What Is Direct Primary Care? A PA-Turned-Physician Explains Why He Left the Insurance System

Dr. Reid Lancaster and three of his daughters

If you have ever sat in a waiting room, watched your doctor spend more time typing than talking to you, or been bounced between offices trying to get a referral, you already understand the problem that direct primary care was built to solve. You may just not have had a name for the solution yet.

This post is for you if you are new to direct primary care, often shortened to DPC. We will walk through what it actually is, how it is different from concierge medicine, and why a growing number of physicians are walking away from insurance-driven medicine to practice this way. To bring it to life, we are using the story of Dr. Reid Lancaster, a recent guest on the My DPC Story podcast, who took an unusually winding road to get here.

First, what is direct primary care?

Direct primary care is a simple idea. Instead of billing your insurance for every visit, your doctor charges a low, flat monthly membership fee. In exchange, you get direct access to that physician: longer visits, same or next-day appointments, and often their cell phone number. There are no copays for visits and no surprise bills for a checkup.

Because the physician is not spending hours coding visits and fighting insurance denials, they can carry a much smaller patient panel and actually know the people they care for. It is a return to the kind of relationship most of us assumed medicine was supposed to be.

Is direct primary care the same as concierge medicine?

This is the single most common question newcomers ask, so let's clear it up early. The answer is no, and the difference usually comes down to price and structure.

Concierge practices often charge thousands of dollars a year and typically still bill your insurance on top of the membership. Direct primary care is built to be affordable. Dr. Lancaster, who practices in La Quinta, California, just outside Palm Springs, points out that concierge practices in his area can run from four thousand to twenty thousand dollars a year. His DPC sits well below that.

He also fully opted out of Medicare and does not bill any insurance. That structure is what lets a DPC keep costs low and keep the relationship between doctor and patient, rather than doctor and insurance company. As he puts it, a DPC can work alongside your insurance for things like labs, specialists, and hospital care, while handling your day-to-day primary care directly.

Who is direct primary care actually for?

There is a myth that DPC is a luxury for the wealthy. Dr. Lancaster's community is one of the best arguments against that idea. His area includes some of the richest people in the world and, minutes down the road, a large uninsured population living in poverty, plus retirees, college students, and young families. His patients come from across that whole spectrum.

In fact, some of the people who value DPC most are those who have been burned by the system the hardest. He describes patients with insurance who still could not get a kidney stone treated for weeks because no specialist office would return their calls. When your insurance card cannot get you seen, a doctor who picks up the phone starts to look like the better deal at any income level.

The story: from physician assistant to DPC founder

Dr. Lancaster did not start out as a physician. He first became a physician assistant, drawn in by a mentor who showed him what autonomy and a real patient relationship could look like. He loved the work. But within two years, the same forces that burn out so many clinicians started to wear on him: endless insurance requirements, denials, and the click-heavy grind of modern medicine.

The turning point was oddly specific. He spent weeks trying to get a Medicare patient a wheelchair the man clearly qualified for, facing denial after denial, and nearly bought one from a thrift store himself out of frustration. That memory stuck. Not long after, he caught a short news segment about direct primary care and could not stop thinking about it.

He made a bold decision. Believing he needed to be a physician to practice the way he envisioned, he went back to medical school, became a DO, completed a family medicine residency, and opened Ethos Modern Medicine. He is now three and a half years in and effectively full at 600 patients, with no marketing.

PA, NP, or physician? An honest take

Because Dr. Lancaster has lived on both sides, and because his wife trained as a nurse practitioner, he offers a candid perspective that is useful for anyone considering a healthcare career. He is direct about the value of physician training, especially residency, and how much it expanded what he can safely handle in primary care without simply referring patients out. It is a thoughtful, respectful conversation about the real differences in education, and worth a listen if you are weighing your own path.

Lessons for anyone thinking about opening a DPC

Even if you are brand new to this world, a few of Dr. Lancaster's lessons stand out:

Mistakes are lessons, not disasters. He once launched an AI phone answering service he named Jarvis. Patients hated talking to a robot, and his consults dropped 80 percent in two months. He pulled the plug, learned that people want to talk to a human, and moved on. None of his mistakes were practice-enders.

Hire a little earlier than feels comfortable. Each time he brought on help before he thought he strictly needed it, growth accelerated and his quality of life improved.

Set boundaries upfront and keep them. He actually undersells his practice to new patients, telling them exactly what he does not offer and what hours he keeps. That honesty filters out mismatches and protects his time with his wife and four daughters.

The future looks like your local coffee shop

One of the most encouraging ideas in this episode is how Dr. Lancaster imagines DPC growing. Not as a national franchise or a corporate chain, but as a network of independent practices, each with its own personality, the way you might choose a local coffee shop over a big chain. You have seen one DPC, you have seen one DPC. That variety is a feature, not a flaw, and it means there is room for many more physicians to build something of their own.

New to DPC? Start here

If this is your first real look at direct primary care, welcome. There are hundreds of physicians building practices like this in communities across the country, and the community supporting them is stronger than ever.

To hear Dr. Lancaster's full story, listen to this episode of the My DPC Story podcast. And when you are ready to learn more or find your own starting point, head to mydpcstory.com/starthere.