Ask the Founders: The Questions Physicians Actually Have About Going Direct

We asked physicians what they most wanted to know about leaving insurance and building a direct specialty care practice. Dozens wrote in, endocrinologists, podiatrists, rheumatologists, surgeons, neurologists, from more than fifteen states. The same questions came up again and again: how to price it, how to find patients, how to transition without a cliff, and how to make it work in a procedural specialty.

So we brought them to the two people who have done it. Dr. Diana Girnita, founder of the DSC Alliance and Rheumatologist OnCall, and Dr. Lara Briseno Kenney, co-founder of the DSC Alliance, sat down to answer the questions that came up most. Real questions, honest answers, no script.

If you are anywhere on the road to direct care, one of these is probably yours.

Key Takeaways – Pricing, patient acquisition, and the insurance-to-direct transition are the three questions nearly every specialist has. – Procedural and surgical specialties can go direct too, and the founders address how. – The deepest, live version of these answers happens in the founding-member webinars. – Founding membership is free for your first 12 months.

Every question below was submitted by real physicians. We grouped the ones that overlapped and kept the details anonymous.

On pricing: membership, per-visit, or tiers

An endocrinologist in Michigan planning to open in fall 2026 asks, along with rheumatologists in Connecticut and Texas: “What do you wish you knew about pricing before you opened? Membership, non-membership, or tier pricing? Do patients really pay an annual membership to a specialist, and how do you handle the cost of labs and specialty medications?”

[Dr. Girnita answers] The biggest thing I wish I had understood is that your pricing model should follow the medicine, not the other way around. In rheumatology, most of what I do is long-term management of chronic autoimmune disease, rheumatoid arthritis, lupus, psoriatic arthritis, so a membership makes sense: those patients need continuity, monitoring, and access to me between visits, and that is exactly what a membership pays for. For the patient who needs a one-time answer, a second opinion or a single complex consult, I offer a consult fee instead. So my model is simple: memberships for the people I manage over time, consults as the front door for everyone else. Some of those consults become members; many don’t, and that is fine.

Yes, patients absolutely pay a membership to a specialist, once they understand what they are getting: direct access, unhurried visits, and someone who actually manages their disease instead of seeing them for ten minutes twice a year. I keep it to one straightforward membership rather than tiers, because simple is easier to explain and easier to run.

On labs and medications, here is the rule that saved me a lot of grief: I do not try to be the insurance middleman. I order what the patient needs, and I show them the cash price up front.For routine labs, transparent cash pricing is often cheaper than their copay. If they chose to use their insurance they can use it for covering the cost of labs.

For expensive specialty drugs, biologics especially, the patient’s own insurance still covers them the same way it always did; I write the order, and their plan and specialty pharmacy handle it. I help with prior authorizations where I can, but I make it clear that the relationship with the insurer belongs to the patient, not to me. 

[Dr. Briseno Kenney answers]  I think it is important to begin with what are your offering and what type of practice you want?  What is the “product” you are offering the “consumer” and why would they want to pay for it?  As medical subspecialists entering a direct care space, if you would prefer to have a membership based practice, you need to identify which diagnoses and typical scenarios require a close relationship with your specialty and ongoing management.  For example, in hematology, this would be a patient with a chronic hematologic disorder that affects their day to day quality of life and or interplays prominently with all their health management.  Sickle cell or an inherited hemoglobinopathy would fit this.  A patient with chronic anemia would most likely see the value in having an ongoing, close, collaborative, relationship with a Hematologist that they know and trust.  A patient with a new finding of anemia, that needs a consult, maybe an iron transfusion and nothing more, is likely to return to their PCP and not find value in continuing their relationship with you.  Personally, I recommend focusing on patients you can have as members so that you can have a panel of around 200 (more if you like) that provide the steady income you need to pay the bills and take some money home.  Then you can offer consults as an adjunct to that.  Some of those consults will convert to a membership, some won’t.  They will continue to build your reputation and word of mouth,either way and provide some cash flow.  I do not recommend tiered memberships because I don’t want to track all those different invoices and use, but others do this successfully.  I like simple.  I also don’t recommend simply having a fee for service practice but without insurance. That leaves you with complicated finances and the ongoing issue of having to always be seeing more and more patients, losing income during time off or holidays and not having the work life balance that you deserve.  Do you want to work full time or part time?  What salary would you like to eventually earn?  Once you are clear about what you want to offer and how many patients you want to manage, you can start to think about how much you want to charge.  The patient you envision serving and attracting will have a price point that they are willing to pay.  If you want a concierge, VIP, feel to your practice with a prime location, interior designer decor, spa like or executive feel, you should charge high prices to attract people who fancy themselves above the rest and like knowing they could afford the higher prices.  If you want working class folks, small business owners, farmers, tradesman and people who value a dollar, you are going to want to charge a fair price and avoid pricing them out of trying your care.  Look around at how much people are paying in your area for DPC memberships, monthly cell phone bills, internet services and similar.  At the end of the day, it is going to be an educated guess what your market will bear.  If you are new to the area or the idea is new to the area, I would error on the side of slightly lower pricing so you can generate some business and start the word of mouth without people not even inquiring due to sticker shock.  Shock them by being affordable, then impress them by being GOOD.
For the business books, jot down your ideal panel size, the membership price you are considering, and do the math.  Is that total enough to cover your overhead and survive?  Adjust accordingly.  Remember, don’t be paralyzed by analysis.  Get started. You can change your pricing however and whenever you want.  

A rheumatologist in Massachusetts and a breast surgeon in Missouri ask: “How do you feel strong and confident discussing your pricing, and how do you develop pricing for procedures and office visits?”

[Dr. Girnita answers]

Confidence with pricing comes from two things: knowing your value, and being transparent about it. The system you came from hides prices, so simply being able to say your fee out loud, clearly, and explain what it includes, already sets you apart. I never apologize for my price and I never bury it. When you believe the care is worth it, and you can look a patient in the eye and tell them exactly what they get, the confidence takes care of itself.

It also helps to stop thinking of the fee as payment for your time. You are not selling minutes; you are selling access, judgment, and an outcome the patient could not get elsewhere. Once I made that shift, pricing stopped feeling awkward. For office visits, I price around the value of the relationship and the access. For procedures, price to cover your true cost plus a fair margin, and keep it transparent, patients respect a clear number far more than a mysterious one. Practice saying your price without flinching. That is a skill, and it gets easier every single time.

[Dr. Briseno Kenney answers]  You have to feel confident in what you have to offer, which is why you need to figure out what you can offer and what you want to offer, first.  You also need to educate yourself about what isn’t happening successfully in insurance based medicine so that you can point out the contrasts (to yourself as well as your patients).  Be honest with them about why you believe in this model and what made you leave your “cushy” employed paycheck.  Be vulnerable and genuine.  Patients know they aren’t getting the care they deserve anymore but many don’t realize how much doctors are on their side about this and fed up with the care as well.  We, the doctor and the patient, should be each other’s biggest advocates because we both want better, more affordable, care.  If your pricing is fair, you’ll be proud to be able to offer it.  I set a membership price, charged an enrollment fee of three times that amount and my one time consult fee was set to twice that that (ex. $50/month, $150 enrollment, $300 consult).  I rarely bothered to charge more than overhead and drug price for procedures but you can price them however you want.

On finding patients and referrals

A neurologist in California, a nephrologist in Pennsylvania, and an allergist in Iowa ask: “When you first started, where did your patients and referrals actually come from? What worked, what didn’t, and how long did it take to build a panel?”

[Dr. Girnita answers]

My first patients did not come from referrals, they came from my reputation and from being findable. When I opened Rheumatologist OnCall, I built a telemedicine-first, multi-state practice, so my reach was never limited to one town. Patients found me because they were searching for answers: a rheumatologist who had time, a second opinion without a six-month wait, someone who could see them even though there was not a specialist within a hundred miles of where they lived.

What worked was showing up where patients were already looking, clear information online, educational content, and a presence that let people find me and feel like they knew me before they ever booked. What did not work was waiting for other doctors to send me patients. Building a panel took months of consistency, not weeks, but every patient who had a good experience told others, and word of mouth compounds. If I could tell my earlier self one thing, it would be this: start creating content and building your visibility before you open, so the funnel is already filling when you launch.

[Dr. Briseno Kenney answers]

My first patients were prior patients from my employed panel that sought me out and several medical personnel from my prior employers.  There people self referred because they knew me and trusted my expertise and judgement above the other options available to them.  My goal was a minimum panel of 150 members and a maximum panel of 200 members.  This suited my life at the time, with three small children and interests outside of medicine.  It took one year to reach my goal of 150 members.  The panel remained stable between 175-200 members after that time.  Depending on time of year and obligations, I occasionally stopped taking new patients.

A mental health specialist in California asks: “Did you focus your marketing on educating people about what direct care is, or on audiences already familiar with the model?”

[Dr. Girnita answers]

I educated, because I had no choice, when I started, the term direct specialty DID NOT existed. We were defining the category as we built it. But here is the important nuance: I did not lead with the model. Patients do not wake up searching for “direct specialty care.” They search for their problem, a rheumatologist who will listen, help with joint pain, an answer about their autoimmune disease. So I led with their problem and their situation, and I educated them about the model second, as the reason I could offer what they were looking for.

Educating the market is real work, but it pays off twice: it brings patients in, and it builds your authority as the person who explains this clearly. That authority is also what makes search engines, and now AI assistants, recommend you. So yes, educate, but always in service of the patient’s problem, never as a lecture about billing.

[Dr. Briseno Kenney answers]  No one in my area was familiar with the term Direct Care or the model of DPC or DSC. Well, to be fair, DSC did not exist as a term at that time.  I myself was unaware of the model until a family medicine colleague mentioned hearing about it at a conference they attended.  First I educated myself.  It wasn’t hard to share what I learned because I was so excited about the model and genuinely enthusiastic about what it could accomplish (and equally dissatisfied and disillusioned with the insurance based/employed model).  As I read those first articles and books, I was telling everyone I knew about what I was learning and my plans; the clinic nurses I worked with, my colleagues, my hair dresser, my family and friends and my patients.  

An allergist and immunologist in Arizona and a nephrologist in Georgia ask: “How do you build referral relationships, and do you get more from fee-for-service primary care or direct primary care physicians?”

[Dr. Briseno Kenney answers]  Different people will experience different local patterns but I would NOT expect to get any referrals from anyone.  That is the honest truth.  Prior colleagues will rarely bother to refer to you versus place an order in the EMR for within the system.  Most primary care doctors are employed, so same situation.  I think it’s still important for them to hear about what you’re doing because it is vital to the future of our profession and it provides some hope for them, but don’t expect them to send you patients.  Occasionally they will call you up about a particular person that needs “someone like you” but it won’t play much of a role in your practice.  You don’t need to build a referral network.  You aren’t employed and you aren’t empaneled as “in network” with insurers.  What you need to do is go straight to the patients/the consumers and tell them what you are offering.  Make sure what you are offering is something they feel they actually need/value.  This is not how you thought as an employee or a specialist in a system. Think about all the times you walked into a new consult and the patient was like “why am I here? “  Those people didn’t even know why they needed you or if they needed you and wouldn’t have bothered to see you.  An easy example would be an abnormal lab consultation.  There was little to no value for that patient.  

On that note, expect very few referrals from independent primary care doctors.  A good primary care doctor, WITH adequate time and resources, won’t need the help of specialists very often.  That is the way it is supposed to be and the way it used to be.  It is estimated that a family medicine or internal medicine doctor should be able to address 80-90% of the medical care and that is part of the appeal of DPC care for both the doctors practicing DPC as well as the patients.   

[Dr. Girnita answers] I agree with Lara, do not build your practice on the expectation of referrals, especially from employed physicians, who almost always have to keep referrals inside their own system. The exception, and it is an important one, is direct primary care. DPC physicians are independent, they think like you, and they genuinely want good specialists they can send their members to. Those relationships are worth cultivating, one solid DPC partnership can send you a steady trickle of exactly the right patients. So I would put it this way: do not depend on referrals, but do build relationships with the DPC community, because that is your natural aligned network. Everyone else, go straight to the patient.

A rheumatologist in Nevada asks: “How important is a social media presence, and how do you begin creating content?”

[Dr. Girnita answers] This one is close to my heart, because content is how I built my practice. Patients across the country found me because I answered their questions publicly, in plain language, on the platforms where they were already searching for health information. That is the key: go where your patients actually are. If your future patients are searching health questions on Google and YouTube, that is where you should be, not chasing trends on a platform your patients never open.

Start by answering the questions you hear every day in clinic. Every patient question is a piece of content. You do not need production value or a script, you need clarity and consistency. Be yourself; direct care is a relationship, and people want to sense who you are before they book. Content is a long game, but it is the highest-leverage thing a telemedicine practice can do, because it works while you sleep, it makes you findable, and increasingly it is what AI tools pull from when a patient asks who they should see. I would rather have one well-answered patient question published than a dozen polished ads.

[Dr. Briseno Kenney answers]  What is important, is your visibility to your desired patients.  First you need to know what type of patient you intend to attract.  If you are going to primarily see middle aged, male, tradesman and farmers, they are unlikely to find you on TikTok. No matter how many cutesy videos you make, you’ll be wasting your time and energy.  In fact, you may also attract patients that aren’t a good fit and have a negative impact on your growth.  However, people need to be able to find you and to snoop around and feel like they know you and the type of doctor you are.  Direct care, ideally, involves a more complicated interpersonal relationship and is less transactional. So, people want to know who you are and what you are about.  When they google your name, they need to find information about how to contact you, what you charge, who you are and what you are doing.  I simply bought up a few domains and funneled them to my website (which was diy on square space) and a FB business page.  I created very little “content” on FB.  To this day my FB page is mostly pictures of me, the clinic, and the most popular posts are ones where I give practical opinions on things or rail against the system. 

A podiatrist in New York, a geriatrician in California, an allergist in California, and a hernia surgeon in California ask: “How do you start from scratch, especially after moving to a new area where you don’t know anyone professionally, and what is the most effective way to attract and retain patients, including for a surgical practice?”

[Dr. Girnita answers] For a telemedicine practice, the “new in town” problem mostly disappears, and that is one of the quiet superpowers of this model. You are not dependent on knowing people locally, because your patients can be anywhere you are licensed. So the fastest path is to be findable: a clear website, a complete directory listing, transparent pricing, and content that answers patients’ questions. That reaches people whether you have lived somewhere thirty years or thirty days.

If your practice has to be local or hands-on, a surgical or procedural one, then the in-person relationship-building Lara describes matters, and you pair it with the infrastructure question: get privileges at an existing hospital or surgery center, use cash-pay facilities, and do not feel you have to build your own operating room to go direct. Whichever path you are on, you attract patients by being easy to find and clear about your value, and you retain them by being reachable and genuinely good.

[Dr. Briseno Kenney answers]  If you are unknown in an area, you better start by making yourself known!  In smaller towns, you can definitely still get the newspaper and local business organizations to put you on the front page for free.  Everyone you encounter, take the moment to share with them what you are doing and WHY.  People will be interested in the idea but they’ll be excited about your story and your purpose.  When you get your hair cut, talk their ear off about it and throw out some opinions when you overhear someone complaining about not being able to get in with their doctor or the bill they just got from the hospital.  I can’t tell you how many Uber drivers know about DPC and DSC after giving a direct care doctor a ride somewhere!  Attend any professional gatherings, or start your own.  When I first moved, I was the “new guy” and so I started a monthly women’s group for all the local female physicians, nurse practitioners (independent practice state) and dentists in town.  It was a great way to meet up, grab a quick bite, collaborate on patients and complain about our jobs.  I also spoke at Rotary, Chamber of Commerce and the local nursing program.  

An endocrinologist in California asks: “How did you scale without sacrificing quality or the personal touch with each patient? Was it the team, adding physicians, or leveraging AI without making it feel generic?”

[Dr. Girnita answers] I did scale, but not the way employed medicine means it. I never scaled by cramming more patients into a day, the whole point was to stop doing that. I scaled reach: telemedicine and multi-state licensing let me care for patients who had no rheumatologist near them at all, without shortening a single visit. That is the kind of scale direct care makes possible, more access, not more volume per hour.

The way you protect the personal touch while you grow is by putting systems and technology on the busywork, not on the relationship. A good team member handling scheduling and intake, and AI tools handling documentation and administrative drudgery, free you to spend your actual attention on the patient. Use technology to remove everything that is not medicine, and it never feels generic, because the human part, the listening, the judgment, the relationship, is still entirely you.

[Dr. Briseno Kenney answers]  I never scaled.  I didn’t want to or need to.  I went from being solo with no staff, to having an MA full time and an RN part time.  

On going hybrid and transitioning

A podiatrist in Virginia, a rheumatologist in Texas, and a podiatrist in Maryland ask: “Can I go hybrid first, dropping a few insurances and seeing direct patients part-time within my group, then transition fully? How do I structure it, and how do I educate existing patients through the conversion?”

[Dr. Girnita answers] Hybrid is a completely legitimate on-ramp, and for many specialists it is the smart way to reduce risk. Start by dropping your worst-paying, most administratively painful contracts first, and open a set of direct or telemedicine slots alongside your existing schedule. Structure the two sides cleanly and separately: your direct patients sign a direct-care agreement and are never billed through insurance, so the finances do not get tangled.

For your existing patients, be honest and personal about the change. Tell them why you are doing it and exactly what will be different for them, more time, more access, a clear price. Many will follow you when the relationship is strong. Just remember hybrid is a bridge, not the destination. It is there to let you build the direct side with a safety net, and once that side can stand on its own, you cross the rest of the way.

A podiatrist in Michigan and a podiatrist in Illinois ask: “If I have a strong insurance-based revenue line, does moving to direct care mean a knowing pay cut, and can I rebuild the revenue past it?”

[Dr. Girnita answers] Usually there is a dip at the transition, that is honest to expect, but it is rebuildable, and you often come out ahead of where you started. The reason is that in direct care you keep far more of every dollar: no billing department, no claim denials, no army of staff working the insurance treadmill, so your overhead drops dramatically. And with telemedicine and multi-state reach, your potential patient base is much larger than a single insured local panel, which is what lets you rebuild the top line. Plan for a runway, give yourself the financial cushion to get through the dip, and know that the ceiling on the other side is higher and far more within your control.

[Dr. Briseno Kenney answers]  Yes.  The best data we have for this is from the Direct Primary Care space.  Early on in that movement, most clinics were not starting from scratch but rather changing from insurance to direct care membership models.  At the time of transition, most practices retained 

A rheumatologist in Texas asks: “What are the pearls on making the transition, and how does malpractice liability insurance view this kind of practice?”

[Dr. Girnita answers] My biggest pearl: build before you leap. If you can, start creating content, securing your licenses, and clarifying your model while you are still employed, so you are not starting from zero on day one. Keep your pricing transparent and your model simple; complexity is what overwhelms people in the first year.

On malpractice, premiums for direct and telemedicine practices are typically the same like in person. But you have to describe your practice correctly to the carrier, using the words “direct care” and, if relevant, “telemedicine across multiple states,” and work with a broker who understands multi-state telehealth, because a generic policy may limit or exclude it. Start that conversation early; underwriting can take weeks, and you do not want it to be the thing standing between you and your first patient.

[Dr. Briseno Kenney answers]  Malpractice rates are significantly lower for Direct Care, but often times you have to help them by using the words Direct Care and Concierge to explain what you are doing.  On average, rates are ½ that of traditional practices, or less.  My first year in business my malpractice was $1900 for the year.  Last year, my malpractice was $4200 for the year.

An endocrinologist in Texas, a podiatrist in New York, and a sleep specialist in Pennsylvania ask: “How do I start direct care inside an existing insurance clinic, or alongside hospital contract work? And when my adjunct services (orthotics, laser, regenerative therapies) drive most of my revenue, does it still make sense to start limiting insurances?”

[Dr. Girnita answers]

You can often start direct care alongside employment or contract work, but the first thing to check is your contract, specifically any non-compete or moonlighting restrictions. Once you know what you are allowed to do, you can begin offering direct visits in the space your contract leaves open and grow from there.

If adjunct services drive most of your revenue, you do not have to give those up. Keep what works, and layer direct care onto the cognitive and continuity part of your practice, the ongoing management and access that patients will happily pay for directly. Then start trimming the lowest-value insurance contracts first. You rarely have to flip the whole thing at once; you shift the mix deliberately, one contract at a time, toward the work you actually want to be doing.

A podiatrist asks: “Do you keep a brick-and-mortar location or travel to see patients, and can you transition out of surgery if you decide you want to?”

[Dr. Girnita answers] I built my practice telemedicine-first, which means almost no real estate and patients across many states, and I would encourage anyone whose specialty allows it to seriously consider that model, it is lighter, more flexible, and more accessible for patients. Whether you keep a physical location, travel to patients, or work virtually is a design choice, and direct care lets you make it on your own terms.

And yes, you can absolutely move away from surgery or procedures if that is what you want. One of the freedoms of this model is that you get to build the practice around the medicine you actually want to do. If your joy is in the cognitive, continuity side of your specialty, you can design a direct practice that emphasizes exactly that.

On procedural and surgical specialties

A breast surgeon in Pennsylvania, a hematologist-oncologist, and a pediatric cardiologist in Illinois ask: “How does direct care work for a surgical or infusion-based specialty without investing in your own surgical center? Could a group of specialists partner to share that risk?”

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[Dr. Briseno Kenney answers]  In the 1980’s 80% of practices were private practice.  Why can’t you perform surgery at the hospital or an existing surgery center?  You simply need privliges.  This has been done for decades upon decades.  It’s up to you to find a way, to innovate and to lead.  There isn’t a play book. As Hematology/Oncology I kept privileges at three hospitals and sent my chemotherapy and blood orders to them.  The Surgery Center of Oklhoma is the most established example for how surgeons and anesthesiologists can build an independent, cash based, surgical center.  

[Dr. Girnita answers] You do not need to build your own facility to go direct. As Lara says, get privileges at a hospital or an existing surgery center and do your procedures there, physicians did exactly this for decades. For infusion-based care, which is very familiar territory in rheumatology, you can order infusions through an existing infusion center or partner facility with transparent cash pricing, rather than building the infrastructure yourself. And a group of specialists absolutely can share the risk and the cost of a facility or an infusion suite, that kind of collaboration is one of the most promising directions for procedural direct care. The Surgery Center of Oklahoma is the proof that a cash-based, transparent surgical model works at scale

A gastroenterologist in Missouri asks: “Are there GIs doing this outside a concierge model?”

[Dr. Briseno Kenney answers]  Yes.  There are two types of setups I have seen. One focused on providing cash pay endoscopy services.  This would be direct care FFS model.  The other is to focus on chronic GI illnesses that require active, informed, care and continuity.  This is membership modeled.

[Dr. Girnita answers] Yes, and the two patterns Lara describes are exactly right, and they apply across specialties. Either you build around cash-pay procedures, endoscopy in GI, as a direct fee-for-service model, or you build around the chronic conditions that need ongoing, informed management and price that as a membership. Many practices do a bit of both. The model follows the care the patient needs, not the specialty label.

On operations and continuity of care

A neurologist in Arizona asks: “How do you handle specialty meds that need prior authorization and referrals when you don’t take insurance for visits, and how do you reassure patients their insurance will still cover what you order?”

[Dr. Briseno Kenney answers]  It is important to educate patients about knowing their own insurance plan/policy.  It is not a job you want.  Have them call the insurance to find out what is covered, what requires prior authorizations, if out of network physician orders and referrals will be honored or ignored.  A meet and greet session is a good time to go over this and recommend this.  In reality, you have ZERO power or say with the insurance.  Which, is why you are divorcing yourself from that role and it is important to keep that clear.  Being sandwiched in between the patient and the payor is part of what has made patients think that their doctor is the one at fault for the denials, the bills etc.  Remove yourself. Your patient is the one who is paying/buying the insurance. The relationship with insurance is SOLELY between the patient and the insurer. Anything that is reasonably priced with cash pricing, I encourage them to pay cash rather than utilize insurance and get a huge bill months down the line.  Again, I am not a part of that.  If they decide to use the insurance, I make sure they know what it would have been cash and then I provide the order as they requested for that lab/test/med.  Almost always, months later they will come back demanding to know why they got a bill for 4 times what I told them it should cost and that is when I remind them that the actual price (cash) and the insurance/facility billing are not remotely rational.  They don’t usually choose to do that again and pay cash for most things after that.  For truly expensive items, I have them find out the requirements for their insurance policy, and I provide them as able.  

An allergist in Florida asks: “How do you keep patients in continuous care, rather than one comprehensive evaluation before they go find someone who takes insurance?”

[Dr. Girnita answers] Continuity is built into the model when you design it around the right patients. In rheumatology, the conditions I treat are chronic by nature, they require ongoing management, so a membership that keeps patients in continuous care is not a sales tactic, it is simply good medicine for those diseases. More broadly, patients stay in continuous care when they can feel the ongoing value: they can reach you, you know their history, and they trust that you are managing their condition rather than just evaluating it once. Show that value visibly, and the relationship continues because the patient wants it to, not because they are locked in.

[Dr. Briseno Kenney answers]  My patients are with me because they think I am the best doctor they could find and that I genuinely care about them.  They don’t come to me because I do or don’t take insurance.

A physician in infectious disease, wound care, and obesity medicine in Georgia asks: “What payment methods do direct practices use, and does anyone take crypto?”

[Dr. Girnita answers]

 Keep payments simple and frictionless. Memberships run as a recurring charge, ACH or card, through the practice software, and consults are paid by card at the time of service. That is really all you need. Crypto is not necessary; what matters is that paying you is effortless and transparent, because every extra step between a ready patient and a completed payment is friction you do not want.

[Dr. Briseno Kenney answers]  We charge a recurring membership that is run through the EMR via ACH direct withdrawal or charged to a card.  I have a few members that pay cash.

Get the full answers, live

We could only fit a handful of questions here, and every one of them deserves more than a paragraph. That is what the founding-member webinars are for. Each session, Diana, Lara, and guests go deep on one part of the journey, pricing, marketing, the transition, the procedural specialties, and answer your questions live.

Founding membership is free for your first 12 months, and it includes the full webinar library, the guides, the national directory listing, and a community of specialists who have already solved what you are working through.

A few of you asked a fair question: why does membership cost what it does when a website is cheap to run? Two answers. First, your founding year is free, so the cost to look is nothing. Second, you are not paying for a website. You are paying for the shortcut, the guides, the live webinars, the directory that sends patients to your door, and a room of specialists who save you from learning every lesson the hard way, alone. The value is the years it takes off your journey, not the software.

Join the founding round free → Your first year is on us. If your question is above, come hear it answered in full.

Want more of the founders in their own words before you join? A few places to start: Dr. Girnita on the KevinMD podcast, on how she built a direct specialty care practice, and Voices in Medicine: Diana Girnita on direct specialty care.

Featuring Dr. Diana Girnita, MD, PhD, founder of the DSC Alliance and Rheumatologist OnCall, and Dr. Lara Briseno Kenney, co-founder of the DSC Alliance. Have a question for the next session? Reply to any DSC email or ask in the community.