When I made the decision to leave the traditional, insurance-based system and start a direct primary care (DPC) practice, I didn’t do so under any illusions. I knew what the critics would say. In fact, I’d already heard it.

• You’re making it harder for patients to find a primary care doctor.
• You’re reducing access for the underserved.
• You’re selling out.

I’ve read the blog posts, like the one recently published on the Harvard Medical School site titled “How buying primary care on the free market adds to doctor shortages.” And I get it. I really do. From a 10,000-foot policy-level view, a physician moving from a 2,000-patient panel in a traditional system to a 300- or 600-patient panel in a DPC model can look like a loss for access.

But here’s the thing: It was never that simple. For me, as for the roughly 20 percent of physicians planning to leave the profession in the next two years, the choice wasn’t between 2,000 and 500 patients, it was between 500 and zero.

The unspoken assumption in these critiques is that the alternative to DPC is staying in the system. What if the actual alternative is severely cutting down on hours or leaving medicine entirely?

Because that was the choice I was staring down. And I’m not alone.

Burnout isn’t a buzzword — it’s a crisis.

I was burned out. Not just tired, not just stressed. I was the kind of burned out where you start imagining what it would be like to never drive to the clinic again. The kind where you fantasize about quitting medicine—even though it’s the thing you’ve poured your whole self into for years (or decades). The kind where you start wondering if your patients might be better off with someone else—someone who isn’t barely holding it together.

And I was doing this work in a community that I care deeply about. I had over ten years of experience working in a community hospital, a federally qualified health center, and community urgent care. I didn’t want to leave. But staying in that system—where every minute was tracked, where I was expected to squeeze complex care into 15-minute visits (or less), where I spent more time documenting and playing whack-a-mole with my inbox than connecting with families—was slowly destroying me.

I knew I needed a different way. Not because I was giving up on my patients, but because I was trying not to give up on myself.

DPC wasn’t a step away from medicine. It was a step back into it.

Let’s be honest: Many physicians are reducing clinical hours

One of the frustrations I have with the criticisms aimed at DPC physicians is how selectively they’re applied.

Yes, I reduced my panel size. Yes, I opted out of the insurance-based system. But I didn’t reduce my commitment to caring for patients. I didn’t check out. I still spend long days seeing families, managing chronic illness, addressing mental health concerns, and helping parents navigate complex social systems. (And, on top of that, I have to manage all of the finances and operations of a business!)

What gets less attention is that many academic physicians and administrators are already working limited clinical schedules. I know physicians in leadership roles who haven’t seen patients in years. I know colleagues who see patients one day a week and spend the rest of their time teaching, doing research, or consulting. And that’s fine. That’s necessary. But we don’t level the same kind of moral judgment at them that we do at DPC doctors.

When we talk about “access” and “shortages,” we have to look at the full picture. We have to be honest that doctors across the system are making adjustments—stepping back, shifting roles, cutting hours—in response to burnout and systemic dysfunction. DPC just happens to be more visible, because it’s a structural change.

But it’s not the only change happening, and we should be asking why so many of us are seeking refuge, not just scolding those who are.

DPC is not a perfect system—but neither is the one we left.

Listen, I’m not going to sit here and pretend DPC is the solution to every problem in American health care. It’s not. We still have deep inequities. We still have systemic racism, barriers to access, rural care deserts, and a fragmented public health infrastructure. DPC doesn’t solve all of that.

But the traditional insurance-based system isn’t solving it either. In fact, it often makes it worse.

It’s a system where physicians are asked to carry out complex, nuanced, emotional work in short, volume-driven visits, while managing a bloated administrative burden that grows by the day. It’s a system where patients fall through the cracks, not because their doctor doesn’t care, but because the system is designed to reward volume, not depth.

So many of us came to medicine with the intention to serve—and then found ourselves in a model that made true service nearly impossible.

DPC gave me the chance to build a practice where I could actually deliver the kind of care I was trained to provide. Thoughtful. Personalized. Relationship-based. It wasn’t about “going concierge” or opting out of hard work. It was about building a model where the work meant something again.

And let’s not turn a blind eye to the tragic reality of physician suicide.

One of the hardest truths we need to face as a profession is that physician suicide is real. It’s not rare. And it’s not just the result of individual vulnerability. It’s also the predictable outcome of a system that devalues our humanity.

Physicians die by suicide at significantly higher rates than the general population. According to the American Foundation for Suicide Prevention, an estimated 300 to 400 U.S. physicians die by suicide each year, the equivalent of losing an entire medical school class annually. Despite relatively high rates of education and financial stability, male doctors are 40 percent more likely to die by suicide than non-doctors; for women the rate is 200 to 400 percent higher.

We know these numbers, and yet we still resist real change. When a physician dies by suicide, we mourn. We talk about resilience. We launch wellness committees and schedule mindfulness workshops.

But when a physician tries to prevent that outcome—when they choose to step outside the system and find a way to keep practicing medicine without sacrificing their well-being—we criticize them.

That disconnect should alarm all of us.

Because the future of care depends on doctors being well. On doctors staying in the game. On doctors being able to show up for their patients without emptying themselves in the process.

We don’t get better care for society by breaking the people providing it.

This is a rebalancing, not an exodus.

I know it’s tempting to frame this moment as a rupture—DPC physicians “leaving” the system, taking their marbles and going home.

But what’s happening is more complex than that. This is a re-equilibration. A recalibration. It’s the natural response of human beings trying to adapt to an unsustainable situation.

Some of us are adapting by embracing new models like DPC. Others are doing it through advocacy, leadership, education, or research. Some are staying and fighting to change things from within. That’s all valid. That’s all part of the broader solution.

We don’t have to pit these approaches against each other. We can honor the multiplicity of responses without pretending there’s only one “right” way to serve.

I know many physicians who are thriving in traditional systems. I admire and celebrate them. That just wasn’t my reality, and it isn’t the reality for many others.

Let’s build a system that works for patients and doctors.

If we want to build a sustainable future for primary care—and I believe we all do—we need to make space for innovation, for reinvention, and for honest conversations about what’s working and what’s not.

We don’t have to agree on everything. But we do need to stop turning on each other.

Because the system isn’t going to fix itself. And physicians fighting each other isn’t going to fix it either.

What will? Supporting one another. Listening to lived experience. Respecting diverse paths. And staying focused on the shared goal: a health care system that serves patients well, and allows physicians to thrive in the process.

DPC isn’t the whole answer. But for me, it’s part of it. It’s how I found my way back to the kind of medicine I believe in.

And I don’t regret it for a second.

Marina Capella is a pediatrician.