Answers to six common questions about direct primary care

Increasing numbers of family physicians are practicing in direct primary care (DPC) practices, according to a survey conducted by the AAFP. As of 2023, almost 10% of AAFP members surveyed were in a DPC practice, up from 5% of those surveyed in 2021. The major draw is being able to practice medicine without the hassles related to dealing with health insurers or the time pressures of traditional primary care practice.

For physicians contemplating opening a DPC practice, key concerns are related to capital/cash flow and patient recruitment, according to the AAFP’s 2024 DPC data brief.

Common questions

1. What are the startup costs for a DPC practice? Startup costs can range widely, from $5,000 for a low-overhead model to $100,000 or more for a more traditional office, according to a 2020 FPM article. The U.S. Small Business Administration offers guaranteed loans that could help physicians start a DPC practice, and some physicians supplement their income by moonlighting in emergency departments or urgent care centers as they ramp up their DPC practice. Another option is to join an established DPC practice as an employed physician, which may be preferable for physicians who are less interested in taking on the business operations side of DPC. 

2. How many patients do you need to sustain a DPC practice? The average DPC practice panel size is 402 patients, according to the AAFP’s data brief. But the number needed to reach financial viability will vary based on many factors, including your target salary, real estate costs, and how much you plan to charge patients. 

3. What is the cost for patients? Monthly DPC membership fees range from $50 to $100 for individual adults, $20 to 49 for children, and $100 or more for families, according to the AAFP data brief. Per new federal legislation, starting Jan. 1, 2026, patients in high-deductible health plans can use tax-free health savings accounts (HSAs) to pay for up to $150 a month in DPC membership fees for individuals and $300 a month for families.

4. What about low-income communities? DPC practices can adapt to the communities they serve. For example, one practice in California uses a concierge-DPC hybrid model designed to fund charity care. Its regular patients pay $200 per month, which pays for their own primary care plus that of two low-income patients.

5. What services do DPC fees cover? DPC patients’ monthly fees typically cover extended, unlimited visits in person or virtually in addition to care coordination and comprehensive care management. Vaccinations and simple lab services may also be included. For other lab and imaging services, DPC practices may be able to negotiate cash discounts for patients with large lab chains and local imaging centers, or patients may opt to use their insurance for those separate services.

6. What effect does the practice model have on physician satisfaction? According to the AAFP data brief, 94% of DPC physicians were satisfied with their overall practice, compared to 57% of those who weren’t in a DPC practice. DPC physicians were also less likely to report burnout, with 49% saying they were experiencing no level of burnout, compared to just 14% of non-DPC physicians. This is probably due to the reduced administrative burden of not having to bill insurance.

For more on direct primary care, visit the FPM topic collection.

Posted on Oct. 28, 2025