Direct primary care has gone from a fringe experiment to a legitimate career path in about a decade. Nearly 10% of family physicians now practice in a DPC model, according to the American Academy of Family Physicians (AAFP), and the number of practices has grown from roughly 100 in 2009 to over 2,100 by 2023.
One family medicine physician captured the draw on Sermo. “I love being a PCP and taking care of patients. It is so rewarding to walk into a room knowing all about the patient, their family, and their life. It puts a lot of context around their health care.” DPC is designed to protect exactly that kind of continuity. The model drops insurance billing entirely and gives physicians smaller panels, longer visits, and full control over clinical decisions.
But the transition involves real financial risk that most of the existing content about DPC tends to skip over. This article covers what the model genuinely improves, what it costs in terms of income, benefits, and clinical scope, and the practical questions a physician should work through before making the leap.
Physicians on Sermo are already comparing notes on DPC transitions and sharing real numbers from the first two years. Join the community to see what your peers are saying.
What direct primary care actually is (and isn’t)
Direct primary care is a membership-based model where patients pay a flat monthly fee for primary care services, and the practice does not bill insurance for those services. In exchange, physicians take on the full responsibilities of running an independent business. Most DPC physicians charge between $50 and $150 per month for adults, with lower fees for children. That covers extended visits, care coordination, and ongoing care management, with some practices bundling in basic labs and vaccinations.
DPC is not the same as concierge medicine, though the two are often confused. Concierge practices charge much higher annual retainer fees and typically still bill insurance on top of the retainer. DPC is built around affordability and stays completely outside the insurance system, which is why most DPC patients pair their membership with a high-deductible health plan for hospital, specialty, and emergency coverage.
The model works best for physicians whose practice is primarily longitudinal, relationship-based primary care. If your income depends on hospital privileges, procedures, or specialty referral volume, DPC is a much tougher fit.
In a Sermo poll, 72% of physicians agreed that primary care is a rewarding specialty, and 57% identified as primary care physicians themselves. A general practitioner on Sermo described what makes it worth it: “This specialty allows for a broad and humane approach to medicine, focused on the person rather than the disease.” That patient-centered focus is the foundation DPC is built on, and what gets squeezed hardest in a traditional fee-for-service environment.
The 2026 HSA change every DPC physician should know about
Starting January 1, 2026, a new federal rule changed the patient-side math for DPC. Patients enrolled in high-deductible health plans can now use tax-free HSA funds to pay for DPC memberships, up to $150 per month for individuals and $300 per month for families.
This change matters on the physician side for two reasons. First, one of the hardest conversations in DPC patient acquisition has always been convincing someone who already pays health insurance premiums to pay a separate monthly fee on top of that. Telling a prospective patient they can cover that fee with pre-tax dollars already sitting in their HSA removes the objection in many cases. Second, it makes employer-sponsored DPC arrangements more viable, especially for self-funded companies paired with high-deductible plans.
If you’re considering DPC, factor employer contracts into your acquisition strategy early. The HSA change opens the door to multi-patient agreements with local businesses that might not have been financially realistic before.
Direct primary care: The pros
Physicians switch to DPC for a few consistent reasons, including smaller panels, no insurance billing, and full clinical autonomy. That combination addresses the exact frustrations driving burnout across primary care right now.
Dramatically higher physician satisfaction and lower burnout
The satisfaction gap between DPC and non-DPC physicians is striking. The AAFP’s 2024 DPC data brief found that 94% of DPC physicians report being satisfied with their practice, compared to 57% of non-DPC physicians. On burnout, 49% of DPC physicians reported no burnout at all, compared to just 14% of non-DPC physicians. What’s driving those numbers isn’t the financial model itself, but the elimination of insurance billing and prior authorization from daily practice.
When we asked Sermo members which aspects of primary care they find most rewarding, building long-term patient relationships (26%) and preventing illness through early intervention (25%) topped the list, followed by contributing to community health (19%). DPC is structured around all three of those priorities, which goes a long way toward explaining the satisfaction gap.
Smaller panels, longer visits, real continuity
The average DPC panel is around 402 patients per physician, compared to 1,800 to 2,500 in traditional primary care. Visits typically run 30 to 60 minutes, rather than 7 to 15. If you got into medicine for the patient relationship and you’ve been doing rushed 15-minute visits for years, that difference changes everything about how your day feels.
A family medicine physician on Sermo encouraged peers to explore the option. “I would encourage you to look into opening a DPC. So many resources out there that it isn’t too overwhelming to open one. You may find that balance you are looking for.”
Predictable, recurring revenue
In a fee-for-service practice, your revenue moves with visit volume and payer decisions, which means it can swing month to month. DPC revenue is monthly and membership-based, so once the panel is built, your cash flow stabilizes in a way that traditional primary care rarely offers.
Lower overhead than traditional family practice
Traditional family practice runs at 60 to 70% overhead, much of it tied to billing and coding infrastructure. DPC practices typically run at 30 to 40% because you’re not paying for a billing department, coding staff, or the software and labor that go into chasing insurance reimbursements.
Higher clinical autonomy
Without an insurance company in the middle, you decide what to test, when to follow up, what to prescribe, and how long to spend with each patient. A general practitioner on Sermo described what that freedom looks like. “Direct primary care or subscription-based models empower us to practice patient-centered medicine without administrative burdens.” For many physicians, autonomy alone is reason enough to make the switch.
Direct primary care: The cons
The trade-offs in DPC are just as real as the benefits, and many physicians may underestimate them. The biggest downsides for physicians are income uncertainty during the build phase, the challenge of patient acquisition, the loss of employer benefits, and the added burden of full small-business ownership on top of clinical care.
The income picture is mixed and depends entirely on the panel
ZipRecruiter reported the average DPC physician salary at around $217,000 as of late 2025, which mostly reflects physicians who are still building their panels or running smaller practices by choice. The math is simple on paper (400 patients times $100 per month equals $480,000 in gross revenue) but getting there takes time, and your net income depends heavily on your overhead and location.
You also need to account for costs that were invisible in your W-2 role, including malpractice insurance, health coverage, retirement contributions, and disability insurance that now come out of your pocket, easily adding tens of thousands of dollars a year to your expenses.
Patient acquisition is harder than expected
When polled on Sermo, physicians identified burnout (27%) and administrative burdens (26%) as the biggest challenges in primary care today. DPC addresses both, but it replaces them with something most employed physicians have never dealt with. You have to market yourself to patients and convince them to pay you directly, month after month.
Physicians transitioning an existing traditional panel to DPC typically convert only 10 to 15% of their patients, with some achieving 40% in unusual circumstances. For physicians starting from scratch, the build phase usually takes one to three years to reach a sustainable panel.
A family medicine resident on Sermo asked their peers a question that captures what many physicians feel going in. “I am quite interested in the DPC model, but feel like I have limited knowledge of the downsides beyond equity in access. Do you know of other pitfalls or even more pearls of wisdom about DPC and the startup process?”
Startup costs and financial runway
Startup costs range from about $5,000 for a low-overhead model to $100,000 or more if you’re building out a traditional office space. SBA-backed loans are one financing option, and many physicians bridge the gap with ED or urgent care moonlighting shifts. The most common advice is to budget for 12 to 24 months of personal expenses outside the practice.
Concentration risk on a small panel
When your panel is 400 patients, every cancellation, complaint, or family-wide departure hits your revenue directly. Fee-for-service income is spread across thousands of patients and dozens of payers, so no single loss really registers.
You’re running a small business, not just a clinic
DPC physicians become small-business owners in a way most employed physicians have never experienced. Marketing, hiring, lease negotiations, payroll, vendor management, and patient retention all land on your desk. Some physicians thrive on the entrepreneurial side, while others find it draining and miss the structure that came with being employed.
An ophthalmologist on Sermo described the transition bluntly. “It’s a big mountain to climb in the hopes of maintaining some autonomy.” An OB-GYN raised a related concern. “I have little business savvy. I would be concerned that others would see that this is a way for them to profit at my expense.”
Should you switch to direct primary care?
There’s no universal answer, but the physicians who do best in DPC tend to be in primary care specialties, have enough savings to weather a slow build phase, and are at least comfortable with running a business. If any of those pieces is missing, an employed DPC role or a hybrid model might be a better starting point.
These are the questions worth working through before you decide.
- Are you a primary care provider, or could you be?
DPC works almost exclusively for family medicine, internal medicine, and pediatrics. Direct specialty care models do exist, but they’re far less proven.
- Do you have 12 to 24 months of personal financial runway?
If not, plan to keep a part-time W-2 or moonlighting income during the build phase. Running out of savings before the panel is sustainable is the most common reason DPC transitions fail.
- Does running a small business sound energizing or exhausting?
If the operations side drains you, an employed DPC role (working for someone else’s DPC practice) may be a better fit than ownership.
- What’s your local market like?
Urban and suburban markets with employed, insured populations tend to support DPC pricing better than rural or low-income areas.
- What’s your insurance and benefit situation?
Having spousal health coverage through a partner’s employer can substantially reduce the financial risk of going independent.
- What patients do you want to serve?
If your motivation is broad public health impact across all income levels, DPC’s membership model raises real questions about access and equity. The population you reach is shaped by who can afford the fee.
- Are you willing to give up hospital privileges and procedural revenue?
If not, look at hybrid models that pair DPC with part-time hospital or urgent care work.
How can physicians switch to direct primary care models?
If you’ve decided DPC is worth pursuing, there are three common paths.
- Convert an existing traditional practice to DPC: You notify your current patients and offer them a membership, knowing that only about 10 to 15% will convert. How you frame the change directly affects how many follow you, so patient communication deserves more planning than most physicians give it.
- Start a DPC practice from scratch: This path takes longer to become profitable, but you get to choose your market and design the practice exactly how you want it. For a detailed walkthrough of the financial setup, see Sermo’s guide on starting a private practice.
- Join an established DPC practice as an employed physician: Lower risk and lower financial upside, but it gives you a chance to learn how the model works before taking on ownership yourself. The AAFP CareerLink lists employed DPC positions across a range of markets.
Whichever path you take, a few practical priorities come up in every transition.
- Get your entity structure and tax strategy in place early, because S-corp elections and retirement account choices are harder and more expensive to fix after the fact.
- Lock down malpractice and tail coverage before your last employed day at your current position.
- Keep the technology stack lean in year one and add tools as the panel grows, so you’re not buried in software costs before revenue catches up.
What are the biggest mistakes physicians make when starting a DPC practice?
The same missteps come up in DPC transitions:
- Running out of runway: Underestimating the build time and burning through personal savings before the panel can support the practice.
- Mispricing the membership: Setting fees too low to undercut insurance copays can leave you struggling to break even, while pricing too high for your local market stalls patient acquisition before it starts.
- Overspending early: Sinking money into office build-outs, equipment, and full-time staff in the first year, before revenue can support those costs.
- Underestimating the cost of being independent: Not factoring in malpractice, health insurance, retirement contributions, and disability coverage when comparing DPC income to your current W-2 salary.
- Burning bridges on the way out: Leaving your current employer or referral network on bad terms can hurt you later, especially if a hybrid model ends up making more sense than pure DPC.
- Neglecting operations: Treating the business side as an afterthought until something breaks.
- Assuming the AAFP satisfaction data applies to everyone equally: The AAFP’s numbers come from physicians who chose DPC and stayed, which makes them a self-selected group whose experience may not match yours.
Key takeaways
- The AAFP reports 94% of DPC physicians are satisfied with their practice (versus 57% non-DPC), with 49% reporting no burnout at all.
- DPC panels average around 402 patients versus 1,800 to 2,500 in traditional primary care, with overhead of 30 to 40% compared to 60 to 70%.
- Starting January 2026, patients in high-deductible health plans can use HSA funds for DPC memberships up to $150 per month individually and $300 for families.
- Physicians converting existing panels typically retain only 10 to 15% of patients, and building from scratch takes one to three years.
- DPC works best for primary care physicians with financial runway, a market that supports the pricing, and a genuine interest in practice ownership.
The bottom line on direct primary care
DPC is one of the highest-satisfaction, lowest-burnout primary care models available right now, and the data backing that claim holds up. The 2026 HSA change makes the patient-side economics more attractive than they’ve ever been, which should make the ramp-up faster for physicians entering the model now. But the build phase is financially uncomfortable, patient acquisition takes longer than most physicians expect, and the shift from clinician to practice owner requires skills that medical training doesn’t cover. Whether DPC is the right move depends on your specialty, market, finances, and your willingness to run a business.
Sermo is where physicians compare notes on real practice transitions, from conversion rates and pricing strategy to what year two actually looks like.
