How to Start a Direct Primary Care Practice: A Step-by-Step Guide (2026)

In less than a decade, we’ve seen Direct Primary Care (DPC) go from a curiosity to an entirely new industry. Between 2017 and 2025, we saw the number of DPC practices grow by a staggering 837%. And the growth didn’t stop there, with the industry seeing a 7% compound annual growth rate between 2025 and 2026.

For those looking to capitalize on this thriving marketplace, or those who simply feel the call to provide a higher level of patient care, this blog is for you. Let’s take a look at how to start a Direct Primary Care practice with a step-by-step guide.

What Is Direct Primary Care (and Why Start a DPC Practice)?

Let’s start with the very basics: what is Direct Primary Care? And how does Direct Primary Care work?

The Direct Primary Care model typically exists outside traditional insurance billing, with membership and flat fee models being the most popular choices right now. What are the benefits of Direct Primary Care? For the patient, it means better care and better outcomes. For you, it means a lighter roster and more job satisfaction.

You have probably also heard it referred to as membership medicine, or direct pay primary care.

Is a DPC Practice Right for You?

This is the big question, isn’t it? To answer this thoughtfully, we need to look at all the Direct Primary Care pros and cons and answer them honestly.

Yes, the marketplace is exploding right now. But on the other hand, you’re not the only one who knows that. There could be two or three other DPC practices opening in your market at the same time you do. What’s your differentiator?

However, this could be a very personal decision for you. If you’re feeling yourself burned out by the traditional fee-for-service model, you are far from alone. And that’s one area where DPC really makes a case for itself. DPC physicians get to spend more time with their patients and help them see better outcomes.

This leads to a greater overall sense of satisfaction.

How to Start a Direct Primary Care Practice, Step by Step

1. Build your business plan & financial model

You need to define your financial model before signing a lease or buying your EHR software.

How much money will you need? DPC practices can cost anywhere from $5,000 to $70,000 to get off the ground. It all depends on location, staffing, and equipment.

You’re also going to want to estimate your:

• Break-even membership panel
• Monthly expenses
• Target income

Take all that data and build a 12-month plan (at least) with personal and 6 months of business cash reserves. A clear business plan helps you price memberships confidently and avoid running out of cash during your first year.

2. Choose a legal structure & register the entity

Next, you will want to choose the business structure allowed in your state, which could be:

• LLC, Professional LLC (PLLC)
• Professional Corporation (PC)
• Other types of entities

From there, you will want to make it official and:

• Register your business name
• Obtain an Employer Identification Number (EIN) from the IRS
• Secure any required state licenses

Also, be sure to choose a practice name that reflects your brand and is easy for patients to remember and find online.

3. Handle compliance — Medicare opt-out

This part is incredibly important and complex, and too crucial to take any chances. This is why we recommend working with an attorney with proven experience in this area. A simple missed step can delay your grand opening by months, or even keep it from happening.

This may include:

• Medicare opt-out paperwork
• HIPAA compliance
• Malpractice insurance
• Any state-specific DPC regulations

You may also need CLIA certification and OSHA compliance if you plan on performing in-office lab testing.

4. Set your membership pricing & tiers

You will have a number of Direct Primary Care membership options to choose from, and several possible pricing models.

It may be tempting to base your price on what competitors in the area are doing. But it makes more financial sense to base them on your financial goals.

Are people in this area willing to pay more? In most cases, you will find the answer is “Yes!” if you can distinguish yourself and root your custom DPC membership models in a superior experience.

5. Draft your patient membership agreement

Your membership agreement sets expectations for both you and your patients.

It should clearly define:

• What’s included in your memberships/plans
• What’s not included
• The specific payment terms and schedules
• Your cancellation policies

Have your attorney review the document before using it, and consider starting with a proven DPC membership agreement template to save time.

6. Secure your location & equipment (physical vs virtual)

You don’t need a huge brand opening or massive clinic to start a DPC practice. In fact, many DPC physicians keep overhead costs low by beginning with:

• A small office
• A shared medical space
• A house-call model
• A telehealth-first setup

You only need to invest in the essential clinical equipment needed for your early offerings. There’s always room to expand as your patient list grows and your calendar fills with paying customers.

Keeping startup costs low preserves cash for scaling without being weighed down by early investments. You don’t want your growth anchored down by a piece of equipment that isn’t generating actual revenue.

7. Pick your EHR & tech stack

Too many DPC startups will start with a free or almost-free EHR to keep costs down in the early stages. This seems logical, but it can be a growth barrier. When things ramp up and you’re ready to go to the next level, you may find yourself stymied by a potential migration nightmare as you go from a free EHR to a professional or enterprise-grade product.

We recommend an EHR built for Direct Primary Care, something built to scale, and something purpose-built for membership medicine—not fee-for-service billing.

Your EHR should support:

• Patient portals
• Online scheduling
• Telehealth
• e-prescribing (including EPCS) and labs

Of course, ACH billing for recurring DPC membership will also be crucial.

For example, Cerbo was built with DPC needs in mind. We combine these workflows into one system, reducing the need for several bolt-on products that create the dreaded frankenstack and hours of double entry.

Click here to learn more about the best Direct Primary Care EHR software on the market.

8. Set up labs, meds & imaging partnerships

Your vendor partnerships will help you keep your costs down and deliver high-quality care.

Begin by:

• Comparing wholesale lab providers
• Negotiating cash-pay imaging rates
• Deciding whether you’ll dispense medications in-house or partner with a pharmacy

Many DPC practices also integrate with supplement and specialty lab platforms to streamline ordering and improve the patient experience.

9. Marketing & patient acquisition

This may surprise you, but we’re gonna recommend that you focus on your brand before you get into the specifics of your marketing plan. A strong message and a clear identity will create more business than an aggressive ad spend in the early days.

From there, you will want to incrementally explore:

• Creating an Intuitive website with a great patient experience
• Claiming and optimizing your Google business profile to earn local search traffic
• Building an incentivized referral program
• Networking in your area
• Exploring how to expand and optimize your social footprint

Again, the above steps can easily miss the mark if you haven’t figured out your brand first.

10. Launch & onboard your first members

Consider soft-launching with a select group of patients. That way, you can iron out the workflow wrinkles and spot potential issues before scaling.

Your pre-launch checklist should include:

• Creating a frictionless enrollment process
• Helping members activate their patient portal
• Communicating frequently during their first few months

Set realistic goals for the first year or so. Shooting for around 10 new members per month can help you achieve steady and sustainable growth, while maintaining excellent patient care.

Startup Costs & Timeline (Table)

Common Mistakes to Avoid

We have helped countless DPC practices get off the ground during those tumultuous first few years. Based on our observations, the most common growth-killing mistakes include:

• Underpricing is more common than overpricing
• No financial runway for lean times
• Over-building/over-equipping
• Over-staffing or panic hiring
• Going with the wrong EHR
• Setting weak personal boundaries that result in burnout
• Skipping legal review or not getting legal advice

If you can avoid these, you will likely survive.

Tools & Tech You’ll Need

The right technology keeps your DPC practice lean and efficient.

Your EHR should be your practice’s medical operating system, with integrated:

• Charting
• Recurring membership billing
• Patient portal
• Online scheduling
• Telehealth
• e-prescribing (including EPCS)
• Lab ordering

For example, Cerbo was purpose-built for Direct Primary Care, reducing the need for multiple disconnected tools. You can pair it with Stripe for secure recurring payments, and you can consider a membership platform like Hint if it fits your workflow.

Our clients in functional practices also benefit from using Fullscript and Rupa Health for supplements and specialty labs.

Click here to read more about how we’re the best EHR for cash-based practices and DPCs.

Tips From DPC Doctors

Here is real advice from real DPC doctors who have already made these mistakes so you don’t have to:

• Expectation Management: Doctors on r/FamilyMedicine want you to know that it can take an average of 9 to 12 months to build a sustainable initial patient panel. They add that having a combination of a side hustle and financial runway can help you through that first year.
• Shut out the Haters: Remember, you’re still in a space that’s being proven to the mainstream. It still has detractors. DPC physicians on Reddit advise not wasting energy on people who are angry that you do not accept traditional insurance or Medicare. They’re not your target market, or your problem.
• Offline Marketing is Huge: Even in this digital-everything world, people who have gone through this DPC journey want you to know that happy patients are your best tool. Local reputation builds slowly but steadily as people realize the value of direct access.

Ready to See What a DPC Practice EHR Should Do For You

As we mentioned in a previous section, it’s hard to overstate the importance of this decision. If you don’t choose an EHR that was designed for DPC practices, you will find yourself working for it instead of the other way around.

“I can’t stress enough how important it is to choose the right system from day one,” said Clinic Manager, Paula Tomczyk. “This is a long-term investment, and the system you pick will directly impact your practice’s efficiency.”

Are we the best EHR software for a DPC practice owner? Click that link to find out.

FAQ

How much does it cost to start a DPC practice?

This depends on a number of factors we listed here today. You can potentially start a lean telehealth or shared office PC from anywhere between $7000-$15,000.

However, a classic brick-and-mortar clinic is going to cost you considerably more. The price could start at $30,000 and get into six figures very quickly.

How many patients to break even?

There is no easy answer for this, which is why you should find an answer to this question before you launch your practice.

Some DPC physicians can break even with 100 to 200 members. And they might be considered profitable with 250 members. Or it might take 500 members.

Your offering, your financial goals, and your market will be key in arriving at finding your own number.

Do I have to opt out of Medicare?

In most cases, you’ll need to formally opt out of Medicare and enter into private contracts with your patients if you plan to charge Medicare beneficiaries a DPC membership fee for covered primary care services.

Opt-out rules are governed by CMS and include filing an affidavit before the applicable deadline. Consult a healthcare attorney to ensure you comply with federal and state requirements.

How much should I charge for membership?

Most DPC practices can charge anywhere from $50-$100 a month for adult patients.

However, don’t base your membership model on what other people are doing. Start with your financial goals, and work backwards from there. Don’t plan your future on what other people are doing.

Do I need malpractice insurance?

You absolutely need malpractice insurance. It should be one of the first things you take care of before opening your doors.