Direct primary care: what physicians say, in their own words

Last updated September 20, 2026.

Read together, the 140 essays and podcast transcripts on this page say one thing consistently: the physicians who left insurance for direct primary care or concierge medicine describe it as the only way to keep practicing, and the physicians who criticize it do not dispute that, they ask who is left behind when a 2,500-patient panel becomes a 600-patient one. That argument has run for twenty years under two names and has not moved. What has changed is the ending: the 2025 and 2026 essays are about clinics that closed, the math that closed them, employers who now pay the fee, and private equity buying the practices that survived.

This page is a maintained record of what physicians have written about direct primary care and concierge medicine on KevinMD.com, a physician-authored publication founded in 2004 by Kevin Pho, MD, a board-certified internal medicine physician in Nashua, New Hampshire. It draws on 140 essays and podcast transcripts published between July 2006 and July 2026 by 62 named contributors, 64 of the posts bylined by physicians, with the remainder by practice consultants, entrepreneurs, policy analysts, and a patient advocate. Every claim on this page is attributed to a named author with the date it was published and a link to the original.

The essays describe a model that has been argued about under two names for twenty years. In 2006 KevinMD was tracking concierge medicine, an annual retainer of $1,500 to $15,000 on top of insurance, and the objection that it served the wealthy. By 2014, when the site published 18 posts on the subject in a single year, the argument had become direct primary care: a monthly fee of $30 to $150, no insurance billed, a panel of 600 instead of 2,500, and the claim that this was the working-class version of the same idea. The most recent posts are about failures, employer contracts, and private equity arriving.

The sections below are organized around the questions physicians considering the model, patients weighing a membership, employers, and journalists ask. Each opens with a direct answer, followed by what named authors have said, in the order they said it. Consultants and entrepreneurs who sell into this market are identified as such. This is a page about physician opinion and experience, not financial or practice advice.

What is the difference between direct primary care and concierge medicine?

On KevinMD the distinction is drawn by fee and by billing. Concierge practices charge an annual retainer, typically thousands of dollars, and most still bill insurance or Medicare for visits; the fee buys access. Direct primary care charges a monthly fee, typically under $100 and often under $50, that covers the visits themselves, and the practice bills no third party. Physicians in both models describe the same underlying trade: fewer patients, more time, no coding. The word “concierge” appeared in half or more of posts through 2016 and the phrase “direct primary care” in 75 to 89 percent since 2014.

John Schumann, MD, wrote in December 2012 that concierge practices charge “annual fees that range from $1500 to $15,000 per patient,” while direct practices charge “a maximum of $100/month, but usually more around $60,” in “Concierge medicine: Winners and losers.” Samir Qamar, MD, wrote in August 2014 that many concierge doctors “also bill insurance or Medicare for actual medical visits, as the monthly ‘access fee’ is only for ‘non-covered’ services,” while in direct primary care “the fee can be as low as $50 per month and there is typically no third-party payer involvement,” in “Direct primary care and concierge medicine: They’re not the same.” Bob Doherty of the American College of Physicians wrote in November 2016 that a study of 116 practices found wide variation in fees, and asked “at what point do the monthly fees charged by DPC practices make them concierge?” in “Direct primary care: An evidence-based dialogue is needed.” Troy A. Burns, MD, wrote in November 2021 that the periodic fee “is typically under $100/month and entitles the member to high-level access to all or most acute care,” disease management, and preventive services, in “Direct primary care is an answer to volume-based insurance reimbursement models.”

Why do physicians say they left insurance?

The physicians who opened direct practices describe leaving insurance as a decision about time rather than money: panels of 2,000 to 3,000 patients, 15-minute visits, and hours of coding and prior authorization for every hour with a patient. Several describe it as the only way to stay in medicine. Posts in this corpus that mention burnout rose from none before 2010 to 38 percent since 2022.

Steven Reznick, MD, wrote in August 2011 that concierge medicine “arose as a result of government, private insurance, and employer intrusion into the health care field,” destroying primary care and the time a physician can spend with patients, in “Why concierge and direct pay medicine is not unethical.” Josh Umbehr, MD, wrote in May 2014 that his subscribers “pay between $10 and $100 per month to see me whenever they need to,” for as long as they need to, and that his wholesale lab rates “come out lower than the copay of most insurance plans,” in “Affordable direct care doctors are the long-term health care solution.” Rob Lamberts, MD, who left a large practice for a direct one in 2013, wrote in August 2015 that a panel of “600+ patients and survival for two and a half years puts me in the higher ranks of solo DPC practices,” and that the model’s simplicity is what keeps overhead low and panels larger than concierge, in “This is what a successful direct primary care practice looks like.”

Allison Edwards, MD, a family physician, wrote in February 2020 that at the end of residency, after watching patients take off work and navigate bus lines to wait all afternoon for a delayed 15-minute visit, “I realized I couldn’t keep being a doctor and care,” truly care, if she stayed, so she left the system, in “I wanted to care for people, so I became a direct primary care doctor.” Sara Pastoor, MD, wrote in December 2022 that the model “gives practices predictable, upfront cash flow without the hassle of insurance-driven red tape,” in “The solution to America’s primary care shortage is direct primary care.” Ronke Dosunmu, MD, wrote in January 2026 that insurance-based practices manage “panels of 2,000 to 3,000 patients” while patients “expect concierge-level access and time within insurance-based practices,” and that same-day access “requires the much smaller panels that direct care models maintain,” in “Patient expectations in primary care: the structural mismatch.” Ronald L. Lindsay, MD, wrote in June 2026 that the argument physicians should leave insurance because the economics no longer work “is not wrong, but it is incomplete,” because “the professional identity that once made the work meaningful has been hollowed out,” in “Professional identity in medicine has been hollowed out.”

Who does direct primary care serve, and who does it leave out?

This is the argument physicians on KevinMD have had longest. Advocates say a $50 membership plus wholesale drugs and labs costs uninsured and high-deductible patients less than insurance does, and describe practices full of plumbers and bartenders. Critics, including physicians who serve the poor and a medically complex patient, say a model that requires a monthly payment and a physician who leaves a 2,500-patient panel for a 600-patient one worsens access for everyone not in it. Posts mentioning access, two-tier care, or cherry-picking rose from 12 percent in 2006 to 2009 to 78 percent since 2022.

Kevin Pho, MD, noted in December 2007 a Seattle practice offering concierge quality to the city’s working poor, patients earning $50 or $60 a day, and in October 2008 questioned whether concierge care was really too expensive against cash-only practices charging as little as $79 a month; both posts are short commentaries from before 2009, counted here but not indexed or linked. W. Ryan Neuhofel, DO, MPH, wrote in June 2014 that his first patients were “diabetic plumbers, homeschooling families, alcoholic bartenders, but very few with homes on the golf course,” and that his nurse joked the practice was the safety net’s safety net, in “Building a concierge safety net practice.” In December 2014 he wrote that most direct primary care fees fall “between $30 and $150 per member per month” and that his average was about $42, in “Direct primary care: Setting the record straight.”

Stephen C. Schimpff, MD, wrote in July 2014 about a practice charging $50 a month for adults under 45 and $10 for children, whose physicians carry 600 patients each and whose patients with multiple prescriptions save “literally hundreds of dollars per month for a family,” on wholesale drugs, in “Blue collar concierge medicine is for everyone.” Stephen C. Schimpff, MD, wrote in August 2014 that “It seems logical that closer care means better care, fewer referrals to specialists and fewer hospitalizations,” and that a retrospective review found MDVIP patients “more likely to have higher quality measures (HEDIS)” than patients in regular practices, in “Does direct primary care improve quality measures?” Chris Larson, DO, wrote in November 2014 that a patient’s five medications, including insulin, cost less than $35 a month on a discount list, and that “The revenue that is generated through the monthly fee of $39 to $89 per month” pays the overhead and the doctor’s salary, in “How direct primary care reduces the costs of care.” Kenneth Lin, MD, a family physician, wrote in March 2015 that patients between 138 and 400 percent of the poverty level “often face several thousand dollar deductibles,” and argued for creative models to reach the poor, in “Providing health care to the poor: It’s time to get creative.” Bob Doherty wrote in November 2016 that “less well-off patients, who can’t afford to go without insurance or pay a monthly fee, might be disadvantaged,” in “Direct primary care: An evidence-based dialogue is needed.” Dana Y. Lujan, MBA, a practice consultant, wrote in November 2025 that even affordable memberships of $50 to $75 a month face hidden economics in lower-income markets, where “the behavioral economics of these populations create high churn and unstable revenue,” and that the Medicaid cliff niche exists but is narrow, in “Direct primary care in low-income markets.” Zoe M. Crawford, LCSW, a psychotherapist and a medically complex patient, wrote in December 2025 that the model “has fallen short for me, often spectacularly so,” because a low fee can push a practice to refer out for tests and specialists it cannot cover, in “Direct primary care limitations for complex patients.”

Is direct primary care ethical, and does it worsen the shortage? Physicians disagree.

Physicians on KevinMD have argued since 2006 about whether opting out is defensible, and the argument has not moved much. One side says the system that made primary care unsustainable is the unethical party, and that a physician who stays and burns out helps no one. The other says a physician who cuts a panel from 2,500 to 600 has, arithmetically, left 1,900 people to find care elsewhere in a shortage, whatever the fee. The 2012 posts predicting the Affordable Care Act would drive primary care into two tracks read, in the 2026 posts, as having been right.

Kevin Pho, MD, noted in July 2006 a concierge physician who returned to conventional practice after seeing how hard it was for patients to afford the fee, and in December 2008 that regulators feared the effect of doctors opting out of Medicare and health insurance; both are pre-2009 commentaries, counted but not linked. Steven Reznick, MD, wrote in August 2011 that concierge physicians give “pro bono scholarships to patients who cannot afford their membership fees,” and that membership costs “less than a cup of Starbucks grand latte per day,” in “Why concierge and direct pay medicine is not unethical.” Dike Drummond, MD, wrote in October 2012 that the physician shortage would “drive primary care into two opposite tracks,” with a “tidal wave of new demand for concierge medical services,” in “How the surplus of patients will impact primary care.”

Margalit Gur-Arie wrote in April 2015 that “A few disenchanted primary care doctors decided to bypass this unfair (to them) system and opened little concierge practices,” charging what they believed their services were worth, in “Tomatoes, ketchup, and direct primary care.” W. Ryan Neuhofel, DO, MPH, answered the shortage argument in September 2016, writing that “I’m not going to take insurance” is “not the solution” for every physician, but that direct primary care physicians “are now trying to rescue others; hopefully, before we all go over the waterfall,” in “Direct primary care physicians are trying to rescue other doctors.” Sara Pastoor, MD, wrote in December 2022 that “Critics of the DPC model argue that with each PCP carrying only 600 patients,” the shortage is made worse, and that the model instead keeps physicians in primary care, in “The solution to America’s primary care shortage is direct primary care.” Landen Green, DO, wrote in January 2023 that the model provides “80 to 90 percent of health care needs for a fraction of the cost,” in “Direct primary care: more access, more savings, more care.” Marina Capella, MD, wrote in August 2025 that she opened a direct practice knowing the policy-level view would count it as a loss for access, and that for physicians planning to leave medicine “the choice wasn’t between 2,000 and 500 patients, it was between 500 and zero,” in “I knew choosing DPC would exacerbate primary care physician shortages, and I chose it anyway. Here’s why.”

Does direct primary care scale? What physicians say about the failures.

The record contains the failures as well as the practices that lasted. Qliance, the Seattle pioneer, closed in 2017; Turntable Health in Las Vegas closed the same year; Forward Health closed in 2024 after raising more than $650 million; a university-run clinic in Houston closed after 13 months in 2025. Physicians and consultants on KevinMD draw different lessons: that venture-scale versions fail while solo practices survive, that the model fails where the market cannot sustain the fee, and that bad math, not ideology, is what closes clinics. Posts naming Qliance, MDVIP, Iora, or Forward peaked at 17 percent in 2017 to 2021.

Niran S. Al-Agba, MD, wrote in June 2017 that Qliance and Turntable Health had recently closed, that “Turntable charged $80 per month for adults and $60 per month for children” for a wellness ecosystem including yoga and cooking classes, and that strictly defined direct primary care is an affordable monthly fee under $100 that can meet 80 percent of health care needs, in “Is direct primary care doomed to fail?” Trevin Cardon wrote in July 2017 that “64 percent of market pioneers fail,” and that Qliance’s failure did not mean the model’s, in “Forget what you’ve heard. Direct primary care is here to stay.” Christopher Habig, MBA, a direct care company founder, wrote in November 2024 that Forward’s “high membership fees of $150 per month became increasingly difficult to justify for a subpar experience,” after its automated CarePods numbered five instead of the 3,200 promised, in “Lessons from Forward Health: How direct primary care is the future of health care.”

Dana Y. Lujan, MBA, wrote in October 2025 that the University of Houston’s clinic “did reach socially vulnerable patients, but it ultimately closed due to inflation, staffing ratios,” and the inability to secure employer partnerships, not because of ideology, in “Why direct primary care (DPC) models fail.” On The Podcast by KevinMD in November 2025, she described the same clinic as a “fundamental market mismatch” with a roughly 70 percent revenue deficit, and advised physicians to model panel reductions before leaving insurance, in “Why bad math (not ideology) is killing DPC clinics [PODCAST].” In January 2026 she said a patient whose rent rises $200 will drop a $150 membership they are not using every month, in “Economic reality tests the limits of subscription medicine [PODCAST].”

What do physicians say about employers and private equity?

Two developments since 2014 have changed who pays the fee. Self-insured employers began contracting with direct practices for their workers, which several authors describe as the model’s path to scale and its exposure to the same contract pressures physicians left. And private equity, which had passed over solo direct practices for a decade, began buying concierge and direct primary care platforms in 2024 and 2025. Posts mentioning employers rose from none before 2010 to 44 percent since 2022; posts mentioning private equity or venture capital reached 16 percent in the same period.

Dave Chase, an entrepreneur who later founded a direct care company, wrote in April 2011 that “the Direct Primary Care provision will offer an affordable alternative that by-passes insurance companies altogether,” colliding with the Affordable Care Act’s medical loss ratio rules, in “Direct primary care and medical loss ratio will impact health insurers.” Stephen C. Schimpff, MD, wrote in October 2014 that “A few enterprising groups work with insurers to offer self-insured employers a package of direct primary care,” along with insurance for specialty care and hospitalization, in “Will direct primary care be offered by employers?” Christopher Habig, MBA, wrote in January 2025 that federal rules should “allow patients to use health savings accounts (HSAs) and medical savings accounts (MSAs) to cover DPC costs,” and that HSA eligibility should not require a high-deductible plan, in “Fostering health care innovation through federal policy: a case for direct primary care.” Dana Y. Lujan, MBA, wrote in July 2026 that health care private equity reached “a record $191 billion in disclosed deal value in 2025” and that about 63 percent of physician transactions in 2023 involved a private equity firm or portfolio company, in “Private equity is reshaping concierge medicine.” The record of what physicians have said about private equity ownership itself is on the private equity and corporate medicine page.

How has the direct primary care conversation changed since 2006?

The corpus shows three periods. From 2006 to 2009 the subject was concierge medicine and the posts were short: Kevin Pho tracking physicians converting, a physician converting back, and the first Seattle practice for the working poor. From 2010 to 2016 the phrase direct primary care arrived, 2014 was the peak year with 18 posts, and the physicians who had opened practices wrote the case studies. Since 2017 the subject has been survival: the Qliance closure, employer contracts, burnout as the reason for leaving, and since 2024 the failures, the math, and private equity.

Term 2006 to 2009 (24 posts) 2010 to 2013 (20 posts) 2014 to 2016 (28 posts) 2017 to 2021 (18 posts) 2022 to 2026 (50 posts)
Concierge or retainer 50 percent 50 percent 61 percent 39 percent 50 percent
Direct primary care or DPC 0 percent 25 percent 75 percent 89 percent 82 percent
Monthly fee stated in dollars 8 percent 25 percent 29 percent 22 percent 26 percent
Panel size 0 percent 25 percent 29 percent 33 percent 40 percent
Access, two-tier, or cherry-picking 12 percent 70 percent 54 percent 67 percent 78 percent
Medicare 17 percent 35 percent 39 percent 28 percent 12 percent
Employers or self-funded plans 0 percent 20 percent 32 percent 28 percent 44 percent
Named companies (Qliance, MDVIP, Iora, Forward) 4 percent 15 percent 11 percent 17 percent 6 percent
Burnout 0 percent 10 percent 25 percent 28 percent 38 percent
Telemedicine, text, or email access 4 percent 15 percent 21 percent 44 percent 12 percent
Private equity or venture capital 0 percent 10 percent 4 percent 0 percent 16 percent

Term frequencies are the share of posts in each period using the term at least once, computed on the September 18, 2026 corpus of 140 posts.

The 2006 to 2009 posts are Kevin Pho’s, and they record the concierge era in real time: a physician with second thoughts in July 2006, the Seattle working-poor practice in December 2007, and the regulatory question in December 2008. They run under 200 words, are not indexed, and are counted here but not linked. Steven Reznick, MD, made the ethical defense in August 2011. Dike Drummond, MD, predicted the two tracks in October 2012. The 2014 posts are the model’s case studies: Umbehr, Neuhofel, Schimpff’s series on blue collar concierge and employer contracts, Qamar drawing the line between the two names, Larson on cost, and Lamberts a year later on what a surviving practice looks like. Al-Agba recorded the Qliance closure in 2017, Edwards wrote the first-person case for leaving in 2020, Pastoor argued the model as the answer to the shortage in 2022, Capella conceded the access cost and chose it anyway in 2025, and the 2025 and 2026 posts, most of them by a consultant, are about why clinics fail and who is now buying the ones that do not.

The KevinMD direct primary care corpus by the numbers

The figures below describe the set of KevinMD posts this page draws on, as of September 18, 2026. They are counts of what KevinMD has published, not survey data.

Measure Value
Posts in the corpus 140
Date range July 10, 2006 to July 1, 2026
Named contributors 62
Posts bylined by an MD or DO 64
Posts with direct primary care or DPC in the title 65
Posts with concierge in the title 49
Short posts by Kevin Pho, 2006 to 2011 28, median 90 words
Podcast episodes with full transcripts 14
Posts in the corpus that are not indexed, counted but not cited 31
Total words About 110,000
Peak years 2014, 18 posts; 2026, 14 posts through July
Most frequent contributors Dana Y. Lujan, MBA (15, consultant); Stephen C. Schimpff, MD (6); Dave Chase (5, entrepreneur); Rob Lamberts, MD (5); Josh Umbehr, MD (4)

How this page was built and how it is updated

The corpus was assembled from title searches for “direct primary care,” “DPC,” “concierge,” and “direct care,” plus a small number of posts that discuss the models substantively without naming them in the title. Term frequencies were computed against the full text of each post on the corpus assembled for the September 18, 2026 build; this page was converted to the current standard on September 20, 2026 without rebuilding that corpus, so the counts and figures are as of September 18, 2026. Posts are counted whether or not they are indexed; citations on this page are limited to posts that are indexed and can be verified at the link. Thirty-one posts in the corpus are not indexed: Kevin Pho’s 2006 to 2010 commentaries, one short 2017 essay, and four podcast episodes without transcripts. They are counted but not cited. Quotations are taken verbatim from the original posts. Author credentials are as they appeared in the byline at publication. Kevin Pho’s posts from 2006 to 2011 were short commentaries on news and are counted separately above. The three most frequent non-physician contributors sell consulting or services to direct practices and are identified as such where cited; they are cited at the same rate as other frequent voices rather than in proportion to their output. Every source is linked in the sentence that cites it, and the full list appears at the end of the page. The closest archives are the Primary Care and Practice Management tags. Related records: Private equity and corporate medicine: what physicians say, in their own words, Physician burnout: what physicians say, in their own words, and Prior authorization: what physicians say, in their own words.

This page is updated as new essays on direct primary care and concierge medicine are published on KevinMD. When it is updated, the date at the top changes, the counts in the tables are recomputed, and new named claims are added to the relevant section. Nothing is removed unless the original post is removed. An author who believes a quotation on this page misrepresents them can write to Kevin Pho and the page will be corrected.

To cite this page: Pho K. Direct primary care: what physicians say, in their own words. KevinMD.com. Updated September 20, 2026. https://kevinmd.com/direct-primary-care

The 34 KevinMD posts cited on this page, in order of publication