What is Direct Primary Care?

Direct Primary Care (DPC) is a healthcare model where patients pay their doctor directly. No insurance billing is involved.

I think the best definition of DPC comes from Dr. Phil Eskew. He says in order to qualify as a DPC practice, you must:

• Charge a periodic fee (monthly, quarterly, annually, etc.)
• Not bill any third-parties on a fee-for-service basis for those same patients^*
• Any per-visit charge must be less than the monthly equivalent of the periodic fee^**

^*For example: billing a single patient both a membership fee and billing that patient's insurance is not DPC. That would be considered concierge medicine.

^**For example: your practice is not considered DPC if you charge a $25 monthly fee (essentially an 'access fee'), and then charge a $150 per-visit charge to the same patient

How Direct Primary Care Works

There is no specific standard for DPC other than the points listed above, which gives physicians the freedom to build the practice that fits their style and desires. Patients also have the freedom to find the kind of practice / physician that fits their needs.

Physicians are able to structure practices how they wish, but membership with typical (and successful) DPC clinics include:

• Unlimited office visits
• Basic procedures and tests
• 24/7 access (usually via telephone, text, or similar)
• Prescription management
• Same or next-business-day urgent care visits

Many physicians choose to open a DPC practice based upon their own strengths or "style" of medicine.

Some may emphasize longer appointments and more of a preventive or even a functional medicine approach. Others prefer more urgent care styles and chronic care management - simply offering great access to those in their community, letting patients initiate on their own.

Why Direct Primary Care works so well

Ultimately, DPC aligns the incentives of both patients and physicians.

Patients want to be healthy and have good access to a healthcare professional that has their best interest in mind. Physicians want to be paid fairly and compensated to keep patients healthy. The membership model fits both desires perfectly.

Patient Benefits

• More Time with Your Doctor: Appointments typically last 30-60 minutes instead of the traditional 7-15 minutes.
• Transparent Pricing: No surprise bills, copays, or deductibles. You know exactly what you'll pay.
• Direct Access: Text, call, or email your clinic or even doctor directly. Many offer same-day appointments.
• Personalized Care: Your doctor can focus on your health, not insurance requirements.

A real patient scenario:

Think of your last visit with your primary care physician. It likely started with being greeted by a receptionist that asked for your latest insurance information, and perhaps filling out more paperwork.

You then are taken back by a medical assistant or nurse, who asks you questions in the exam room, takes your weight, height, blood pressure, pulse and oxygen saturation. Then, they say that your provider will be in shortly (luckily you'll get to see your own primary care provider - oftentimes it will be someone else if you needed a semi-urgent care visit).

After waiting a few minutes, the physician sits down at the computer, gazing between you and the computer screen, confirming what you already told the medical assistant a little bit ago. They'll probably ask some of the same questions you've already answered. Then you'll likely get about 7-12 minutes with the physician, ending likely in a prescription medication being sent to the pharmacy and/or a referral to a specialist (where you'll wait another few weeks for that appointment).

Contrast that with Direct Primary Care...

As a member, you can call, text, or sometimes message your clinic and likely get a response right away - even an appointment that same day if you call early. If it's a minor issue, you may even be able to skip the appointment by visiting with the doctor on the phone. If not, they schedule you for a visit later that day.

You show up to the clinic, where they'll likely know you already and let you know the doctor will be out to see you shortly.

Instead of a medical assistant getting you from the waiting area, it's the physician. And this is intentional - it helps them to see you get out of the chair and spend a few seconds between the waiting area and the exam room talking with you. They're likely determining whether it makes sense to get any vitals from you at this moment (weight, height, blood pressure, etc.).

Now you get to explain your issue once - directly to your physician. And now they have the time to really help diagnose AND treat you for that condition.

If they need to prescribe a medication, they may have their own medication on-site that they can get right then and there. And it's often cheaper than what the pharmacy would offer. And because they have time to spend with you, you likely get to avoid a referral to a specialist. Or, if you do need to be referred, you can be confident that it's actually needed.

Benefits for Physicians

• Fewer Insurance Hassles: No need for 3 vital signs for every visit, MIPS, etc.
• Better Work-Life Balance: Smaller patient panels (250-1,000 vs 2,000-3,000).
• Practice More Medicine: Much more patient care versus admin.
• Financial Predictability: Steady monthly revenue stream.
• Professional Autonomy: No insurance interference - practice YOUR way!

A real physician's scenario:

Think about your biggest pain in a traditional primary care practice. It's likely the number of patients you're required to see in a day, paired with the amount of charting that has to be done on each patient.

In DPC, you can tailor your practice to your needs. Of course if you are the owner of your practice, the number of members determines your pay, but you get to choose the balance. Do you want to make a decent salary of $180k, work an easy 4-day week, seeing an average of 5 patients per day? 250-300 patients can get you there fairly easily.

And charting... because you're not dealing with insurance, you don't have to worry about proving whether this visit was a 99214 vs. 99213. You only have to put essential information in the chart. Just think about what would need to go in the chart for good patient care - in case you don't see them for a while or if someone else is seeing them next week. That's it!

If you're concerned about being on-call 24/7, don't be. Read more about the reality of offering after-hours call in our article answering whether DPC physicians are easily overwhelmed.