When a Direct Primary Care Dream Didn’t Work and a Micro Corporation Did

When a Direct Primary Care Dream Didn’t Work and a Micro Corporation Did

This Week’s Real Life Lesson

Some of the most meaningful coaching conversations I have are not with physicians at the height of their careers, but with those standing at an uncomfortable crossroads early on.

That was the case in a recent coaching meeting with a young family physician I will call Dr James Carter.

Dr Carter came out of residency with a clear vision. He wanted to practice direct primary care. He wanted to deliver babies. He wanted continuity, autonomy, and a meaningful relationship with his patients.

In many ways, he wanted what most idealistic physicians want at the end of training. A career aligned with values, not production metrics.

But the first few years did not go the way he had hoped.

What Happened

Dr Carter launched his career with ambition and courage. He entered a direct primary care model while also trying to maintain obstetric privileges. On paper, it made sense. In real life, it was punishing.

The patient panel grew slowly. Cash flow was inconsistent. Call responsibilities were relentless. The operational burden of running a clinic collided with the physical and emotional demands of obstetrics.

What started as vision quickly became survival.

By the time we met, he was exhausted, and concerned he might lose his surgical skills that he had worked so hard for during training. Not burned out in the abstract sense, but worn down by trying to make too many things work at once, without a structural container that could support them.

This is where many physicians internalize failure.

But that is not what I saw.

I saw someone who had learned faster than most, under pressure, and was now ready to pivot with clarity instead of emotion.

What I Learned Watching the Pivot

As we talked, one thing became obvious.

Dr Carter did not fail because direct primary care is flawed. He struggled because he tried to build a lifestyle driven practice before building a resilient business structure underneath it.

That is a subtle but critical distinction.

Rather than doubling down on a model that was draining him, he made a thoughtful pivot. He decided to step back from running a clinic and instead focus on independent contracting as a family medicine physician with surgical obstetrics skills.

This shift accomplished several things at once.

It stabilized income. It reduced overhead. It allowed him to keep practicing obstetrics and maintain his surgical skills. It bought him time and margin.

Most importantly, it restored his sense of agency.

The pivot was not an abandonment of values. It was a strategic retreat to higher ground.

Case Study

Dr James Carter, Family Medicine with Surgical Obstetrics

Dr Carter formed a professional micro corporation to house all of his clinical work.

Instead of being an employee or scattering 1099 income across personal accounts, he created a clean entity that contracted his services intentionally.

Through that entity, he began:

Independent contracting with hospitals Locums style family medicine coverage OB call coverage aligned with his skills Flexible scheduling without long term lock in

The difference was immediate.

Income became predictable. Expenses became deductible. Work became modular instead of overwhelming.

What surprised him most was not the financial improvement, but the psychological shift.

He stopped feeling behind.

He started feeling in control.

Read More in my free eBook: Locum Tenens Guide for Physicians

The Surprising Micro Business Insight

Here is the insight that matters for you.

Early career missteps do not define you. Structural clarity does.

Dr Carter did not need another employer. He needed a container that could adapt as his career evolved.

A professional micro corporation gave him that container.

Inside it, he could practice medicine in different settings, test models, pause ideas that were not working, and preserve optionality for the future.

This is something I have written about repeatedly on my blog, but it hits differently when you watch it happen in real time.

Physicians are taught to commit fully and push through. Entrepreneurs are taught to iterate.

When you operate as a micro business, iteration becomes possible without personal or financial collapse.

Read More in my eBook: Why Every Doctor Should Form a Micro-Corporation

What This Means for You

If you are early in your career and feeling like your original plan is not working, hear this clearly.

You are not behind.

You are gathering data.

Dr Carter’s willingness to pivot early likely saved him years of frustration and financial strain. He did not abandon his identity as a physician. He reframed how he delivered it to the marketplace.

That is the heart of physician entrepreneurship.

Is This Deductible?

On a recent business trip, I met a fellow physician independent contractor for dinner. We talked shop, compared structures, and discussed upcoming contracts.

Was the dinner deductible?

Yes, when handled correctly.

When a meal is directly related to active business discussions with another professional, and not lavish or excessive, it generally qualifies as a deductible business expense, typically at fifty percent.

Documentation matters. Intent matters. Clean bookkeeping matters.

This is one of many small advantages physicians gain when they operate through a business entity rather than as isolated individuals.

Join the Movement

“You are not failing. You are learning faster than the system ever taught you to.”

Physicians like Dr Carter are discovering that autonomy does not come from choosing the perfect model on day one. It comes from building a structure that can evolve with you.

If you are ready to think this way become a member of PEA and join our community of like minded doctors: https://www.simplimd.com/PEAMembership

Inside PEA, you will find free physician e books, practical micro business education, and clear pathways into business strategy consultations and coaching.

If you want guidance navigating a pivot like this, a PEA Business Strategy Consultation can help you pressure test your options before committing years to the wrong structure.