Five surprising findings about the state of direct primary care

For more than a decade, physicians have cited $77 per month as the average price of a direct primary care (DPC) membership. A new national survey suggests that benchmark is now substantially out of date, as well as showing a few other unexpected findings.

The 2024 survey was commissioned by the Direct Primary Care Alliance (DPCA) and led by Kenneth Qiu, M.D., a family physician who launched his Richmond, Virginia, DPC practice directly out of residency. The survey received 465 physician responses, representing approximately 13% of the estimated 3,600 DPC practices in the United States.

Related content: Medical Economics Insider: Direct primary care 101

While not a definitive census of every DPC practice, the DPCA survey offers one of the largest recent datasets describing how physicians are designing and operating their practices.

Here are five findings that surprised even Qiu and his fellow survey committee members:

1. The average DPC membership price is now $98 per month

For more than a decade, the most commonly cited average price for DPC membership has been $77 per month, based on a landmark 2015 study of the model. Other estimates have generally placed monthly fees between $50 and $100.

The new DPCA survey found an average monthly membership price of $98.46 — nearly 28% higher than the frequently cited $77 benchmark.

Prices varied substantially by geography and practice design. Rural practices averaged approximately $82 per month, compared with about $110 in urban areas. The Midwest had the lowest regional average at approximately $80, while Western practices averaged $113 and Northeastern practices averaged $110.

Panel size was also closely associated with price. Practices with fewer than 200 patients charged an average of nearly $106 per month, while those with more than 500 patients averaged approximately $78.

Emily O'Rourke, M.D., who served on the committee that developed the survey, said she was surprised by the results. "The mythological price that was passed around when I was first investigating DPC was that $50 per month was the appropriate — and only — price that you should charge," she said.

O'Rourke initially charged $75 per month when she opened Fountain Direct Primary Care in Chesapeake, Virginia, in 2018. She has since increased her price for new patients to $100. "Interestingly, I calculated that the increase exactly matches the rate of inflation from 2018 until now," she said. Because O'Rourke grandfathered existing patients at their previous rates, her current average revenue per member is approximately $82 per month.

Kelsey Smith, M.D., president of the DPCA and owner of Pioneer Direct Primary Care in Stillwater, Oklahoma, was less surprised by the new higher price point. She said the finding reflects the pressure physicians are experiencing to account for rising expenses and changing market conditions.

The survey also found that 76.4% of practices continue to use some form of tiered pricing, while approximately 15% have eliminated tiers. Some physicians are simplifying age-based tiers or replacing them with family pricing. Qiu's practice, for example, reduces the per-person membership price as additional family members enroll.

The findings suggest that there is no universally "right" DPC price. Membership fees must account for the practice's location, overhead, target population, desired panel size and level of service.

2. A "full" panel can mean fewer than 300 patients — or more than 1,000

A full DPC panel is commonly estimated at approximately 400 to 600 patients. Although survey responses clustered between 400 and 700, a substantial group of physicians considered themselves full with only 100 to 300 patients. At the other end of the spectrum, some reported panels of more than 1,000.

Smith said that her own target changed after she opened her practice. "When I started, I was naive," she said. "My panel in insurance-based care was between 2,500 and 3,000, so I thought, 'Surely I can take care of 1,000 people in DPC.'"

She soon discovered that the more extensive interaction between physicians and patients in DPC changed that calculation. "I very quickly decided that 1,000 was a little bit of an overshoot," she said.

The wide range of panel sizes reflects fundamentally different practice models. Some physicians want to maximize growth, employ staff, add physicians or expand to additional locations. Others deliberately maintain smaller panels, operate part time, combine DPC with another source of income or use the model as a bridge toward retirement.

3. More than 30% of respondents operate with no staff

O'Rourke opened her practice with plans to hire employees as her panel grew. Instead, she discovered that remaining a micropractice gave her a leaner financial structure and eliminated the human resources and management responsibilities that accompany staffing.

The survey suggests that she is far from alone. More than 30% of respondents reported operating without any staff. The most common arrangement, reported by approximately 35%, was one staff member; another 20% reported having two.

Operating a micropractice does not necessarily mean that the physician must personally perform every business function. Tasks such as accounting, billing support, website management and marketing can be outsourced without adding permanent employees. Technology can also reduce the administrative work traditionally divided among front-desk staff, medical assistants and nurses.

At the same time, operating without staff is not inherently superior. Physicians who want to see more patients, spend less time on administrative work, or expand their organizations may benefit significantly from hiring the right person.

Smith, for example, cannot imagine practicing without her longtime medical assistant. "If my right-hand person left, I might have to retire," she joked.

The data demonstrate that both approaches can work. The appropriate staffing structure depends on the physician's desired panel size, workload, overhead and tolerance for administrative responsibilities.

4. Women constituted two-thirds of respondents

Women made up 67% of survey respondents, one of the study's most striking demographic findings.

While voluntary participation and the survey's outreach channels may have influenced the sample, the high level of participation raises an important question: Could direct care offer some women physicians a sustainable alternative to leaving clinical medicine?

Smith believes the model may hold particular appeal for women because it gives physicians greater control over competing demands on their time and attention. "The advantages that direct primary care offers may be more appealing to a female physician because of the demands placed on our time and attention — and our desire to determine how we structure our practices," she said.

DPC physicians can determine their schedules, panel sizes, staffing arrangements and availability expectations rather than trying to fit their lives into a system designed around volume and productivity.

That flexibility may be particularly relevant given evidence that women physicians leave clinical practice earlier than men. One recent study reported that women physicians departed clinical medicine at an average age of approximately 49. The average age of DPC practice owners in the DPCA survey was 46, suggesting that many physicians are turning to the model in midcareer.

5. Osteopathic physicians were disproportionately represented

Osteopathic physicians made up 24% of survey respondents — a proportion higher than their representation in the overall physician workforce.

Smith offered one possible explanation based on her experience working with osteopathic physicians in insurance-based practice. "The pressures of an insurance-based practice caused them to leave a lot of their osteopathic skills behind because manipulation and osteopathic care do not fit nicely into the constraints of a 15-minute visit," she said.

Longer visits and greater control over scheduling may allow osteopathic physicians to reincorporate skills that are difficult to use in a conventional high-volume practice. "I can only imagine that many osteopathic physicians who have come to direct primary care feel some independence in being able to incorporate those skills back into their daily schedules," Smith said.

From standard benchmarks to intentional practice design

The survey's central lesson is not a new set of universal benchmarks, but evidence that DPC can support a wide range of practice designs.

"We've said for years that if you've seen one DPC practice, you've seen one DPC practice," Smith said. "It's not a one-size-fits-all model, and these data support that even further."

For physicians considering DPC, the most useful questions may no longer be simply, "How much should I charge?" or "How many patients should I have?"

The better questions are: What kind of practice do I want to build? What kind of life do I want to live? And what financial and operational structure will make both sustainable?

"We want to show doctors that they can set their own expectations for their patient panels and design their practices around what works best for them," Smith said.

Although the survey was produced by the Direct Primary Care Alliance, Smith emphasized that its findings belong to the broader DPC community. "We hope that the physicians who read this report can make better decisions moving forward and continue to advance the movement," she said.

Rebekah Bernard, M.D., is a family physician in Fort Myers, Florida, and served on the Direct Primary Care Alliance Members Insights Committee that produced the DPCA survey. Read the entire survey report here.

Music Credits
Medical Education by Art Media - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 Cold open. Bernard sets up the three questions the survey was built to settle: what a membership costs, what counts as a full panel, and how many physicians run solo.

0:57 Meet the guests. Kenneth Qiu, M.D., of Richmond, Virginia, who chaired the committee; Emily O'Rourke, M.D., of Chesapeake, Virginia; and Kelsey Smith, M.D., of Stillwater, Oklahoma.

1:46 Why the alliance ran it. Years of trading panel-size and pricing figures with no data behind them, and a deliberately short instrument so physicians would finish it.

3:16 The sample. 465 responses, roughly 13% of an estimated 3,600 practices, with Texas and Florida leading and a tilt toward non-expansion states.

4:57 Women were 67% of respondents. Smith on why the model appeals to them, and Bernard on women leaving clinical medicine younger than men.

5:31 Mostly family physicians, 11% internal medicine, 6.4% pediatrics. Osteopathic physicians at 24% — Smith says manipulation doesn't fit a 15-minute visit.

7:03 Average owner age of 46, ranging from 29 to 73. Qiu on the spike at 40 he calls the "peak of despair," and residents now launching in their third year.

8:13 The panel surprise. Answers clustered at 400 to 700, but a sizable group called themselves full at 100 to 300. O'Rourke thought she was the only one staying micro on purpose.

9:31 Qiu has heard full defined anywhere from under 50 to more than 1,000.

10:10 Smith came from a 2,500- to 3,000-patient insurance panel and assumed 1,000 would be easy. The depth of interaction in DPC changed that fast.

11:00 O'Rourke reframes full as the point where income and work-life balance both hold, stretched across a wide band.

12:01 Staffing. More than 30% run with no staff at all, 35% have one person, 20% have two.

12:40 O'Rourke on outsourcing instead of hiring, and why rooming a patient is an artifact of the seven-minute visit.

13:45 The other camp. Bernard and Smith on the right-hand person — Smith says if hers left after 19 years, she might retire.

14:05 Perceived barriers to going solo, from drawing labs to answering your own phone.

15:30 The headline number. The decade-old $77 benchmark gives way to a national average of $98.46.

16:02 O'Rourke on the "mythological" $50 ceiling, and moving from $75 to $100 — which she calculates matches inflation exactly. Grandfathered patients keep her actual average near $82.

16:49 Price by geography. Midwest lowest at about $80, West highest at $113, Northeast at $110, rural $81.56 against roughly $110 urban.

18:10 Panel size against price: under 200 patients charge nearly $106, over 500 charge about $78. Qiu on why first-generation rural practices never raised theirs.

19:08 Practice age against price. The five- to 10-year band prices lowest at about $86, newer practices near $110.

20:10 Smith on dropping age tiers once she found age didn't predict utilization.

21:02 The breakdown: 76.4% still tier, about 15% have gone flat, the rest use family pricing.

21:31 Qiu switched to family pricing to pull whole households in, with deliberately loose rules about who counts.

22:45 "If you've seen one DPC, you've seen one DPC." Smith says the data support it more strongly than ever.

23:39 Bernard's takeaway: stop benchmarking against other practices and ask what kind of practice and life you're building.

24:21 Smith on the report belonging to the whole community, not just the alliance.

24:43 Where to read the survey, and sign-off.