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Opening a DPC Practice in Your Home
A question asked frequently within the DPC community is whether or not you can successfully open a direct primary care practice in your own home. It is a natural question to ask since, in many ways, the DPC model is ‘going back to the future.’ We are trying to recapture the spirit of the old-time family doctors who cared for many of us and our families in generations past. Many of these physicians had offices attached to their homes and were very successful. The question is whether or not that can be done today.
There are a small handful of DPC physicians who are practicing in a home office and are very happy doing so. There are several pros and cons, and many factors to consider before going down this road. We do our best to outline them here.
Without a doubt, the first thing to examine is how would having a practice within your own house affect your family? If you have a spouse/significant other, are they on board with this concept? Will working out of your home improve your relationship because you may be home more because you have no commute? Will it hurt it because you have a hard time walking away from work and respecting home/work boundaries? Is your spouse/partner going to work in the practice with you? Some love the idea of just going down the hall to go to work and being able to have lunch in their own kitchen or a nap in their own bed. On the other hand, some prefer clear delineation between home life and work-life to promote balance.
If you have children, how will this affect them? There is a definite advantage to working out of your home if you have young children, especially if both parents work in the practice. It would allow you to check in on the children throughout the day. If a child is home from school sick, it is easy to keep an eye on them without having to take a day off. Older patients often love to see the doctor’s children coming in and out of the office. It promotes a sense of family in your primary care practice. On the flip side, some physicians prefer not to have their children underfoot, and to maintain boundaries between patients and their private lives. If the children tend to be noisy, that can irritate you and the patients. There are also considerations in terms of whether or not you want to have your children potentially interacting with strangers in your front yard. It is also important to have you think about keeping your front yard free of loose toys, bicycles, etc. It detracts from a professional appearance and can create tripping hazards. Also, your pediatric patients might help themselves to play with your children’s toys, which may not be ideal.
The second issue to research is whether or not local town ordinances will permit you to run a medical office out of your home. In our experience, the codes often vary widely from one town to another. In many cases, home offices are allowed by the municipality if they do not take up more than a certain percentage of the house’s square footage (i.e. 20-25%). Some towns might restrict the absolute amount of square footage that is used for the office space. It is not uncommon in cities and suburbs to require that the business have a certain amount of off-street parking, which is usually based on the square footage of the business. There may also be constraints on signage in order to maintain the residential feel of the neighborhood. Some towns also have a cap on how many employees can work in your office who do not reside in the home.
If after doing this research, you find that you would not meet your town’s criteria for being considered a home office within a residential area, you might have to investigate what it would entail to have your property rezoned. Some localities recognize a residential/professional designation, which is ideal for what you would need. It means that a home can be used for either purpose at any time. If your town does not have this option, you might have to look into petitioning to have your property rezoned for business purposes. Depending on whether or not your town hall is business-friendly or not will determine how difficult this process might be. In order to test the water, you might want to speak to your local code enforcement or planning department to see what they require. Some towns will allow a single parcel to be rezoned to accommodate a business, but some would require that a whole group of them convert. The process would require a formal application, meetings with the planning committee and town council, as well as soliciting input from your neighbors regarding their concerns about the proposed zone change. It is sometimes beneficial to discuss the process with an attorney with experience in this area. If you need to go through this process, it can take several weeks or months, so please factor that into your plans.
It is important to check with your homeowner’s insurance company to see if you will need to add a rider to your current policy to allow for a home business. There is a chance that they cannot cover you at all, at which point you would need to talk with a broker about a new policy. This may be an inconvenience, but not the end of the world.
The optimal arrangement for a home office is to have a space that is completely distinct from your living area, with a separate entrance, which is clearly marked so that patients do not go to the wrong door. As a home office, there is a good chance that you will not need to be ADA compliant, but it is still a good idea, if possible, to be as handicapped accessible as possible. You might want to consider a ramp if the door is not at ground level. If your office space needs structural renovations, you may need a permit and certificate of occupancy from your town. You can expect a visit from your local fire department to be sure that you have fire extinguishers, emergency lights, and fire alarms in the areas open to the public. We will not discuss office design or space requirements here because every practice and physician is unique.
The financial advantages to a home office are many. You should talk with your accountant for formal advice because there are many different approaches and each may have its own advantages. Some examples given by one physician who practices out of his home are: it is legitimate for you as a homeowner to charge the practice rent. This will allow you to defray a portion, if not all, of the cost of your mortgage as a business expense. In order to do this, you should have a formal lease. You may be able to pay some of your utility bills as a business expense. You may also be able to declare a portion of your home improvements, landscaping, and other expenses and supplies necessary to maintain a professional appearance to your building. (Please consult your accountant for formal guidance.)
Frequently, the question is asked about practicing medicine out of your home is about patient boundaries. This generally is not as big an issue as one might suspect. The key to success is to clearly establish boundaries early on. If the office entrance is clearly marked, it is not likely that patients will be knocking on your front door. Patients tend to be extremely respectful of your private time. Occasionally, patients may broach the subject about dropping by to see you after hours but frame it as a joke to feel you out. It may just be a joke, but it is usually best to make it clear, in a friendly way, what your boundaries and expectations of privacy are. It may sometimes be a challenge to enjoy a day off during the week and be in your front yard and have a patient stop by unexpectedly to ask a question, pick up a refill, etc. In most cases, simply letting a patient know that you are enjoying private time and that it would be better if they call before coming over is perfectly fine. The same applies to pharmaceutical representatives. Realistically, the best way to avoid interactions such as this is to not be visible during personal time taken off during your usual business hours. Stay in the back yard, in the house, or away from home.
In summary, there are many things to consider and research before opening your medical practice in a home office. It is a unique situation with many advantages and a few caveats. It may not be a good fit for everyone, but for the right physician and their family, it can be a fantastic arrangement.
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Opening a DPC Practice in Your Home
A question asked frequently within the DPC community is whether or not you can successfully open a direct primary care practice in your own home. It is a natural question to ask since, in many ways, the DPC model is ‘going back to the future.’ We are trying to recapture the spirit of the old-time family doctors who cared for many of us and our families in generations past. Many of these physicians had offices attached to their homes and were very successful. The question is whether or not that can be done today.
There are a small handful of DPC physicians who are practicing in a home office and are very happy doing so. There are several pros and cons, and many factors to consider before going down this road. We do our best to outline them here.
Without a doubt, the first thing to examine is how would having a practice within your own house affect your family? If you have a spouse/significant other, are they on board with this concept? Will working out of your home improve your relationship because you may be home more because you have no commute? Will it hurt it because you have a hard time walking away from work and respecting home/work boundaries? Is your spouse/partner going to work in the practice with you? Some love the idea of just going down the hall to go to work and being able to have lunch in their own kitchen or a nap in their own bed. On the other hand, some prefer clear delineation between home life and work-life to promote balance.
If you have children, how will this affect them? There is a definite advantage to working out of your home if you have young children, especially if both parents work in the practice. It would allow you to check in on the children throughout the day. If a child is home from school sick, it is easy to keep an eye on them without having to take a day off. Older patients often love to see the doctor’s children coming in and out of the office. It promotes a sense of family in your primary care practice. On the flip side, some physicians prefer not to have their children underfoot, and to maintain boundaries between patients and their private lives. If the children tend to be noisy, that can irritate you and the patients. There are also considerations in terms of whether or not you want to have your children potentially interacting with strangers in your front yard. It is also important to have you think about keeping your front yard free of loose toys, bicycles, etc. It detracts from a professional appearance and can create tripping hazards. Also, your pediatric patients might help themselves to play with your children’s toys, which may not be ideal.
The second issue to research is whether or not local town ordinances will permit you to run a medical office out of your home. In our experience, the codes often vary widely from one town to another. In many cases, home offices are allowed by the municipality if they do not take up more than a certain percentage of the house’s square footage (i.e. 20-25%). Some towns might restrict the absolute amount of square footage that is used for the office space. It is not uncommon in cities and suburbs to require that the business have a certain amount of off-street parking, which is usually based on the square footage of the business. There may also be constraints on signage in order to maintain the residential feel of the neighborhood. Some towns also have a cap on how many employees can work in your office who do not reside in the home.
If after doing this research, you find that you would not meet your town’s criteria for being considered a home office within a residential area, you might have to investigate what it would entail to have your property rezoned. Some localities recognize a residential/professional designation, which is ideal for what you would need. It means that a home can be used for either purpose at any time. If your town does not have this option, you might have to look into petitioning to have your property rezoned for business purposes. Depending on whether or not your town hall is business-friendly or not will determine how difficult this process might be. In order to test the water, you might want to speak to your local code enforcement or planning department to see what they require. Some towns will allow a single parcel to be rezoned to accommodate a business, but some would require that a whole group of them convert. The process would require a formal application, meetings with the planning committee and town council, as well as soliciting input from your neighbors regarding their concerns about the proposed zone change. It is sometimes beneficial to discuss the process with an attorney with experience in this area. If you need to go through this process, it can take several weeks or months, so please factor that into your plans.
It is important to check with your homeowner’s insurance company to see if you will need to add a rider to your current policy to allow for a home business. There is a chance that they cannot cover you at all, at which point you would need to talk with a broker about a new policy. This may be an inconvenience, but not the end of the world.
The optimal arrangement for a home office is to have a space that is completely distinct from your living area, with a separate entrance, which is clearly marked so that patients do not go to the wrong door. As a home office, there is a good chance that you will not need to be ADA compliant, but it is still a good idea, if possible, to be as handicapped accessible as possible. You might want to consider a ramp if the door is not at ground level. If your office space needs structural renovations, you may need a permit and certificate of occupancy from your town. You can expect a visit from your local fire department to be sure that you have fire extinguishers, emergency lights, and fire alarms in the areas open to the public. We will not discuss office design or space requirements here because every practice and physician is unique.
The financial advantages to a home office are many. You should talk with your accountant for formal advice because there are many different approaches and each may have its own advantages. Some examples given by one physician who practices out of his home are: it is legitimate for you as a homeowner to charge the practice rent. This will allow you to defray a portion, if not all, of the cost of your mortgage as a business expense. In order to do this, you should have a formal lease. You may be able to pay some of your utility bills as a business expense. You may also be able to declare a portion of your home improvements, landscaping, and other expenses and supplies necessary to maintain a professional appearance to your building. (Please consult your accountant for formal guidance.)
Frequently, the question is asked about practicing medicine out of your home is about patient boundaries. This generally is not as big an issue as one might suspect. The key to success is to clearly establish boundaries early on. If the office entrance is clearly marked, it is not likely that patients will be knocking on your front door. Patients tend to be extremely respectful of your private time. Occasionally, patients may broach the subject about dropping by to see you after hours but frame it as a joke to feel you out. It may just be a joke, but it is usually best to make it clear, in a friendly way, what your boundaries and expectations of privacy are. It may sometimes be a challenge to enjoy a day off during the week and be in your front yard and have a patient stop by unexpectedly to ask a question, pick up a refill, etc. In most cases, simply letting a patient know that you are enjoying private time and that it would be better if they call before coming over is perfectly fine. The same applies to pharmaceutical representatives. Realistically, the best way to avoid interactions such as this is to not be visible during personal time taken off during your usual business hours. Stay in the back yard, in the house, or away from home.
In summary, there are many things to consider and research before opening your medical practice in a home office. It is a unique situation with many advantages and a few caveats. It may not be a good fit for everyone, but for the right physician and their family, it can be a fantastic arrangement.