Direct Primary Care is no longer a fringe experiment. Between 2018 and 2023, the number of concierge and direct primary care practices in the United States grew by more than 80%, with a similar rise in the number of clinicians participating in these models. Recent surveys put the average monthly membership price near $98, and practices now operate in nearly every state.
For many physicians, nurse practitioners, and physician assistants, the appeal is straightforward: smaller panels, longer visits, no insurance billing for primary care, and the chance to practice medicine without the constant pressure of volume-driven schedules. Yet the clinicians who thrive in this model often discover that the membership fee itself is only the beginning.
The freedom – and new responsibilities
Moving away from insurance-based primary care removes a heavy administrative load. Prior authorizations, coding battles, and claim denials largely disappear for the care delivered under membership. In their place come different responsibilities: setting sustainable panel sizes, communicating clearly with patients about what is and isn’t included, and building relationships with employers or local communities who value the model.
Many practices report that the first year or two feels liberating. Visits lengthen. Patients start calling earlier instead of waiting until problems escalate. Clinicians rediscover the parts of medicine that drew them to the field. Over time, however, questions surface that the membership model alone doesn’t automatically answer:
- How do you grow without losing the very access and relationships that make DPC different?
- How do you handle the operational side – staffing, compliance, and cybersecurity – as the practice expands beyond a solo or small team?
- How do you reach patients and employers who would benefit from this approach but have never heard of it?
Relationships Still Drive the Model
One consistent finding across patient-experience data is that DPC members report high levels of access, continuity, and willingness to recommend their clinicians. The model works when the relationship feels personal and reliable. That relationship, however, depends on the clinician having enough time and mental bandwidth. Burnout doesn’t automatically vanish just because the payment structure changes. The clinicians who report the highest satisfaction tend to be intentional about panel size, visit length, and boundaries around availability.
In Oregon, an additional factor is emerging. Beginning in 2026, HB 2540 requires most non-HMO insurers to credit qualifying enrollee direct-to-provider payments toward deductible and out-of-pocket costs when certain conditions are met. The details and insurer processes vary, but the law has the potential to lower one of the financial barriers patients face when combining a DPC membership with major medical coverage. For independent clinics, this creates both opportunity and the need for clear patient communication.
Sustainability Looks Different for Every Practice
There is no single blueprint.
Some clinicians prefer a lean, highly personal practice with a few hundred members. Others want to build teams and serve employer groups. Some focus tightly on primary care; others integrate lifestyle medicine, procedures, or discounted labs and medications. What seems to matter most is clarity – about capacity, about pricing, about the kind of practice the clinician actually wants to run five years from now.
The clinicians who appear most steady are those who treat DPC as both a clinical and a small-business endeavor. They protect time for the work only they can do, simplify operations where possible, and stay connected to peers who understand the unique contours of membership-based care.
Direct Primary Care continues to expand because it solves real problems for both patients and clinicians. The practices that last are the ones that keep solving those problems deliberately – protecting the relationship at the center of the model while building the practical supports that let it endure.
If you’re exploring these questions in your own practice or considering a transition, the conversation is worth having. The landscape is shifting, and independent clinicians still have room to shape what primary care can look like.
If you have questions about independent DPC in Oregon, we’re happy to compare notes!
