What Are Operating Costs For Direct Primary Care Practice?
Direct Primary Care Practice Bundle
Direct Primary Care Practice Running Costs
Running a Direct Primary Care Practice requires significant upfront capital to cover payroll and facility costs before membership revenue stabilizes Expect initial monthly operating expenses to hover near $65,000 in 2026, excluding variable costs like medical supplies (80% of revenue) and EHR fees (55% of revenue) The largest recurring expense is staff payroll, totaling $490,000 annually in the first year Your financial model shows you need a minimum cash buffer of $552,000 to reach the breakeven point, which is projected for July 2026 (7 months) This guide breaks down the seven critical running costs-from physician salaries to malpractice insurance-to ensure your operational budget is defintely realistic
7 Operational Expenses to Run Direct Primary Care Practice
#
Operating Expense
Expense Category
Description
Min Monthly Amount
Max Monthly Amount
1
Staff Payroll
Fixed/Semi-Variable
The 2026 payroll budget is $490,000 annually, including the physician's $220,000 salary.
$40,833
$40,834
2
Clinic Rent
Fixed
Facility rent is a fixed cost locking in $8,500 per month, or $102,000 annually.
$8,500
$8,500
3
Digital Marketing
Fixed
The $120,000 annual marketing budget aims for a Customer Acquisition Cost (CAC) of $85 per new member.
$10,000
$10,000
4
Malpractice Insurance
Fixed
Medical Malpractice Insurance is a non-negotiable fixed cost budgeted at $2,500 monthly.
$2,500
$2,500
5
Medical Supplies
Variable
Supplies and diagnostic materials are a variable cost estimated at 80% of gross revenue in 2026.
$0
$0
6
EHR Platform Fees
Variable
Telehealth and Electronic Health Record (EHR) System Fees are budgeted at 55% of revenue in 2026.
$0
$0
7
Utilities & Maintenance
Fixed
Utilities and Maintenance cover electricity, water, and upkeep, fixed at $1,200 monthly.
$1,200
$1,200
Total
All Operating Expenses
All Operating Expenses
$63,033
$63,034
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What is the total running budget needed to operate the Direct Primary Care Practice for the first 12 months?
The minimum operational budget required to run the Direct Primary Care Practice for the first year is $778,000, driven primarily by payroll and necessary marketing spend. You can see how owner compensation fits into this picture by reviewing guides like How Much Does Owner Make From Direct Primary Care Practice?
Core Monthly Burn Rate
Annual payroll clocks in at $490,000.
Fixed overhead requires $168,000 yearly.
These two categories alone demand about $54,833 monthly.
Payroll represents 63% of the total required capital.
Growth Capital Needs
Marketing spend is budgeted at $120,000 for the year.
The $778,000 total assumes zero revenue for 12 months.
This is the capital needed to keep the doors open, period.
If onboarding takes longer than planned, you'll defintely need more cash.
Which recurring cost categories represent the largest financial risk to the DPC model?
Payroll, driven by the physician's compensation, represents the largest fixed cost risk for the Direct Primary Care Practice model, outweighing facility overhead substantially. If you're mapping out these initial expenses, understanding How Much To Open Direct Primary Care Practice? is key, but managing physician load is the critical lever for controlling unit economics.
Physician Compensation Impact
The stated annual physician salary is $220,000.
This requires covering $18,333 in monthly revenue just for the doctor's base pay.
If your average monthly membership fee is $75, you need 245 members to cover this salary floor.
Payroll is defintely the biggest fixed component requiring high utilization.
Facility Overhead vs. Staffing
Monthly facility rent is fixed at $8,500, totaling $102,000 annually.
The annual rent cost is less than 50% of the physician's annual salary.
Rent is a static overhead cost that scales poorly until you hit membership density.
Managing physician panel size directly impacts the cost per patient served.
How much working capital is required to cover running costs until the Direct Primary Care Practice reaches breakeven?
To sustain operations until the Direct Primary Care Practice hits profitability, you need a minimum working capital buffer of $552,000, which covers the period leading up to the projected breakeven month of July 2026. This runway calculation is defintely critical for managing initial cash burn.
Cash Runway Requirement
Covering monthly fixed overhead expenses.
Funding necessary marketing spend to acquire members.
Managing negative cash flow before revenue scales up.
This $552,000 must be secured and accessible now.
Breakeven Timeline
Hitting breakeven by July 2026 depends entirely on member acquisition velocity. Before finalizing this runway, review the core assumptions underpinning your growth plan; for instance, see How To Write A Business Plan For Direct Primary Care Practice? for structuring those inputs.
Targeting operational profitability in Q3 2026.
Requires consistent member additions every month.
Assumes current membership fee structure holds steady.
If physician onboarding takes 14+ days, churn risk rises.
What is the contingency plan if membership enrollment is 20% below forecast?
If membership enrollment for the Direct Primary Care Practice falls short by 20%, you must immediately freeze discretionary operating expenses to protect cash flow, a situation requiring sharp focus even when understanding how much an owner makes from the practice, which you can explore further at How Much Does Owner Make From Direct Primary Care Practice?
Stop Variable Growth Spend
Halt any planned expansion of the physician team; this defintely stops high fixed-cost commitments.
Immediately freeze the planned $10,000 monthly marketing spend allocated for Q3 acquisition campaigns.
Delay purchasing new clinical software licenses until enrollment stabilizes above 90% of forecast.
Review vendor contracts for 30-day exit clauses; prioritize flexibility over deep, long-term discounts now.
Calculate Runway Extension
If you cut $10k in marketing and pause one planned hire costing $15k in salary plus benefits, you free up $25,000 monthly.
If your current monthly cash burn (operating expenses minus membership revenue) is $50,000, reducing burn by $25k cuts the burn rate in half.
This action extends your cash runway from 6 months to 12 months, buying critical time to fix enrollment issues.
Focus only on retention efforts; the marginal cost of acquiring a new member when short on cash is too high.
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Key Takeaways
The Direct Primary Care practice requires a minimum cash runway of $552,000 to cover initial operating costs until the projected breakeven point in July 2026.
Fixed monthly expenses, dominated by payroll and rent, establish an operational floor hovering near $65,000 before factoring in marketing or variable supply costs.
Staff payroll is the largest single expense category, budgeted at $490,000 annually in the first year, driven by physician and practice manager salaries.
Variable costs, such as medical supplies (80% of revenue) and EHR fees (55% of revenue), are significant initial burdens that scale directly with membership growth.
Running Cost 1
: Staff Payroll
Staffing Baseline
Your 2026 payroll budget starts at a firm $490,000 annually before accounting for employer taxes or benefits overhead. This baseline is anchored by the $220,000 salary for the Primary Care Physician and $75,000 for the Practice Manager. That's your starting line for core staffing costs.
Payroll Cost Inputs
This $490,000 figure represents committed fixed salary expense for your key personnel. To build this, you need the agreed salary for the PCP ($220k) and the Practice Manager ($75k). The remaining $195,000 covers any necessary support staff salaries budgeted for 2026.
PCP Salary: $220,000
Manager Salary: $75,000
Support Staff Budget: $195,000
Controlling Staff Spend
Managing this cost means maximizing patient load per provider, since salaries are fixed. If your PCP can handle 1,000 members comfortably, your revenue per staff dollar improves fast. Don't overstaff support roles early; hire the manager first, then scale assistants only when volume demands it.
Delay hiring clinical support staff.
Benchmark manager efficiency closely.
Focus on PCP member capacity.
Payroll Risk Check
Payroll is your largest fixed overhead component, dwarfing rent ($102k) and marketing ($120k) combined in 2026. If you miss membership targets, this high fixed cost hits operating income fast. You defintely need a clear path to 1,000+ members to absorb this expense comfortably.
Running Cost 2
: Clinic Facility Rent
Fixed Rent Burden
Facility rent sets a high, unmoving floor for your operating costs. This practice commits to $8,500 monthly, locking in $102,000 annually before you see your first member. This cost is completely decoupled from membership growth or revenue performance, so you must plan for this spend immediately.
Rent Calculation Inputs
This $102,000 annual outlay covers the physical space needed for patient intake and physician consultation rooms. To estimate this, you need signed lease terms, usually quoted per square foot annually. It's a core component of your initial fixed overhead, sitting right alongside payroll and insurance premiums.
Monthly fixed rent: $8,500.
Annual fixed rent: $102,000.
Covers physical space needs.
Managing Rent Risk
Since rent is fixed, minimizing its impact means maximizing patient density per square foot. Avoid signing long leases early on; look for flexible terms or shared space options initially. A common mistake is over-leasing space based on optimistic projections that don't materialize fast enough.
Seek flexible lease terms first.
Avoid leasing too much space.
Focus on patient density immediately.
Break-Even Pressure
This fixed cost immediately dictates your minimum viable membership count. If your net contribution margin per member after variable costs (like supplies) is, say, $60, you need 1,700 members ($102,000 / $60) just to break even on rent alone. That's a significant hurdle before payroll starts getting covered, so cash runway planning is defintely key.
Running Cost 3
: Digital Marketing
Marketing Spend Target
Hitting your 2026 growth targets requires allocating exactly $120,000 for digital marketing, which must acquire new members at or below a $85 CAC. This budget directly funds member acquisition to support the practice's recurring revenue model.
Budget Inputs
This $120,000 covers all 2026 digital marketing spend necessary for growth. To hit the target CAC of $85, you need to acquire roughly 1,412 new members annually ($120,000 / $85). That's about 118 new members per month.
Annual Spend: $120,000
Target CAC: $85
Required Members: ~1,412
Cost Control
Manage this spend by prioritizing channels that deliver high-intent leads, like local search ads targeting specific zip codes where your ideal patient lives. If onboarding takes 14+ days, churn risk rises, wasting acquisition dollars. You must track lead source ROI defintely.
Focus on high-intent local search.
Benchmark CAC against membership LTV.
Avoid broad, untargeted outreach.
Acquisition Breakeven
If the average monthly membership fee is $75, an $85 CAC means you need more than one full month of subscription revenue just to cover the cost of acquiring that patient. LTV must quickly exceed this threshold.
Running Cost 4
: Malpractice Insurance
Fixed Insurance Cost
Medical Malpractice Insurance is a fixed operating expense you must budget for immediately. Plan for $2,500 per month, totaling $30,000 annually, before seeing your first member. This cost protects the physician and the practice from liability claims arising from patient care.
Cost Inputs
This premium covers professional liability protection for the physician providing care under the membership model. It's a fixed cost, meaning it doesn't change if you sign 10 or 100 new members this month. You need quotes based on the physician's specialty and projected patient volume to lock in the $30,000 annual rate.
Fixed cost: $2,500/month.
Covers physician liability.
Budgeted upfront.
Managing Premiums
You can't skip this insurance, but you must shop around aggressively during renewal periods. Ask insurers about discounts for low-risk specialties or participation in formal risk management programs. Many practices overpay by sticking with the first carrier offered during setup. Defintely get three competitive quotes.
Shop quotes annually.
Inquire about claims-free discounts.
Ensure coverage limits match risk.
Impact on Break-Even
Since this is a non-negotiable fixed overhead, it directly impacts your break-even point calculation. If your monthly fixed costs are $30,000 higher due to this premium, you need more members paying the subscription fee just to cover this one line item before covering payroll or rent.
Running Cost 5
: Medical Supplies
Supplies Cost 80%
Medical supplies and diagnostic materials are your primary variable expense, hitting 80% of gross revenue in 2026. This means every new patient visit immediately triggers a large, predictable cost outlay. You can't grow revenue without accepting this cost structure.
Inputs for Supply Costing
This 80% covers all consumables tied to service delivery, like diagnostic materials and exam room supplies. You need projections for patient volume and the average supply cost per visit to forecast this. Remember, EHR fees are 55% of revenue, but supplies are higher. It's defintely a major driver.
Project patient visits monthly
Track unit costs for key items
Verify supplier quotes now
Controlling Variable Spend
You can't cut quality, so focus on procurement efficiency. Negotiate pricing tiers with suppliers based on your projected annual volume, not just monthly needs. Standardize kits to reduce waste from unused items. Even saving 5% on this 80% chunk is a big win for profitability.
Centralize purchasing decisions
Lock in annual pricing tiers
Minimize rush/emergency orders
Margin Reality Check
With supplies at 80% variable cost, your gross margin is only 20% before fixed overhead hits. That leaves the remaining 20% to cover $102,000 in rent and $490,000 in payroll. You need serious patient volume to cover those fixed obligations.
Running Cost 6
: EHR Platform Fees
EHR Fee Swing
EHR and telehealth system fees represent a major chunk of your 2026 operating budget, pegged at 55% of revenue. This cost drops significantly, falling to 35% of revenue by 2030, reflecting scale or contract renegotiation. That's a 20 percentage point swing you need to model carefully.
Cost Inputs
This cost covers your Electronic Health Record (EHR) system and telehealth tools needed for membership delivery. Estimate this by taking projected monthly revenue and applying the 55% rate for 2026. It's the second-largest cost after payroll and supplies, so watch its initial impact closely.
Estimate based on gross subscription revenue.
Verify platform support costs per provider.
Factor in integration fees for new tools.
Managing Tech Spend
Since this is a percentage of revenue, efficiency means maximizing member value without overpaying for tech. Negotiate multi-year contracts now to lock in better rates sooner than 2030. If you onboard members faster, the fixed component of the software cost spreads defintely thinner.
Lock in 2030 rate early if possible.
Audit unused software features quarterly.
Ensure platform scales efficiently with members.
Near-Term Risk
If membership growth stalls before 2027, this 55% fee will crush your contribution margin fast. You must hit revenue targets to absorb this high initial tech burden; otherwise, you're paying premium tech prices for low volume.
Running Cost 7
: Utilities & Maintenance
Fixed Utility Cost
Utilities and Maintenance cost a predictable $1,200 monthly. This charge is fixed overhead, meaning it doesn't change based on how many members you see. It covers essential operational needs like electricity, water usage, and standard facility upkeep for the clinic space. That's $14,400 annually.
Cost Inputs
This $1,200 budget item is non-negotiable monthly spending. Unlike variable costs like Medical Supplies (estimated at 80% of revenue), this cost remains steady whether you have 10 members or 500. You need quotes for local utility rates and a maintenance contract to lock in this specific number for your initial budget planning.
Covers electricity and water bills.
Includes routine facility upkeep costs.
Fixed monthly spend, not volume-dependent.
Managing Utilities
Because this is a fixed cost, savings come from efficiency, not volume cuts. Focus on energy-efficient HVAC systems or reviewing water usage habits now. Avoid under-budgeting for emergency repairs; routine upkeep prevents expensive, unplanned facility failures later on. Don't let small fixes slide.
Audit utility providers annually.
Investigate energy-saving retrofits.
Budget for minor preventative repairs.
Fixed Cost Context
While $1,200 seems small compared to the $8,500 monthly rent, these fixed facility costs total nearly $10,000 monthly before payroll. If you defer maintenance, you risk higher future capital expenditures or operational downtime affecting patient access. It's a defintely necessary expense.
Direct Primary Care Practice Investment Pitch Deck
Fixed overhead (rent, insurance, utilities) totals $14,000 monthly, plus $40,833 in payroll, setting the operational floor near $55,000 before marketing and variable expenses
The model projects breakeven in 7 months, specifically July 2026, requiring a minimum cash buffer of $552,000 to cover the initial burn
The projected CAC in 2026 is $85, supported by an annual marketing budget of $120,000
Staff wages are the largest expense, starting at $490,000 annually in 2026, primarily driven by physician salaries
Revenue is forecasted to jump significantly, from $987,000 in Year 1 to $2,390,000 in Year 2, reflecting successful membership growth
Yes, variable costs like EHR platform fees decrease from 55% of revenue in 2026 down to 35% by 2030, reflecting economies of scale
About the author
Benjamin Lane
Local Business Observer
Benjamin Lane writes for Financial Models Lab as a local business observer focused on simple cash flow planning and the early steps of turning a service idea into a business. He explains startup costs in plain language, with startup budget examples that help readers researching what it takes to get started. Drawing on a practical founder perspective, he keeps his writing grounded, clear, and beginner-friendly.
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