At 3am, mid-shift, Dr. Victoria Leventis-Shew got a message from her supervisor: 'You're okay with it. So it's never going to change.' She used retirement savings to open a solo Direct Primary Care practice capped at under 130 patients.

A CT scan costs patients $2,000 at a typical imaging center in Chattanooga. At the cash-pay imaging center Dr. Matthew Hitchcock co-founded, it is $350, same day, with no prior authorization required.

The claim that Direct Primary Care only works in affluent city neighborhoods does not survive contact with the map. This guide walks through rural, urban, suburban and employer sponsored DPC, answers the equity question honestly, and explains the 2026 HSA change that lets patients pay membership fees with pre tax dollars.