What Is Direct Primary Care?
- Maryal Concepcion
- 2 days ago
- 9 min read
My DPC Story10 minute readFor all training levels
The Explainer by Maryal Concepcion, MD FAAFP
A plain-language guide for physicians and physicians-in-training who want to understand a different way medicine can work, and why it is gaining momentum.
01
Start Here: The Problem This Solves
If you have spent any time in a primary care clinic, you have probably sensed something that nobody says out loud: there is not enough time. Not enough time to actually listen. Not enough time to think through a complex case. Not enough time to be the doctor you were trained to be.
This is not a personal failure. It is a structural one.
The dominant model of primary care in the United States, built on fee-for-service insurance billing, creates a financial reality where physicians must see large volumes of patients to remain solvent. When survival depends on throughput, the system begins to compress everything that cannot be directly billed.
Relationship. Continuity. Prevention. Thinking time. Trust.
Direct Primary Care (DPC) is an attempt to answer a single question: What happens when you remove insurance billing from routine primary care?
02
The Simple Definition
At its core, Direct Primary Care is a membership-based primary care model. Patients pay their physician a flat monthly fee, typically between $50 and $150 depending on age and region, and in exchange they receive comprehensive primary care services directly.
There are no co-pays per visit. No insurance claims for routine care. No billing codes. No reimbursement negotiations.
The physician earns revenue from their membership panel. The patient gets access to their doctor.
That simplicity is the point.
$50–150: Typical Monthly Fee
Covers unlimited primary care visits, often including telehealth and direct messaging
400–800: Typical Panel Size
Compared to 2,000+ in traditional fee-for-service primary care
DPC is often confused with concierge medicine. They are not the same. Concierge practices typically charge membership fees on top of insurance billing. DPC replaces insurance billing for routine care entirely. The patient still carries insurance for hospitalizations, emergencies, and specialist care, but they use their membership for everything their primary care physician can handle directly.
03
What Changes When the Incentive Changes
The most important thing to understand about DPC is not what it costs. It is what it changes structurally, and how that structural change ripples through the entire experience of practicing medicine.
In fee-for-service medicine, revenue is tied to visit volume. More visits, more revenue. Faster visits, more visits. The incentive points toward speed.
In DPC, revenue is tied to membership size. Once a panel is established, revenue is largely predictable regardless of how many visits happen in a given month. The incentive is no longer speed. It shifts toward something else entirely: keeping patients healthy and satisfied enough to remain members.
When you are paid per visit, time is a cost. When you are paid by membership, time becomes a clinical tool. That one shift changes nearly everything downstream.
What becomes possible in practice
Extended appointments without financial penalty, often 30 to 60 minutes as standard
Same-day or next-day access, because panels are small enough to accommodate it
Direct physician communication by phone, text, or secure message without scheduling a formal visit
Proactive outreach, calling patients before problems worsen rather than waiting for them to appear
Genuine preventive care conversations that are not squeezed into the last two minutes of a 15-minute slot
Reduced administrative burden, because there are no insurance claims to file, no coding to justify, no prior authorizations for routine services
DPC physicians frequently describe practicing at a level of depth they did not know was possible inside the constraints of traditional primary care. Not because they became better clinicians overnight, but because the structure stopped working against them.
04
The Business Model, Plainly Explained
Understanding DPC financially requires understanding two concepts: overhead and recurring revenue.
Why overhead matters so much
In traditional primary care, a significant portion of every dollar earned goes toward the cost of billing. Coding staff. Claims processors. Appeal management. Billing software. Compliance. The administrative layer required to extract reimbursement from insurance companies is enormous, and it is baked invisibly into the cost of running a practice.
DPC eliminates most of that layer. Without insurance billing for routine care, the practice does not need a billing department. The overhead profile shrinks substantially, which means a DPC physician can run a financially viable practice with far fewer patients than a fee-for-service physician requires.
The math, briefly
Consider a physician with 600 members at $85 per month. That is $51,000 per month in gross revenue, or roughly $612,000 annually before expenses. After accounting for a modest staff, rent, malpractice insurance, an EMR, and taxes, many DPC physicians arrive at a take-home income that is competitive with employed primary care positions, while seeing a fraction of the daily patient volume.
The question is not whether DPC is financially viable. It is whether the startup process feels familiar. For most physicians, it does not, because business formation was never part of medical training.
Startup costs are lower than most assume
Many DPC practices launch for under $50,000. Some launch for under $25,000. Because the model does not require a large staff, an elaborate billing infrastructure, or high patient volume from day one, the barrier to entry is meaningfully lower than traditional private practice models. Panel growth is gradual. Revenue stabilizes as membership builds.
05
DPC vs. Traditional Primary Care: At a Glance
Here is how the two models differ across the dimensions that shape daily practice life.
Factor
FFS: Fee-For-Service
DPC: Direct Primary Care
Panel Size
1,800–2,500 patients
400–800 patients
Visit Length
10–15 minutes typical
30–60 minutes typical
Revenue Model
Per-visit billing
Monthly membership
Administrative Load
High (coding, claims, appeals)
Low (no insurance billing)
Schedule Control
System-determined
Physician-determined
Patient Access
Appointment-based
Direct, often same-day
Ownership
Typically employed
Typically physician-owned
Income Predictability
Variable (depends on volume)
Stable (recurring membership)
Note: Comparisons reflect general trends. Individual practices vary significantly.
06
Common Misconceptions, Addressed
DPC attracts both enthusiasm and skepticism. Some of the most common concerns are worth addressing directly.
Myth: DPC is only for wealthy patients.
Reality: At $75 to $100 per month, DPC membership is accessible to many working adults, particularly when paired with a high-deductible plan. Some DPC clinics offer tiered pricing, family caps, employer-sponsored memberships, or scholarship arrangements that extend access to lower-income patients. The model is not inherently exclusive, though like any model, it can be designed that way if a physician chooses not to prioritize equity.
Myth: DPC physicians are abandoning patients who need them most.
Reality: Many DPC physicians practice in rural or underserved areas where they are the only available primary care option within a wide radius. Others serve working-class communities through employer contracts. The concern about access is legitimate and worth taking seriously, but smaller panel sizes do not automatically mean less equitable care, especially when the quality and continuity of that care improve substantially.
Myth: You need business experience to open a DPC practice.
Reality: Business skills help, but they are entirely learnable. Many DPC physicians opened their first practice with no prior entrepreneurial background. The model is intentionally simpler than traditional private practice. The greater barrier is usually psychological: the transition from employee identity to owner identity, rather than any specific knowledge gap.
Myth: DPC is just concierge medicine rebranded.
Reality: Concierge medicine typically adds a retainer fee on top of ongoing insurance billing, making it additive and expensive. DPC removes insurance from routine care entirely and keeps pricing accessible. The philosophical orientation is different: concierge medicine targets premium service for premium pay; DPC targets restored relationships and structural simplicity for a broadly affordable monthly fee.
07
Who Chooses DPC, and Why
I stopped performing medicine. I started practicing it.
DPC Physician, My DPC Story Podcast
DPC tends to attract physicians who share a cluster of values and frustrations. They are not a monolithic group, and not every physician who is drawn to DPC will ultimately choose it. But certain patterns emerge consistently.
Physicians who choose DPC commonly describe:
A desire for longitudinal relationships with patients they actually know
Frustration with the administrative volume of insurance billing relative to its clinical value
A need for schedule autonomy that employed positions rarely provide
A preference for smaller, more intentional panel sizes
An interest in building something that reflects their clinical values, rather than inheriting institutional culture
A sense that they were trained for a depth of care that the system rarely allows
DPC also attracts physicians at different career stages for different reasons. Early-career physicians are drawn to it as a way to build a practice aligned with their values from the start, before accumulating years of adaptation to a system that may not fit them. Mid-career physicians often discover it as a restructuring path after burnout, a way to reclaim what drew them to medicine without leaving the field.
You do not have to be burned out to consider DPC. You just have to be honest about what kind of medicine you want to practice, and whether the structure you are in supports that vision.
08
Questions Physicians Most Often Ask
Can I open a DPC practice right out of residency?
Yes, and a growing number of physicians do. It requires more upfront planning than entering an employed position, but the startup process for a DPC clinic is simpler than traditional private practice. Many residency graduates who choose DPC describe the early learning curve around business formation and panel growth as challenging but manageable, particularly with mentorship from established DPC physicians.
Does DPC work in rural or underserved areas?
Yes, and in some ways it works especially well there. Rural DPC physicians often describe their practice as the only consistent primary care presence in the region. Without the need for a large patient volume to sustain billing overhead, a rural DPC physician can build a financially viable practice with a smaller community panel than traditional fee-for-service would require.
What happens if a patient needs a specialist or hospitalization?
DPC covers primary care. Patients are expected to carry insurance for hospitalizations, specialist visits, imaging, and other services outside primary care scope. DPC physicians often become skilled at negotiating discounted rates for labs and generic medications on behalf of their members, adding additional value to the membership. The physician also coordinates referrals and specialist communication, often with more thoroughness than a high-volume practice allows.
How do DPC physicians handle panel growth early on?
Most DPC practices grow gradually over 12 to 24 months. Physicians often start with a small founding panel, sometimes as few as 50 to 100 members, and grow through word of mouth, community relationships, and sometimes employer contracts. Income is modest in early months. Most physicians who plan carefully can supplement with part-time urgent care or telehealth work while building. Reaching a stable panel of 400 to 600 members typically takes one to two years.
Is DPC legal in every state?
DPC is legal in all 50 states, but state regulations vary regarding the specific structure, disclosure requirements, and whether DPC agreements may be considered insurance contracts under state law. Most states have enacted DPC-specific legislation clarifying that membership agreements are not insurance products. Working with a healthcare attorney familiar with your state's framework is strongly recommended before opening.
Can DPC work with Medicaid or Medicare patients?
This is a nuanced area. Physicians who participate in Medicare cannot charge Medicare patients a membership fee for services already covered by Medicare, which creates a structural conflict with the DPC model. Many DPC physicians opt out of Medicare participation entirely, which is permitted but is a significant decision. Some DPC practices serve Medicaid populations through state pilot programs or managed care organizations that have contracted with DPC clinics. Federal interest in DPC as a model for improving primary care access has grown, and regulatory flexibility is evolving.
09
Is DPC Right for You?
That is ultimately a question only you can answer. But there are honest ways to approach it.
DPC may align with you if:
You find yourself consistently wishing you had more time with each patient
Administrative burden has begun to feel disproportionate to its clinical value
You are drawn to the idea of building something that reflects your own values rather than inheriting institutional culture
Longitudinal relationships matter to you more than specialty variety or procedural complexity
You are willing to accept early income uncertainty in exchange for long-term autonomy and equity
DPC may not align with you if:
You strongly prefer a guaranteed salary and benefits from day one
The administrative and business responsibilities of ownership feel more draining than appealing
You thrive in large team environments with institutional support structures
You are drawn to specialties or procedures outside the scope of primary care
Neither answer reflects a moral stance on what medicine should be. They reflect honest self-knowledge about how you work best and what you need to sustain a career over decades.
The most important thing is that you know this model exists. That you understand it clearly enough to make a real choice, rather than defaulting into a structure by accident.
My DPC Story
Hear It from Physicians Who Built It
My DPC Story features hundreds of conversations with physicians at every career stage, from residents who opened their first practice to mid-career physicians who restructured after burnout. Real stories. Real numbers. Real fears and real outcomes.
LINK HERE --> My DPC Story
Honest conversations about a different way to practice medicine.
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