Transitioning to Direct Primary Care


Imagine practicing medicine without all the administrative burdens related to billing insurance. Here's how one physician made the switch.

Fam Pract Manag. 2020 Jul-Aug;27(4):29-34.

Author disclosure: no relevant financial affiliations disclosed.

After nine years in private practice, I had reached a crossroads. I enjoyed my coworkers and loved caring for my patients, but I had come to hate my job. Administrative duties — meaningful use, patient-centered medical home certification, insurance hassles, etc. — kept me working after office hours and left little time for myself or my family. I was burned out.

At that point, when I was at rock bottom professionally, I attended the Direct Primary Care Summit. Within a few hours, I had decided that direct primary care (DPC) was my future.


  • Direct primary care (DPC) physicians are paid directly by patients or their employers, usually with a monthly membership fee, and don't bill third parties (like insurance companies) on a fee-for-service basis.

  • DPC physicians are a small percentage of the overall primary care picture nationally, but interest in the model is growing as frustrations increase with the administrative burdens of billing insurance.

  • The transition to DPC is difficult financially, but once a practice has matured over several years, DPC physicians can make as much as they made before.

A commonly accepted definition of a DPC practice is one that charges patients or their employers a periodic fee (usually monthly) for a contracted suite of services and does not bill any third parties (i.e., insurance companies or government programs) on a fee-for-service basis. If the practice levies a per-visit charge, that charge is less than the monthly equivalent of the periodic fee.1 By cutting out third-party insurance and the associated hassles and overhead costs, physicians can focus on providing care for a smaller panel of patients and devote more time to each of them. The American Academy of Family Physicians' (AAFP) official position on DPC is that the organization “supports the physician and patient choice to, respectively, provide and receive health care in any ethical health care delivery system model, including the DPC practice setting.”2

In 2016, I founded Hickory Medical Direct Primary Care, where more than 75% of our patients contract directly with us for their care. The rest have memberships purchased by their employers. The businesses pay the monthly membership fee, and the employees pay the visit fees. Like most DPC practices, we strongly encourage our patients to maintain insurance coverage for catastrophic health problems that require hospital care. But we do not bill insurance for any of our services, and visits do not generate charges that patients can submit to insurance. We are happy to write orders for medications, procedures, and referrals that patients can then bill through insurance, but we often find that patients' out-of-pocket costs are less when they pay cash for these services than when they use their insurance, especially for medications. Among the growing number of patients on high-deductible plans, few are able to meet their deductibles annually, so they often bear the full cost of their health care.


Dr. Kauffman is the founder of Hickory Medical Direct Primary Care in Bellefontaine, Ohio. He is past president of the Ohio Academy of Family Physicians and currently serves on the American Academy of Family Physicians Commission on Continuing Professional Development.

Author disclosure: no relevant financial affiliations disclosed.


show all references

1. Defining direct primary care. DPC Frontier. Accessed May 1, 2020.

2. About direct primary care. American Academy of Family Physicians. Accessed May 1, 2020.

3. Mapper. DPC Frontier. Accessed May 1, 2020.

4. Martin S. AAFP survey reveals DPC trends. American Academy of Family Physicians. June 19, 2018. Accessed May 1, 2020.

5. Sansweet JB. Choosing the right practice entity. Fam Pract Manag. 2005;12(10):42–44.

6. 2018 Direct Primary Care (DPC) Study. American Academy of Family Physicians. Accessed June 17, 2020.

7. Shay DF. Opting out of Medicare: how to get out and stay out. Fam Pract Manag. 2017;24(6):17–20.

8. Cole ES. Direct primary care: applying theory to potential changes in delivery and outcomes. J Am Board Fam Med. 2018;31(4):605–611.

9. Qliance. New primary care model delivers 20 percent lower overall healthcare costs, increases patient satisfaction, and delivers better care. Jan. 15, 2015. Accessed May 1, 2020.

10. Forrest BR. Direct primary care: implications for the health care workforce. Presented at the University of North Carolina Sheps Center Health Workforce Seminar. Feb. 1, 2018. Accessed May 1, 2020.


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