A recent Johns Hopkins study has reignited that debate. The research documents rapid growth in concierge and direct primary care practices and warns that these models may worsen access to care.
That framing feels intuitive. It is also incomplete.
It assumes that traditional primary care access was functioning before physicians began moving into fee-based models. It was not.
Long before concierge and direct primary care gained traction, primary care access had already eroded. Patients waited weeks or months for appointments. Visits were compressed into minutes. Physician panels routinely exceeded 1,800 to 2,500 patients per clinician, far beyond what safe, longitudinal care can realistically support. Burnout was framed as an individual failure rather than the predictable outcome of system design.
When clinicians leave those environments, they are not abandoning primary care. They are leaving systems that no longer allow them to practice it responsibly.
Access was already compromised.
Access is often discussed as a moral concept, but it is fundamentally an operational one. Access is not the number of physicians listed in a directory. It is the ability to be seen in time, to be heard, and to receive care that is not rushed or fragmented.
Traditional primary care has struggled on all three fronts. Many patients technically had a primary care physician but could not get an appointment when they were sick. Continuity was undermined by excessive panel sizes. Administrative burden expanded while clinical time shrank.
Blaming membership-based care for access problems ignores the access that was already lost.
Physician movement is not physician loss.
Between 2018 and 2023, thousands of clinicians moved into concierge and direct primary care practices. That movement is often interpreted as a net loss to the system.
It is not that simple.
Many physicians entering these models were already constrained by payer contracts, narrow networks, and reimbursement structures that limited whom they could effectively serve. In some cases, they were already inaccessible to Medicaid patients or those outside dominant commercial plans. Smaller patient panels do not automatically translate into reduced capacity if they prevent physicians from leaving medicine altogether.
Burnout is not a soft outcome. It is a supply issue.
When clinicians exit primary care entirely, capacity is lost. When clinicians restructure how they practice in order to stay, capacity may look different, but it is preserved.
The wrong causal arrow
Framing concierge and direct primary care growth as the cause of physician shortages mistakes a signal for a source.
Physicians are not leaving functioning systems. They are leaving systems that stopped working clinically, ethically, and operationally. Fee-based models did not create those conditions. They emerged in response to them.
That distinction matters.
If we misdiagnose the problem, we will pursue the wrong solutions. Restricting or stigmatizing physician autonomy does not restore access. It accelerates attrition.
The real risk worth watching: corporatization, not choice
What stands out most in the data is not just growth, but who is driving it.
While the number of concierge and direct primary care practices grew by roughly 83 percent during the study period, corporate-affiliated practices grew by 576 percent, according to the Health Affairs analysis.
That ratio alone deserves scrutiny. Investor-backed scale changes the economics entirely.
The individualized care model that attracts both physicians and patients relies on smaller panels, longer visits, and relief from productivity metrics. Those features are difficult to reconcile with return expectations that depend on growth, standardization, and margin expansion.
When capital enters the equation, pressure inevitably returns. Panel sizes creep upward. Visit volume becomes a metric again. Utilization expectations resurface. The very dynamics that distorted traditional primary care reappear under a different label.
This is not speculation. It is how scale behaves across health care sectors.
The concern is not that physicians are choosing alternative models. The concern is that, without guardrails, those models will be reshaped by the same forces physicians were trying to escape. That is the implementation risk worth watching.
A different question to ask
None of this is an argument for uncritical expansion of fee-based care. Nor is it a defense of every concierge or direct primary care model.
If policymakers want to address access, the question is not why these models are growing. The question is why so many physicians felt they had no sustainable alternative.
Physicians are not leaving primary care. They are leaving broken systems.
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, and author of The CEO Physician: Strategic Blueprint for Independent Medicine. Dana 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. She has been featured in Authority Magazine and publishes on KevinMD, MedCity News, and Medium, where she writes on health care innovation, direct primary care, concierge medicine, employer contracting, and compliance. She has forthcoming BenefitsPRO. Additional professional updates can be found on LinkedIn and Instagram.
