More than half of physicians (52%) support the direct primary care (DPC) model, according to a Doximity poll of 946 physicians. Others say that they need more information before forming an opinion (30%), while some express mixed feelings (13%), and a small percentage (5%) do not support DPC.
The top five specialties that support DPC are orthopaedic surgery (68%), family medicine (57%), psychiatry (57%), pediatrics (54%), and internal medicine (54%).
A large majority of younger physicians, aged 25-34, have mixed feelings on DPC (89%). The strongest supporters of DPC are aged 55 to 64 (63%), though other strong supporters are aged 65 to 74 (61%) and 75 and older (61%).
When it comes to other demographics, slightly more women (55%) support DPC than men (50%), and respondents from Texas (67%) and Pennsylvania (56%) overwhelmingly support DPC.
Doximity spoke with Sonia Singh, MD, who founded her own DPC micropractice in Houston, TX. Dr. Singh shared that despite increasing buzz around DPC, many physicians still harbor misconceptions about what the model truly entails. She added that, based on recent conversations, and the data from Doximity’s poll, it’s clear that many doctors mistakenly equate DPC with “concierge” or “cash practice” models that cater primarily to the ultra-wealthy. This couldn’t be further from the truth.
Dr. Singh explained that in traditional concierge practices, “patients have insurance and are being charged copays and being billed through their insurance AND paying some type of retainer or fee, which allows the doctor to keep the practice small.” The concierge fees are typically the same or more than a DPC membership fee (the average DPC membership fee is around $75/month, according to the Society of Actuaries Report). Dr. Singh stressed that “although some DPC practices [like her own], offer concierge-style care, they are open to patients regardless of insurance status and unlike traditional concierge practices, which still leave patients vulnerable to surprise bills, DPC practices provide full price transparency and predictable monthly costs for primary care.”
“The mission [of DPC] is to re-prioritize the doctor-patient relationship, to return professional autonomy to physicians and to provide high-quality care to patients at a transparent and predictable fixed monthly fee, regardless of insurance status,” Dr. Singh said.
Support for DPC comes from a variety of specialties. The most supportive specialties according to Doximity’s poll are family medicine, pediatrics, and internal medicine; more than half of the respondents within each were in support of DPC. These three fields, which are typically non-procedural and outpatient-focused, are often under-reimbursed in the traditional fee-for-service model, according to Dr. Singh. The DPC approach offers an attractive alternative, with lower overhead and more direct, longer-term relationships with patients. However, the poll results also show strong support for DPC from orthopaedic surgeons (68%) and psychiatrists (57%), which hints at broader physician dissatisfaction with the current system.
Age appears to be a critical factor in support for DPC, with older physicians (aged 55-plus) being the most enthusiastic backers. Dr. Singh shared that this makes sense; many of these doctors have witnessed the increasing corporatization of health care and seen firsthand how it has eroded physician autonomy.
“They likely see the value in placing power back in the hands of physicians,” after having experienced greater independence and more favorable reimbursements earlier in their careers, Dr. Singh theorized.
“I cannot speak for other specialties,” she said, “but as an internal medicine primary care physician, once I came off my salary guarantee and became aware of the volume of patients I needed to see in order to receive my desired compensation, I began to realize that traditional practice was simply not sustainable.” In contrast, younger physicians, who are still early in their careers or in training, may not yet feel the frustrations that push their older counterparts toward alternative models like DPC.
Women, too, are showing stronger support for DPC than their male colleagues. Dr. Singh said that this aligns with studies indicating that women physicians are often underpaid and tasked with more invisible labor, particularly in primary care. The DPC model, which offers flexibility, professional satisfaction, and reduced administrative burdens, is an appealing solution to many of these systemic inequities.
Strong supporters of DPC are from Texas (67%) and Pennsylvania (56%). This tracks with data from DPC Frontier, which maps clinics across the country and shows a number of “pure DPC” clinics in both these states. Texas became the thirteenth state to enact DPC laws according to DPC Frontier, while Pennsylvania currently has no DPC laws.
DPC is not without its challenges — both for physicians and patients. Starting a DPC practice involves financial risks and business acumen, something not all doctors are prepared for or equipped with. For patients, while DPC offers affordable and accessible primary care, it doesn't replace insurance, leaving patients who are uninsured vulnerable to large expenses from possible emergencies or hospitalizations that may occur. Another risk in the DPC model is the issue of providing equitable access and care. A recent study cited this as a limitation, stating that DPC clinicians may “focus on recruiting low-risk patients, as they require fewer services and lower health expenditures, making them more financially advantageous for the DPC practice. This cherry-picking practice risks exacerbating health inequities in primary care access and delivery.”
Dr. Singh, however, has a diverse patient population in terms of coverage. Some of her patients do not have access to employer insurance and do not qualify for low-cost or free plans through the marketplace. Others have had multiple job changes, gaps in employment, or changes to insurance, but they’ve been able to maintain continuity in care seeing her as their PCP.
“DPC in no way replaces insurance, but for some of these patients, there is incredible value in paying a flat fee that is typically less than what their insurance premium would be, and having consistent access to a doctor who can help keep them out of the ER or urgent care, manage their chronic medical conditions, and quickly address acute issues,” she said.
For some physicians and patients, the benefits of DPC — longer appointments, direct access, and personalized care — far outweigh the downsides, making it a compelling and sustainable option for today’s health care landscape. However, this poll data shows many physicians simply don’t know what exactly DPC is, and may equate it with concierge medicine. More education is needed to shed light on this option, and more research is needed to further understand if the limitations of DPC are actually occurring in the real world.
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