One year ago today, Patricia Okafor walked through my door and said, "Oh, this is lovely." Since then, 347 more people have walked through that same door and entrusted me with their health. Verdant Family Medicine is one year old, and I want to mark the occasion by doing what I've tried to do throughout this blog: sharing the complete, transparent truth about how this year has gone.
Let me start with the numbers, because I know many of you are physicians or aspiring DPC docs who are running your own projections and want real data points.
Current enrolled membership: 348 patients. Monthly membership revenue: approximately $28,400. Monthly overhead (including my salary, which I started taking at month six): approximately $22,000. Monthly net income to the practice: approximately $6,400, which I'm reinvesting for now. My personal salary: $14,500 per month ($174,000 annualized). That's less than I made at Meridian, but it's a comfortable living, and it's growing as the panel grows.
Total revenue for the first year: approximately $198,000 (remember, the first several months were very lean as the panel built up). Total expenses for the first year, including startup costs: approximately $225,000. Net loss for year one: approximately $27,000, covered by our savings reserve. We still have about $68,000 in the reserve, and with the practice now generating positive monthly cash flow, we won't need to draw from it again unless something unexpected happens.
I reached breakeven at month seven, which was one month ahead of my projections. I hit 200 patients at month nine. Growth has been remarkably steady at 15-25 new patients per month, with attrition of only 3-5% annually. The most common reason patients leave: they moved away. The most common reason patients join: word of mouth from existing members. My marketing spend has been minimal, about $200 per month on basic Google ads and local directory listings, because organic growth from satisfied patients has been the primary driver.
Now, the less quantifiable aspects. The quality of medicine I'm practicing is incomparably better than what I was doing at Meridian. I spend an average of thirty-two minutes per patient visit. I see twelve to fourteen patients per day. I know my patients' names, their families, their jobs, their worries. I remember what we talked about last time. I follow up personally after hospitalizations. I answer texts and calls from patients who need guidance between visits. I am practicing family medicine the way I was trained to practice it, and the clinical outcomes reflect that.
In the past year, I've caught three cancers early through thorough screening conversations that would never have happened in a fifteen-minute visit. I've successfully managed twelve patients' chronic conditions to the point where they've been able to reduce or eliminate medications. I've provided same-day acute care over 200 times, keeping patients out of urgent care centers and emergency rooms. I can't prove a counterfactual, but I believe deeply that this model produces better health outcomes, and my patients' gratitude tells me they feel the difference too.
My technology stack has been a crucial enabler of this practice model. Hero EMR continues to perform excellently, and the AI features have only gotten better over the past year as the system has received updates and improvements. The ambient scribe now handles even complex multi-problem visits with impressive accuracy. The 98% first-pass claim rate they advertise is something I've experienced when billing for the handful of services I do submit insurance claims for (certain vaccines, Medicare wellness visits for a few patients). The system has saved me time every single day, and that time goes directly back into patient care.
One thing I didn't fully appreciate before starting this journey was how much the technology would affect my overhead structure. Because of Hero EMR's phone agent, AI scribe, and automated patient registration, I've been able to operate with just Denise and myself for the entire first year. No receptionist, no billing department, no transcriptionist. In a traditional practice with 348 patients, I would need at least two to three additional staff members. At average salary and benefits, that's $100,000 to $150,000 per year in labor costs I'm not paying. This is one of the most underappreciated aspects of choosing the right technology for a small practice: it doesn't just save time, it fundamentally changes your cost structure.
The emotional journey of the past year has been as significant as the financial one. I am not burned out. That sentence still feels miraculous to write. I wake up on Monday mornings and look forward to going to work. I haven't cried in a parking lot in over a year. I exercise again. I cook dinner with James instead of charting on my laptop while he eats alone. I read books for pleasure. I sleep through the night. These are basic human experiences that the corporate medical system had stolen from me, and getting them back has been worth every moment of fear and uncertainty.
There have been hard moments. The financial stress of the early months was real and significant. There were times when James and I had difficult conversations about contingency plans. There was a month when four patients left in the same week and I spiraled into self-doubt. There were lonely moments when I missed having physician colleagues down the hall to consult with (I've since joined a DPC physician group that meets monthly, which has helped enormously). There were administrative headaches and insurance complications and the ongoing DEA registration saga that I won't bore you with again.
But here is what I know, one year in, with certainty: this was the right choice. Not just for me, but for my patients. The DPC model works. It works for physicians who are burning out under the weight of a broken system. It works for patients who are tired of feeling like a number. It works financially, if you plan carefully and have the runway to get through the early months. And it works as a way to practice medicine that is sustainable, fulfilling, and aligned with the reasons we all went into this profession in the first place.
If you're where I was two years ago, sitting in your car after another impossible day, wondering if there's another way, I want you to know: there is. It's not easy. It's not risk-free. It requires planning and savings and courage and probably a supportive partner who's good with spreadsheets. But it exists, and it's real, and one year in, I have never been more certain that I made the right choice.
Thank you for following along on this journey. I'll keep writing, because the story isn't over. Verdant Family Medicine is growing, and I'm already thinking about what year two might bring. But for now, I'm going to close this laptop, walk out to my waiting area with its consignment-store furniture and its fiddle-leaf fig and its shelf of real books, and get ready for my first patient of the new year.
It's going to be a good one. They all are, now.