Asked and answered: 7 key questions about direct primary care

Physicians weighing a move to direct primary care tend to ask the same questions: How many patients will follow me? What will I earn? Will a smaller panel worsen the shortage?

Those questions and others came up when Medical Economics and Physicians Practice convened four physicians in direct primary care (DPC) for a panel discussion earlier this year: Rebekah Bernard, M.D., owner of Gulf Coast Direct Primary Care in Fort Myers, Florida, who moderated; Kelsey Smith, M.D., founder of Pioneer Health DPC in Stillwater, Oklahoma, and president of the DPC Alliance; Maryal Concepcion, M.D., FAAFP, founder of Big Trees MD in Arnold, California; and Richard Berry, M.D., founder of Maple Health Direct Primary Care in Mentor, Ohio.

Direct primary care removes insurance from the physician-patient relationship entirely. Concierge medicine, by contrast, often bills insurance alongside a membership fee, Smith said. Here are seven more questions physicians have for DPC doctors, answered by physicians who have the experience to know.

How many patients will follow me, and what does a full panel look like?

Expect somewhere between 10% and 20% of an established panel to make the switch, Bernard said, though the number varies practice to practice and is hard to predict in advance.

"When you talk to DPC doctors, you'll often hear it tossed around that about 10%, maybe 20% of your practice panel, if you're an established doctor in a community, about 10 to 20% will follow you into a DPC model. For me, it was probably about 10%."

Concepcion had no expectations going in; about 80% of the patients who joined her practice in its first year turned out to be her former patients, she said.

Once established, most panelists put a full DPC panel at 600 to 800 patients for a single physician. Berry caps his own panel at 600.

"What I found in my office is we like to max people out at 600, and I know at 600 nobody is going to call me at midday because they have a genuine, acute issue, and I turn around and say, sorry, can't get you in, see you tomorrow. We've never had that."

His average is seven to eight patients a day, he said. Bernard, who has seen as many as 800 patients after absorbing a partner's panel, said she is more comfortable around 550, with more flexibility.

Do I need a full staff, or can I run a DPC practice alone?

It depends on overhead, Smith said. Physicians who keep overhead low, such as those doing home-based visits without staff, can reach financial viability with far fewer patients than a practice carrying rent, utilities and employee costs. As her own panel grew past 600, Smith said her medical assistant issued an ultimatum: “‘If you're going to grow anymore, you've got to find somebody else to help out, or I'm leaving.’ And I was like, ‘OK, you can't leave.’”

Smith hired a second full-time staff member and later added a second physician to the practice. Berry took a different approach, bringing two physician assistants (PAs) with him when he left his previous employer to open Maple Health.

"I bought them both from my old clinic. We worked together for four years in the insurance-based health care. Then I left, set this up, and then brought them across."

Bernard, who has one staff member, said she has always relied on having “that right-hand person” rather than running a solo, staff-free practice.

What technology is actually worth investing in?

Opinions differed. Concepcion uses an artificial intelligence (AI) scribe, a patient portal built into her electronic health record, and point-of-care tools, including a 12-lead electrocardiogram (ECG) and a phone-based ultrasound.

Berry, who hails from England, takes a lighter approach to clinical technology.

"I generally don't use much in the way of scribes. Problem is, basically, the accent. It's like whenever I use dictation, it just doesn't understand me, and then it tries to spell everything the English way, and it's just a disaster."

Technology is most useful on the business side of the practice, such as advertising and reporting, rather than clinical documentation, he said. Bernard cautioned that more contact channels aren't always better.

"Sometimes I feel like I have too many ways for people to contact me. And if I was doing it over again, I probably wouldn't be doing texting."

How do I approach employers who want to provide health care for their workers, and what’s the appeal for a self-funded company?

Chambers of commerce were the most common starting point that the panel cited. For self-funded employers, the appeal is direct cost avoidance, Berry said. He built much of Maple Health's employer base that way. His smallest business client has two employees; his largest has 175. Smith markets directly to businesses with fewer than 50 employees, which are not required under the Affordable Care Act to provide insurance.

"Small employers really want to take care of their people, and they’re really hungry for an affordable way to do that, because they want to have a way to market for the best employees for their small business, whether that's a plumbing group or electrical group or a construction company or an oil well service company, of which I have some of each."

Concepcion's employer relationships have taken less conventional forms: a benefits adviser arranged for her practice to provide remote allergy care to a school district roughly eight hours from her clinic, after asking what it would cost if patients didn't have to travel for in-person visits. The price landed at what another physician had been charging to see those same patients once a year in person.

Are patients actually using HSAs to pay for DPC now?

The One Big Beautiful Bill Act, passed last year, clarified that health savings account (HSA) holders can put up to $150 per person per month toward DPC membership fees, ending years of ambiguity about whether the accounts could be used that way, Bernard said. Adoption varies widely by market. In Berry’s practice, where high-deductible plans are common among small-business clients, HSA use is already substantial.

"We're seeing, I would say, at least 25% minimum of our patients actually utilize HSA."

Smith's patients use HSAs far less, though she expects that to change as more employers understand the new rules.

"Not nearly that amount ... I think it will dramatically increase in the next few years, if I had to speculate, just because it has given employers a different way to think about structuring their plans."

Doesn’t a smaller panel just make the primary care shortage worse?

There's some truth to the criticism, Berry acknowledged, but he argues quality matters more than raw numbers.

"I used to look after 2,500 people, and now look after 600 people. That leaves 1,900 people that had a doctor, that don't have a doctor. But then you've got to look at the longevity. What's better for the community? It's the 600 who were looked after well than 2,500 looked after badly, or not at all."

Smith pointed to the medical student pipeline. Trainees who rotate through burned-out primary care practices are less likely to choose the specialty, she said, regardless of what drew them to medicine originally.

"I really think DPC ... makes primary care a viable option again, where it has not been in the past."

Bernard added that physicians already in other specialties have told her they wish they could open their own DPC practices. Concepcion argued the shortage narrative obscures a separate trend: physicians being replaced by nonphysician providers. She cited a California law, AB 890, which she said allows a nurse practitioner with 4,600 hours of experience to practice largely unsupervised.

If you could tell a physician considering DPC one thing, what would it be?

Growth is no longer a matter of speculation, Smith said.

"DPC is growing. It is skyrocketing across the nation. It is a viable practice model, no matter your community size.... Don't hamstring your decisions that are going to make your professional life sustainable because you haven't thought outside the box. Throw the box away."

Concepcion pointed to data behind that growth: the share of physicians identifying as DPC practitioners within the American Academy of Family Physicians rose from 4% to 11% over roughly three years, she said.

Berry's advice was about overcoming inertia, not uncertainty.

"It's about reaching out. There are so many people who are like, I can't do this because…and the reality is, you can't do this because you don't know how to get over that hurdle yet. Reach out to us, and let us kind of solve those problems for people."

Learn more

The DPC Alliance, the American Academy of Family Physicians and DPCfrontier.com offer directories, state-law summaries and other resources for physicians exploring DPC. Full panelist bios and practice links are available at medicaleconomics.com. The panelists spoke as part of “Direct Primary Care 101: Reclaiming independent practice with less burnout,” the spring 2026 Medical Economics Insider.