employed salary. Make an informed decision, not a fearful one.

8. Line up your moonlighting bridge — identify urgent care or locum opportunities in your target market for the first 6-12 months.

A major tailwind: HSA eligibility (2026)

As of January 1, 2026, patients with HSA-eligible high-deductible health plans can use tax-free HSA dollars to pay DPC membership fees (up to $150/month individual, $300/month family). This removes a significant financial barrier for patients and should accelerate new member acquisition for DPC practices. Over 7,200 employers already offer DPC benefits, and that number is growing.

The bottom line

Starting a DPC practice out of residency is harder than signing an employment contract. It requires financial planning, a tolerance for uncertainty, and 6-12 months of hustle. But by year two or three, you'll own a practice with 400-600 patients, work 35-45 hours a week, spend 30-60 minutes with each patient, and never submit a prior authorization.

The physicians who've done it overwhelmingly say the same thing: it saved their relationship with medicine.

Browse DPC practices on the directory to see the model in action, or explore listing your future practice.