In this episode of the DPC Pediatricians Podcast, Phil and Marina are joined by Nate Goodman, CPA, for a practical conversation about accounting and tax strategy for practice owners. Nate shares his journey into accounting and explains why many small business owners feel frustrated despite “having an accountant.”

Together, they break down the differences between bookkeepers, accountants, and tax advisors, highlighting why true tax advising should be proactive and ongoing—not just a once-a-year tax filing. Nate emphasizes the value of regular check-ins, understanding your financial systems, and using the tax code strategically to improve your practice’s financial position. This episode is packed with clear, actionable insights to help DPC pediatricians take control of their finances and make more informed decisions year-round.

This episode explores whether direct primary care pediatrics can work in rural communities and concludes that it is feasible but requires tailoring to local realities. Phil and Marina explain that many rural areas have lower, more homogeneous incomes, so pediatricians must study median income and set realistic monthly fees—often lower than urban practices—while clearly defining what is included, such as a well‑child exam plus a limited number of sick visits, with extra services billed separately to keep the model sustainable. Sparse populations mean not all children will join DPC, so physicians must confirm there are enough potential patients and use strategic contracts and panel sizes to make the math work. A key opportunity is telehealth, which allows management of issues like rashes, parenting questions, and behavioral concerns without long drives, making DPC attractive for families who would otherwise face significant travel. Phil and Marina describe niche approaches—such as behavioral health, ADHD, autism, or PANS/PANDAS care and parent‑coaching micro‑practices—that rely heavily on virtual visits and can serve a wider region, and they note that some rural areas include pockets of higher‑income families (for example, a town with an elite boarding school) that can sustain higher‑priced pediatric DPC, reinforcing their point that each DPC practice must be uniquely designed for its community.

This episode explains that pediatricians can start a Direct Primary Care (DPC) practice even while carrying substantial student loans, as long as they plan carefully and intentionally. Phil and Marina share personal examples of launching DPC with 1500–2000 dollar monthly loan payments and original balances around 250,000 dollars to show it is possible but requires realism about cash flow. They describe strategies like keeping a part‑time employed position, timing departure around potential loan‑forgiveness milestones, and building savings and cutting expenses before opening. A major theme is not allowing fear or uncertainty about federal loan programs and politics to be the primary reason for staying in a burnout‑inducing job. They encourage combining detailed financial planning with an internal sense that “this is the right time,” emphasizing that student loans are usually a challenge to plan around, not an automatic deal breaker for DPC.

In this episode, Phil and Marina discuss how Direct Primary Care (DPC) physicians can still experience burnout, though from different causes than in traditional fee‑for‑service systems. Instead of systemic pressures, burnout in DPC often stems from overcommitment, poor boundaries, and underpricing. They emphasize the need for clear expectations with patients, realistic pricing, and structured time management to sustain balance and prevent exhaustion. Ultimately, they encourage DPC doctors to take ownership of practice design so that their systems truly support well‑being and longevity in medicine.

Summary: This podcast episode features a conversation between DPC pediatrician Dr. Marina and entrepreneur/coach Sarah from Soul Seat Academy, focused on how physicians and small business owners can effectively hire, lead, and, when necessary, fire team members in a way that centers culture and humanity over rigid metrics. The discussion emphasizes hiring for cultural alignment and a “servant’s heart” first, then training for skills using clear job descriptions, fun and specific role titles, and detailed standard operating procedures so employees feel safe, supported, and empowered in their roles. They highlight the importance of regular check‑in meetings that normalize two-way feedback, encourage employees to propose solutions, and actively address “workplace trauma detox” from past toxic environments so trust can grow over time. Finally, Sarah shares her structured “come to deity” conversation framework for handling serious performance issues, outlining clear paths of resolution, resignation, or termination while still treating people with dignity and viewing mistakes as “tuition” for learning rather than automatic grounds for dismissal.

Key Highlights

* Legislative Changes: The episode opens with discussion about the passage of the “One Big Beautiful Bill Act” in Congress, which brought significant Medicaid cuts and reduced subsidies for marketplace health insurance plans. While some provisions favored DPC practitioners, many families face potential insurance premium hikes next year.​

* Insurance Premiums and Family Impact: Phil and Marina note that many families relying on subsidized health insurance will need to decide whether to continue paying increased premiums or go uninsured. Those with employer-based insurance are less affected, but marketplace plan holders may need to reevaluate their budgets, possibly impacting their DPC memberships.​

* DPC Practice Opportunities: Phil views the situation as a double-edged sword. While a few current patients may leave DPC due to financial strain, there is a larger pool of new families, especially those dropping costly insurance, who may seek out DPC for its affordability and benefits. The advice is to focus on attracting these new families rather than only trying to retain those considering leaving.​

* Communication Strategy: The episode emphasizes reaching potential new patients through social media, newsletters, and website updates, highlighting the fixed-fee, high-value nature of DPC. Phil and Marina stress that energy should not be spent trying to convert skeptics of DPC, but rather on making services known to those seeking alternatives due to insurance changes.​

* Employee Health Plans and DPC Fit: The trend toward high-deductible employer health plans is identified as another avenue for DPC growth. Such plans often pair with Health Savings Accounts, which complement the DPC model for families looking to manage healthcare spending.​

* Retention, Flexibility, and Patient Care Quality: While discounts or accommodations for loyal families facing hardship are optional, Phil and Marina point out that not all losses can or should be prevented. They highlight the inherent value of DPC, such as time spent with families, ability to address 90-95% of patients’ needs, and access to creative care solutions like e-consults to minimize specialist costs.​

Actionable Advice

* Focus on community outreach to families affected by insurance premium hikes.

* Use clear, empathetic messaging to position DPC as a solution for uninsured or high-deductible families.

* Accept unavoidable churn but explore flexible pricing for loyal patients when appropriate.

* Utilize online platforms (social media, website, newsletters) to share DPC’s unique value.

* Prepare for an influx of new patients as insurance rates rise, positioning DPC as an accessible, high-quality alternative for pediatric care.​

The episode closes with encouragement for DPC pediatricians to see the coming changes as opportunities for service and growth rather than just challenges, reaffirming their mission to provide accessible care amid a shifting healthcare landscape.

This podcast episode provides actionable, step-by-step advice for pediatricians who are considering launching their own direct primary care (DPC) practices, highlighting critical preparation strategies, pitfalls to avoid, and essential resources for a smooth transition.​

Key Highlights

* Defining Your Vision and Brand

* Before taking practical steps, aspiring DPC practitioners should define the vision for their clinic, including which populations or services to focus on, care models, and how their personal strengths differentiate their practice.​

* Building a suitable brand and refining this vision will influence choices regarding location, size, and offerings, setting the foundation for future growth.​

* Crucial First Steps

* The most important initial actions include learning about DPC via summits, podcasts, and online groups, understanding personal motivations, and saving up for startup costs if needed.​

* Developing a resilient mindset for success is key, particularly as launching a practice involves overcoming doubts and embracing flexibility as situations inevitably evolve.​

* Navigating Contracts and Legal Issues

* Phil and Marina strongly advise obtaining and reviewing employment contracts to anticipate legal hurdles such as non-compete clauses, restrictions on patient communication, and potential backlash when departing existing jobs.​

* Consulting an attorney, or using tools like ChatGPT for contract review, can help identify risks, plan exit timelines, and ensure compliance with state-specific regulations.​

* Administrative Set-up

* Establishing a legal entity such as an LLC or PLLC (depending on state) is necessary to receive payments, open business accounts, and set up other key infrastructure.​

* Choosing a business name should be approached with care to avoid complications later; alternatives like “doing business as” names can help adapt as the practice evolves.​

* Phil and Marina caution against unnecessary spending on third-party business registration services, highlighting that state and federal registrations are generally straightforward and inexpensive when done directly.​

* Planning and Resource Management

* Practitioners should create a clear timeline and a checklist for tasks leading up to the launch, using tools like startup guides or project boards to stay organized.​

* Flexibility is important, as some steps may take longer than expected, and pivoting plans is often necessary in entrepreneurial ventures.​

* Support and Community

* Leveraging online groups, summit content, and available startup guides greatly facilitates the transition, offering motivation, expertise, and camaraderie for new DPC doctors.​

Final Advice

The episode closes with Phil and Marina encouraging listeners to seek out the DPC Pediatrician startup guide, join supportive communities, and give themselves grace for unexpected delays, assuring them that the journey, while challenging, is filled with opportunities and supportive colleagues.

This podcast episode centers on the challenges direct primary care (DPC) pediatricians face around delegation and burnout as their practices scale, and provides practical advice and personal stories addressing these issues.​

Key Highlights

* Challenges of Scaling:

* Pediatricians express frustration with shifting from high-volume patient care to handling extensive administrative duties, such as filing, forms, QuickBooks, and more, after opening their own DPC practices.​

* Many practitioners start solo to maintain a lean operation and only begin hiring help, such as part-time staff or virtual assistants, once the workload becomes unsustainable.​

* The Art of Delegation:

* Delegation is difficult for many physicians due to perfectionist tendencies developed during medical training, making it hard to trust others with important tasks.​

* Phil and Marina share that learning to delegate is a skill requiring practice and an acceptance that others may not do things perfectly, but must do them “well enough”.​

* Practical Solutions for Burnout Prevention:

* The digital age offers tools such as Loom for asynchronous training and record-keeping, which make delegation and onboarding easier, even for virtual assistants located overseas.​

* Examples are shared, including offloading birthday card duties and documentation tasks to trusted helpers, freeing up time for the clinicians.​

* Hiring help does introduce short-term challenges and mistakes during training, but this period is necessary for long-term relief and productivity.​

* Strategic Growth and Self-Care:

* Physicians are encouraged to critically evaluate which tasks they genuinely enjoy and which should be delegated to others, including administrative and personal scheduling duties.​

* The importance of anticipating future needs, enlisting help before feeling overwhelmed, and accepting that the first hire might not always be the perfect fit are emphasized.​

* Extreme ownership in the business is discussed, urging practice owners to take responsibility for ensuring clear communication and good systems rather than blaming staff for mistakes.​

Episode Summary

In this Episode Phil and Marina urge listeners to delegate sooner rather than later, to prioritize personal and professional well-being, and to embrace intentional growth and self-care practices for their clinics and themselves.