Prior to the advent of insurance and the modern health care system, physicians practiced medicine in its purest form. Physicians cared for patients in places that made sense: workplaces, homes, or modest offices in the community. Patients paid a fixed price with cash or sometimes nothing at all if times were hard. This arrangement functioned because expectations were modest. Patients were not purchasing miracles. Most serious illnesses ran their course toward recovery or death regardless of intervention. The simplicity of the financial transaction matched the simplicity of what medicine could offer at the time. Medicine was limited but personable.
Direct Primary Care (DPC) resembles this older paradigm by circumventing insurance to recreate that simple transaction. There is no intermediary to complicate the relationship or raise prices. DPC is a membership-based practice model where patients pay a fixed fee for primary care. The flat fee typically covers unlimited office visits, direct communication with the physician, generic medications dispensed at cost, and basic laboratory work. There are no copays or surprise bills. The transaction is direct and predictable. As DPC is limited by the bounds of primary care, most patients still pay for insurance.
This model functions by dramatically reducing patient panel sizes. While traditional primary care physicians might manage upward of 2,000 to 3,000 patients, DPC physicians typically limit their practice to fewer than 1,000 patients. This smaller panel enables longer appointments, same-day access, and direct communication. Revenue from fewer patients paying directly can match or exceed practices with triple the volume through insurance reimbursements.
However, DPC is expensive. Even at $75 per month, that amounts to $900 per year per person, excluding services outside primary care. For a family of four, that totals $3,600 annually. This may be affordable for some patients but remains prohibitive for those already with the greatest health and social needs.
The impact extends beyond individual choice. Every patient who moves to DPC represents one fewer patient in the traditional system. These patients are typically healthier, more educated, more affluent, and likely carry higher-reimbursing private insurance plans. These are exactly the patients that traditional practices need to balance out the sicker and more complex patients. This is comparable to wealthy families leaving public schools for private ones: a rational individual choice that collectively undermines the shared institution.
There is already a significant shortage of PCPs, driven in part by medical students increasingly pursuing higher-paying specialties and by rising burnout among current PCPs. DPC offers reasonable hours, improved patient relationships, comparable or higher income, and higher job satisfaction. However, when a physician transitions to DPC, someone who previously cared for 2,500 patients may now serve only about 800. The remaining 1,700 patients must then seek care elsewhere, further increasing the burden on physicians in traditional practices and driving more students and physicians away from primary care.
While DPC is a symptom of a dysfunctional health care system, it also reflects the true potential of primary care. Every patient deserves the timely, accessible, and relationship-centered care provided by DPC. The challenge is that this level of care is only attainable because DPC operates outside the constraints of the insurance-based system. To make primary care both personable and accessible to all patients, the health care system rather than individual practices must look to DPC as a model of primary care at its best.
Do you think that DPC is a sustainable path forward? Share in the comments.
Jason Denoncourt is a medical student at UMass Chan Medical School in Worcester, MA. He is interested in family medicine and health policy. He enjoys running, skiing, and cooking in his free time. Jason is a 2025–2026 Doximity Op-Med Fellow.
Illustration by April Brust
