Direct primary care’s gains may be the traditional care setting’s losses

A recent Health Affairs study found primary care physicians are gravitating to direct primary care (DPC) and concierge practices. This trend is causing a concerning ripple effect on access to care across the country. 

According to research led by Oregon Health & Science University, the number of DPC and concierge practice sites in the United States grew by more than 83% from 2018 to 2023. Similarly, the number of clinicians participating in these types of practices increased by nearly 79%. 

In an interview with Physicians Practice, lead author Dr. Jane Zhu differentiated between the two care models. Concierge practices typically charge annual membership fees of $3,000 to $5,000 and continue to bill insurance. DPC, on the other hand, generally charges monthly fees of $50 to $100 and doesn’t bill insurance for routine primary care. 

There are now more than 1,000 DPC offices in the country, according to the advocacy group DPC Nation, and about 250,000 Americans are members of these practices. (That works out to 250 patients per practice.) The numbers are small but growing. In Maine, for example, roughly half of the state’s three dozen DPC clinics have opened in the last fire years, News Center Maine reported. 

The popularity of DPC comes largely at the expense of primary care. Concierge and DPC offices have smaller patient panels – hundreds as opposed to thousands. As the Medical Group Management Association (MGMA) noted, that can help reduce administrative burden and payer friction while giving physicians greater control over their schedule and the care they deliver.   

While viewed as an overall win for patient and clinician experience, DPC growth is “tightening physician supply in already constrained markets,” the consultancy Chartis said. It’s also happening at a time when 1 in 6 Americans don’t have a primary care physician, patients in some metro areas face 8-month waits for new patient appointments with PCPs, and there’s a projected shortfall of more than 70,000 PCPs over the next decade. 

 “[I]t’s important everyone understands the potential impact these practices have on the health care system at large,” co-author Dr. Dan Polsky said. That’s especially true for patients and physicians in traditional primary care settings, added co-author Dr. Zirui Song, given that the industry “increasingly face[s] more patients needing new primary care doctors but fewer doctors to meet that need.” 

MGMA referred to the physicians’ shift to concierge and DPC medicine as an “escape value,” especially since 45% of PCPs reported feelings of burnout in a recent Commonwealth Fund survey. For the organization, the path forward requires rethinking what primary care looks like: How can the PCP office mimic the DPC experience while maintaining payer relationships, and what would make a redesigned PCP model feasible at scale? 

One option may be virtual primary care. Mass General Brigham – based in the aforementioned metro area where patients may wait months to see a new PCP – has rolled out a program called Care Connect. A patient begins by engaging with an artificial intelligence chatbot, which will direct the patient to the appropriate care venue and provide a chat summary to the clinician who will see the doctor next. One patient, told she’d had to wait nearly two years to see a PCP just to get a refill for blood pressure medications, scheduled a virtual appointment through Care Connect within two days. 

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.