For years, concierge medicine and direct primary care (DPC) were viewed as fringe alternatives, reserved for affluent patients or entrepreneurial physicians willing to step outside the insurance system. But in my opinion, these models are no longer “nice-to-have” side projects. They’re becoming essential pathways for physicians to reclaim careers, reduce burnout, and meet patient expectations in an evolving health care landscape.
Burnout is pushing physicians to the edge.
The pandemic only magnified what many physicians already knew: the traditional insurance-driven system is unsustainable. Electronic health record (EHR) clicks, prior authorizations, shrinking reimbursement, and endless administrative tasks have taken priority over meaningful patient care. I’ve spoken with physicians who entered medicine to build long-term patient relationships but now find themselves spending more time coding visits than listening to their patients. That disconnect drives many to exhaustion and, for some, early exits from the profession altogether. In my view, concierge and DPC models aren’t just practice redesigns; they are lifelines.
Patients want something different, too.
It’s not just doctors who are fed up. Patients are equally frustrated with long waits, rushed visits, and the revolving door of in-network providers. When given the choice, more patients are willing to pay directly for care that offers time, trust, and accessibility. Concierge and DPC practices typically allow for same-day or next-day appointments, longer visits, and 24/7 communication. Membership fees create predictability and transparency, which patients appreciate, especially when weighed against high-deductible insurance plans that don’t deliver meaningful access. This is why I believe patient demand is one of the strongest forces moving these models from the margins into the mainstream.
Red tape doesn’t go away overnight.
One of the most common misconceptions I hear in my advisory work is that physicians can simply “pick a price” and launch a direct care practice. The reality is more complex. Stark Law, the Anti-Kickback Statute, state corporate practice of medicine (CPOM) rules, and telehealth regulations all still apply. I’ve seen physicians learn this the hard way, often after they’ve already hung a shingle. Compliance missteps not only create legal risk but can also erode the very trust they’re trying to rebuild with patients. My opinion: if we want these models to thrive, we have to treat compliance as foundational, not optional.
Hybrid models are a bridge, not a compromise.
Not every physician is not ready (or able) to walk away from insurance contracts on day one. That’s where hybrid models come in. A hybrid practice blends traditional fee-for-service with a membership-based option, allowing physicians to gradually shift their panel while still maintaining insurance revenue. I’ve advised physicians who use hybrid models as testing grounds: they start with a small group of patients willing to pay for access and expanded services, then scale that membership tier as they grow more comfortable. Hybrid models also provide a safety net for physicians concerned about financial risk during transition. In my opinion, hybrid approaches deserve more attention. They don’t dilute the direct care movement; they accelerate it by offering a realistic, low-barrier entry point for more physicians.
Why this is no longer niche
When I began consulting with physicians exploring direct care, conversations were often filled with hesitation. Would patients pay? Would colleagues understand? Was it sustainable? Today, those same conversations feel entirely different. Doctors aren’t asking if these models will work; they’re asking how quickly they can transition. Patients are coming in with questions about DPC memberships they’ve read about online. Employers are beginning to explore direct contracting with DPC and concierge practices as an alternative to traditional insurance. The market has shifted. These models are no longer boutique side experiments. They are viable, scalable solutions to a broken system.
A physician’s blank canvas
I often describe direct care models as a “blank canvas.” They allow physicians to start fresh, design a practice around what matters most, and leave behind the clutter of red tape. For some, that canvas includes longer visits and personalized care. For others, it means smaller patient panels and time for innovation or research. The point is choice, a freedom that traditional systems rarely allow. In my opinion, the shift we’re witnessing is not about abandoning patients who rely on insurance; it’s about restoring balance. Concierge and DPC give physicians a way to practice medicine as it was meant to be: relational, not transactional.
Where we go from here
The trend is clear. Burned-out doctors, dissatisfied patients, and employers desperate for alternatives are converging on a model that was once seen as niche. In my experience, the physicians who succeed are the ones who recognize three truths:
- Burnout won’t be solved by working harder inside the same system.
- Patients value time and access enough to pay for it directly.
- Compliance is non-negotiable; freedom doesn’t mean lawlessness.
Concierge, direct primary care, and hybrid models are not silver bullets, but they represent some of the most promising movements in health care today. They are no longer fringe experiments. They are, in my opinion, the future.
Dana Y. Lujan is a health care strategist and operator with more than twenty years of experience across payers, providers, and health systems. She is the founder of Wellthlinks, a consulting firm that helps employers and providers redesign care models through concierge and direct primary care. Lujan has led multi-state network development, payer contracting, financial modeling, and compliance initiatives that strengthen provider sustainability and employer value. She previously served as president of the Nevada chapter of HFMA and is pursuing a JD to expand her expertise in health care law and compliance. An active author on Medium, where she writes on health care innovation, direct primary care, concierge medicine, employer contracting, and compliance, she also has forthcoming publications in KevinMD, MedCity News, and BenefitsPRO. Additional professional updates can be found on LinkedIn and Instagram.
