What's holding direct primary care back, with Kenneth Qiu, M.D.

Direct primary care physicians charge an average of about $98 a month for a membership, and those who consider their practices full care for roughly 400 to 700 patients, according to a national survey led by Kenneth Qiu, M.D. Qiu says most of the practices that responded have a single physician, and a third of those have no staff at all.

Medical Economics Senior Editor Richard Payerchin sat down with Qiu, a family physician who founded EuDoc in the Richmond, Virginia, area straight out of residency and led the Direct Primary Care Alliance's "State of Direct Primary Care" report.

Qiu says the community's rule of thumb is that 1% to 5% of a physician's fee-for-service patients will follow them into a new practice. Physicians starting from scratch often moonlight while their panels grow. Qiu says that work generally requires being opted into Medicare, which means billing Medicare for any Medicare patient they see. Many choose not to see those patients, which he says slows practice growth and limits access for beneficiaries.

He also discusses repealing certificate-of-need laws, letting patients apply cash prices toward their deductibles, how his model differs from concierge medicine, why many practices stop growing around five physicians and how academic medicine still looks down on primary care.

Don't miss our recent episodes on unanswered patient calls, defamatory online reviews, patient access to medications and value-based care.

Music Credits:

Midnight Serenade by MORRIX Holyhold - stock.adobe.com

A Textbook Example by Skip Peck - stock.adobe.com

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

0:00 – 0:32 | Cold open. Qiu on how his model differs from concierge medicine.

0:32 – 1:23 | Introduction. Austin Littrell introduces the episode and the guest.

1:23 – 2:55 | Meet Kenneth Qiu, M.D. Qiu describes opening his practice straight out of residency and first learning about the model as a fourth-year medical student.

2:55 – 4:48 | Why the alliance ran the survey. Figures on pricing and panel size had circulated by word of mouth with no hard data behind them.

4:48 – 6:57 | Reaching physicians outside organized medicine. How the committee pushed the survey through every network it could find.

6:57 – 10:07 | What the survey found. Practices in 49 states, average pricing near $98, full panels of roughly 400 to 700 patients and a large share of solo practices.

10:07 – 12:02 | How many practices are out there. Qiu explains where the estimate of about 3,600 practices nationwide comes from.

12:02 – 15:46 | Will your patients follow you? Building a panel, moonlighting while a practice grows and the Medicare billing rule that slows new practices.

15:46 – 18:46 | Removing barriers. Repealing certificate-of-need laws and letting patients apply cash prices toward their deductibles.

18:46 – 19:39 | P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

19:39 – 22:10 | Not concierge medicine. Why Qiu says criticism aimed at concierge practices doesn't fit his model.

22:10 – 25:12 | Wearing every hat. The business demands of a solo practice and why growth often stalls around five physicians.

25:12 – 27:57 | Primary care's image problem. How academic medicine looks down on family medicine and how the alliance reaches students and residents.

27:57 – 30:42 | The next generation. Qiu credits the survey's collaborators and explains why physicians starting out of residency may push the model further.

30:42 – End | Closing thoughts and outro. Payerchin thanks Qiu, and Littrell wraps the episode.