In 2021 a Direct Primary Care clinic opened in our town. The doctor who ran it asked me to handle his monthly accounting and his taxes, and I took the work the way I would have taken any other engagement. Then I watched what the model actually did — for his patients, and eventually for my own family — and I fell in love with it.
I already knew the system was broken, from the other side of it. When I went self-employed, my health insurance premiums ran about what I made in a month. Something was obviously wrong, and here was a practice three miles from my house fixing it without waiting for permission.
Direct Care takes the insurance billing out of medicine. It does not take the business out of it. You still have to price a membership so it holds its margin, work out what a second provider really costs, know what to set aside every quarter, and read the four numbers each month that tell you whether this is working. Nobody taught you any of that. It is not what you went to medical school for.
Most accounting firms are not built to help with it, and that is structural rather than personal. A CPA needs 80 to 100 returns a year just to cover their own salary, so most run 250 to 500 of them at a few hundred dollars each. At that volume the only workable model is break-fix: something goes wrong, you call, you get a bill. Nobody in that system has time to ask what your membership price should be. That is not a character problem — it is the business model. It is also the same reason you left insurance-based medicine.
So we pointed the whole firm at one kind of business: Direct Care practices, and the functional and integrative medicine practices built the same way. Every practice we take on gets a CFO, an Advisor and an Associate, a written tax plan every year, and a conversation already on the calendar before the big decisions instead of after them.
We cannot be on the front lines doing what you do. But if we can take the financial weight off the back end, that is the job. What we want is for you to fall in love with medicine again and not be constantly worried about money.
