When I first mentioned Direct Primary Care to my colleagues at Meridian, the responses ranged from confused to skeptical. One of my partners, a gastroenterologist who bills insurance for a living, looked at me like I'd announced plans to practice medicine via carrier pigeon. "You're going to charge patients directly? Like a cash business?" He made it sound vaguely illicit.
So I want to use this month's post to lay out what DPC actually is, because I think there are a lot of misconceptions. I've spent the last four weeks reading everything I can find: research papers, blog posts from practicing DPC physicians, financial analyses, legal frameworks, and about a thousand Reddit threads of varying quality. Here is my best understanding of the model.
Direct Primary Care is a practice model where patients pay their physician a flat monthly membership fee, typically somewhere between $50 and $150 per month for adults, in exchange for comprehensive primary care services. There is no insurance billing for the services covered under the membership. No copays at the point of service. No deductibles. No claims. The relationship is directly between the doctor and the patient, with the financial complexity stripped away.
What does the membership typically include? Most DPC practices offer unlimited or near-unlimited office visits, same-day or next-day appointments, extended visit times (thirty to sixty minutes is common), direct communication with the physician via phone, text, or a patient portal, basic in-office procedures, and often wholesale pricing on labs and medications. Some practices also include basic urgent care services, chronic disease management, and preventive care.
The financial model works because of panel size. In a traditional insurance-based practice, a family medicine physician might have a panel of 2,000 to 2,500 patients. You have to see that many to generate enough billing revenue to cover overhead, staff, malpractice, and your own salary. In a DPC practice, because each patient is paying a monthly fee regardless of how many times they come in, you can sustain a practice with 400 to 800 patients. That smaller panel size is the entire magic of the model. Fewer patients means more time per patient, which means better care, which means better outcomes and happier doctors.
I was particularly struck by a study I found from the American Academy of Family Physicians that showed DPC physicians report significantly lower burnout rates than their fee-for-service counterparts. The satisfaction data is compelling on both sides of the stethoscope: patients love the access and the time, and physicians love being able to actually practice medicine.
Now, the questions that keep me up at night. The biggest one is financial viability. I've been building spreadsheets (James has been helping, and by helping I mean he's taken over the spreadsheet entirely and it now has seventeen tabs). The math works if I can reach approximately 300 patients at an average membership of $85 per month. That gives me gross revenue of about $306,000 annually, from which I need to subtract rent, staff salary, malpractice insurance, supplies, technology costs, and my own compensation. It's tight but workable. The question is how long it takes to reach 300 patients.
Most DPC physicians I've talked to say it takes twelve to eighteen months to reach a sustainable panel size. That means I need enough runway to cover expenses during the ramp-up period. James and I have been saving aggressively, and we've estimated we need about $150,000 in startup capital and reserves. That number makes my stomach hurt a little, but we've run the scenarios conservatively and we think we can do it.
Another question that came up in my research is the legal landscape. DPC is not concierge medicine, which is an important distinction. Concierge practices typically still bill insurance and charge an additional retainer fee on top. DPC practices do not bill insurance at all for covered services. This distinction matters legally because some states regulate DPC membership agreements differently from insurance products. Fortunately, my state has a DPC-enabling statute that explicitly exempts monthly membership agreements from insurance regulation, which simplifies things considerably.
I also spent a lot of time this month talking to DPC physicians who are already doing this. I called seven of them, and every single one said some version of the same thing: "It's the hardest thing I've ever done, and I've never been happier." One physician in Oregon told me she sees twelve to fifteen patients a day now instead of twenty-five, spends thirty minutes with each one, and hasn't filled out a prior authorization in two years. I actually got chills when she said that.
The part that excites me most is the potential to rebuild the doctor-patient relationship. In my current practice, I often feel like a stranger to my patients despite seeing them regularly. The visits are so short and so dominated by documentation that there's no room for connection. In a DPC model, I'd have the time to actually listen, to understand the full picture of someone's health, to follow up personally, to be the kind of doctor I went to medical school to become.
So where am I now? I'm increasingly convinced that DPC is the right model for me. Next month, I'm going to dig into the business planning side of things: LLC formation, business plans, financial projections, and all the things they definitely did not cover in my medical education. James is already building a Gantt chart. The man loves a Gantt chart.