After nearly a decade as a DC-area hospitalist, Dr. Nadia Sirdar opted out of Medicare to properly care for elderly patients aging in place, and built a Direct Primary Care practice where half her patients turned out to be husbands wanting the same care as their wives.

Dr. Ashley Agan left academic medicine after patients waited six months and traveled across the country just to see her, proof she could build Scottie ENT, a direct-pay practice in Dallas, on Google reviews and transparent pricing instead of billboards.

When corporate ownership bought the Direct Primary Care practice Dr. Josh Chow spent five years building, he did not take a new job. He and his wife spent just over $100,000 in donated equipment, loans, and grit to open Ohana Medical instead.

A $5 increase per member, applied across a panel of several hundred patients, can be the difference between a Direct Primary Care practice that survives and one that quietly fails. Why pricing, not patient volume, is often the real problem.

When their clinic closed overnight after federal legislation defunded its parent organization, three physicians lost 13,000 patients in weeks. Half of their $50,000 startup budget for Open Arms Primary Care came from strangers on GoFundMe.