Are you ready to start a direct primary care practice?

By Lilian White, MD

In 2022, 51% of family physicians reported experiencing burnout. What if there was a pill that could eliminate feelings of burnout in 35% of physicians? Though the double-blind, randomized, controlled trial is not out yet, direct primary care (DPC) is looking pretty promising.

The number of physicians practicing in a DPC setting grew by 555% from 2017 to 2025. More and more physicians are wondering—is it time to start my own DPC practice?

DPC is a practice model that charges patients or their employers a periodic fee (often monthly) for services and does not bill third parties (e.g., insurance) on a fee-for-service basis. In a recent AAFP survey, more than 90% of physicians working in a DPC practice experienced improved professional satisfaction, personal satisfaction, relationship with patients, and ability to practice medicine compared to their peers in other practice settings.

Every month, I spend several hours talking with students, residents and physicians interested in DPC. With more than 3,000 DPC practices across the country, interest and awareness of DPC has been growing exponentially, particularly in light of the rate of burnout among family physicians.

I opened my own DPC practice after graduating from residency two years ago. My friend Kenneth Qiu, MD, and I recently published an article in FPM detailing how to start a direct primary care practice after residency.

This blog post will focus on common questions about starting a DPC practice, and I’ll share some of my own learnings from the past two years.

One of the most common concerns physicians have when considering opening a DPC practice is capital/cash flow. Insurance-based practices require a significant investment to start—often in the tens of thousands if not hundreds of thousands of dollars. Most overhead costs of operating an insurance-based practice relate to billing and coding insurance and staffing. More staff are needed in an insurance-based practice due to the high patient volumes needed to drive revenue. In DPC, there is no billing or coding of insurance and minimal staff are needed because the revenue model is subscription based rather than volume based. This meaningfully reduces the cost of starting and operating a practice.

Though there is no limit to the amount someone might spend on opening a practice, there are some minimal costs required. I opened my office in a bare bones way, spending $5,000 total during the first two months of opening until the practice broke even and began to pay for itself. This included rent, malpractice insurance, supplies, etc. It did not include my own salary, which I began to contribute to a few months later.

For this reason, I tend to encourage physicians who are starting a DPC practice after residency or in an area where they have not had an established patient panel to have a side gig or two as they grow their practice. Having a side gig and keeping initial overhead costs low reduces pressure to grow the practice quickly. For physicians with an established patient panel, it is commonly estimated that about 5% to 10% of their panel will follow them, often making a side job unnecessary.

Pressure to see patients in a short period of time is an important factor in the development of burnout and may often lead physicians to consider DPC. Practicing in a DPC model impacts time with patients, family, and free time in various ways. A physician’s autonomy over their schedule is also tied to reduced burnout.

I love having more time with patients in my practice. I can get to know patients in a more holistic way with a deeper understanding of their medical history and values. This allows me to personalize their care and has significantly increased my own professional satisfaction.

Running my own practice has been the ultimate test of time autonomy. I’ve been able to adjust my schedule in a way that feels sustainable and healthy for what I hope to be a long career in medicine. I set aside a couple of hours for initial patient appointments and one hour for follow-up appointments. This allows me to go through my day unrushed. I set aside time for a good lunch break, so I’m refreshed to care for patients in the afternoon. One day a week is set aside for administrative time for personal and professional use.

Some physicians are concerned about coverage for vacations as a solo physician. Though systems may already be in place for cross-coverage as a physician working in a large health care system, the flexibility and freedom to take vacations when and for the duration desired is not always available.

There are several ways to approach taking vacation as a DPC physician. In my solo practice, I will answer urgent calls and check messages a couple times a week when I’m on vacation. If I’m traveling, I’ll ask a local DPC physician to see any patients that need to be seen in person. This is common practice. Other physicians may send an out-of-office message and ask patients to seek care at urgent care if they are out of the office. Coverage for vacations may be even easier in multi-physician DPC practices, which are becoming more prevalent.

Administrative time

Outside of office hours, physicians spend an average of one to two hours of personal time completing tasks. Some call this “pajama charting.” Though DPC significantly reduces the administrative burden of caring for patients by not billing insurance, operating a DPC practice does require some time devoted to running the practice itself.

Setting aside one day a week for administrative time allows me to generally finish tasks during business hours (e.g., paying office bills, ordering supplies, learning more about complex medical conditions). This leaves weekends and evenings open for family and personal time. I will occasionally spend evenings or weekends going to professional events or speaking. I can volunteer my time more freely and willingly because I have control over my schedule. I also have the ability to block time for family or personal time during business hours if I need or want to. I rarely enjoy pajama charting—a gift I am thankful to forego.

Some DPC physicians will also work part time or only during school hours in order to care for children. DPC allows the flexibility to do that. For those who are not interested in spending time on the business side of DPC but would enjoy the benefits of the DPC model, there are opportunities to become an employed physician in a DPC practice.

What if I want to care for underserved people?

This is a wonderful aspiration and is hopefully at the heart of many of us as family physicians. How do we define underserved? Underserved is often conflated with those patients receiving government benefits like Medicaid. Though this certainly is true and a worthy population of serving, there’s also a large and growing population of patients who are either uninsured or underinsured. A growing number of patients are either uninsured or underinsured and avoid seeing their physician due to associated costs. DPC practices are uniquely positioned to care for patients who are uninsured or underinsured because they keep out-of-pocket costs low by avoiding unnecessary emergency visits, and offering discounted labs and medications at wholesale prices. We also have the ability to offer discounted services at our discretion. The beauty of running my own practice is that I can offer a discount on membership fees when a patient loses a job or has a financial crisis.

Some DPC practices are also working to innovate and bill insurance for specific patient populations, like those using Medicaid. There is much red tape and administrative burden to navigate with billing government insurance, so this is not common in DPC at this time.

How will politics affect my DPC practice?

During the COVID-19 pandemic, DPC practices experienced significant growth. This demonstrates the resiliency of the DPC model. Recently, H.R. 1 bill was passed. This formalized allowing patients to use their health savings accounts to pay for DPC memberships. Though no practice model is entirely immune from political changes, DPC has demonstrated its ability to sustain patients and physicians through many fluctuations in the external environment.

How will DPC influence my career?

This question tends to come more from medical students and residents, but it is worth addressing for physicians at any career stage. Physician autonomy is highly associated with career satisfaction. I have personally found this to be true. Having my own DPC practice has allowed me the flexibility to write, edit, teach and be involved in my community through offering workshops and serving on a number of boards. Working as an employed physician in a large health care system wouldn’t necessarily preclude these efforts, but I would not have had the bandwidth or flexibility to participate in all of these activities to the degree that I have.

Scope of practice is also an important consideration for making the transition to DPC. Family physicians are often constrained to a narrower scope of practice than they initially intend, indicating external influences are likely at play. Physicians practicing in large health care systems have the narrowest scope of practice. This is perhaps driven by high patient volumes and accessibility/increased reimbursement of specialty care in health systems. Operating in a DPC practice has allowed me to maintain much of my scope of practice that would be unlikely in a large health care system, such as home visits, caring for newborn and children (about 20% of my practice), and procedures.