If DPC Is So Great, Why Isn't Everyone Doing It?

Direct Primary Care is a remarkable model.

Unlimited access to your doctor. A physician working at the top of their scope, so you're not waiting weeks for a costly referral. Long visits with time to discuss whatever is actually on your mind. Wholesale access to labs, medications, and imaging. And the chance to make medical decisions without a payor in the room — no insurance company weighing in on the plan you and your doctor developed together.

Doctors in DPC talk constantly about rediscovering the joy of medicine. Patients say that until they met their DPC doc, it never really felt like anyone listened to them. The model is growing fast — DPC membership is up 837% per capita since 2017 — and there still aren't nearly enough practices to serve everyone who wants this.

So if it's so great, why isn't it catching on faster?

The Objection

The hesitation I hear most is the same one that surfaces any time DPC gets criticized: day-to-day primary care is great, but this can't and shouldn't replace your insurance.

And no DPC proponent has ever argued otherwise. DPC is not insurance, and it isn't a surrogate for catastrophic coverage. Direct Primary Care will handle 80 to 90% of what any patient needs. But if you need surgery, or the emergency room, or a hospital stay — those aren't things your primary care doctor manages. That's where insurance earns its keep — the big stuff, the healthcare equivalent of totaling your car or having your house burn down, where a mechanic or a plumber can't help you anymore. Where I think we go wrong is this: our current system has trained us — trained us very well — not to recognize that there's more than one way to obtain coverage.

What You're Actually Solving For

The real problem is narrower than it looks: if you have a major medical event, you shouldn't be facing bankruptcy or life-altering medical debt. That's a solvable problem, and there's more than one way to solve it. An ACA-compliant Bronze high-deductible plan will do it. So will a catastrophic plan, with an important caveat: catastrophic plans have historically been limited to people under 30 or those qualifying for a hardship or affordability exemption. That's worth a second look this year, though. Under HHS guidance that took effect in November 2025, people 30 and older who are ineligible for premium tax credits based on their income can now qualify for a hardship exemption and purchase a catastrophic plan. For 2026, these plans carry a $9,200 individual deductible — and they cover all preventive services plus at least three primary care visits a year before you hit it.

There's a third path a lot of my patients have taken: a health share. Members pay a monthly amount into a shared pool, and qualifying medical expenses are paid out of it. The monthly cost is often meaningfully lower than comparable insurance, which is much of why people look at it.

But I want to be straightforward about how it actually works, because it surprises people. A health share is not insurance, and that's not a technicality — it's the whole legal structure. You do sign a membership agreement, but the express terms of that agreement disclaim any obligation to pay. Most states require a disclaimer on the application saying so outright, and the organizations themselves are explicit: their guidelines are not an insurance policy, and members remain personally responsible for their own medical bills regardless of what gets shared.

So what makes it work? Guidelines and good faith. You pay in, the organization applies its published sharing criteria, and eligible expenses get shared — and the established ministries have decades of track record doing exactly that, including on large cancer and surgical bills. What you're trading away is the backstop. There's no state solvency requirement, no guaranty fund if the organization fails, and no insurance commissioner to take a grievance to. Most have internal appeals, but those aren't enforceable under state or federal law. There are often caps on sharing, and because these plans aren't bound by ACA rules, exclusions can be significant — pre-existing conditions especially.

None of that makes it a bad choice. It's worked well for plenty of people, including my own family. But it's a different kind of promise than insurance, and you should know which one you're buying.

The cheapest path into any of this is through an employer paying part of your premium. Without that, you're looking at a monthly cost that scales steeply with age unless you qualify for subsidies. It's still cheaper than a Silver or Gold plan — but it isn't cheap, and against that backdrop, adding DPC starts to look like one more expense. So let's look at what you're actually getting for your money right now.

Where Your Money Goes Without DPC

You get one free preventive visit a year. But as many people are discovering, you can't really ask questions about health concerns at that visit without triggering an additional charge. This is not your doctor pulling a fast one. The ACA requires preventive services be covered without cost-sharing — but anything diagnostic or problem-oriented is a separately billable service, subject to whatever cost-sharing your plan carries. So a question that turns into an evaluation becomes its own charge.

That plays out in real numbers. Labs: $50 to $150. A strep test: $30 to $70. An X-ray: $100 to $300. And it applies at any visit, not just the physical — you're in for a sick visit because you think you have a UTI, paying $150 for that, then mention a sore throat, get a strep test, and there's another $30 to $70. On a Silver or Gold plan you might not notice. On a Bronze plan you absolutely will. Even a lower-cost telehealth visit can generate a bill of $40 to $90.

And Then There's the Time

At my old job, phone calls were scheduled for 10 minutes and office visits for 20. Ten of those 20 minutes went to rooming you — a nurse taking vitals, getting you ready — so actual face time with your physician came out to about five to seven minutes. And your doctor is running late, because inevitably someone earlier on the schedule needed more than five minutes. And they're tired, because they've been doing this twenty times a day, four days a week.

That's assuming you got in at all. The average wait for a new-patient appointment across major metro areas is now 31 days — up 19% since 2022 and 48% since 2004. Disappointing patients by not addressing their concerns — because the system won't let you do that and eat lunch — wears on a person.

What It's Doing to Your Doctor

Now consider the administrative load underneath all of that. Your doctor is answering your emails, and everyone else's — patient messages are up 153% over the past five years. Documentation is worse. One study of 307 primary care physicians found they spent a median of 36.2 minutes in the electronic record per visit — for visits scheduled at 30 minutes. That included 6.2 minutes of after-hours work and 7.8 minutes on the inbox, per visit. Broader research puts total daily EHR burden near six hours.

And here's the figure that explains all of it. A 2022 study in the Journal of General Internal Medicine calculated what it would actually take to deliver all recommended care — preventive, chronic, and acute — to a typical panel of 2,500 patients. The answer was 26.7 hours a day.

There aren't 26.7 hours in a day. Which means the system is not asking physicians to work hard — it's asking them to do something arithmetically impossible, and then leaving them to feel personally responsible when they can't. There's a cute name for the time a doctor spends charting late at night after their kids are asleep: "pajama time." It sounds almost charming. It is not.

Nobody in the system is immune. And here's the result: the average age at which physicians now leave clinical practice is 48. Not retirement age. Forty-eight. When I was in the system, I was constantly meeting patients who'd had a doctor they loved — who had quit, or retired, or moved away.

That turnover isn't just sad. It's dangerous. A 2023 study in the Journal of Public Economics found that losing a trusted primary care physician increases emergency room visits, hospitalizations, and mortality. When your doctor burns out and leaves, it measurably affects your health.

What You Get Instead

Now set that against what the money buys in a DPC practice. My visits run 30, 60, or 90 minutes, which means nobody gets shown the door with one problem addressed and three unmentioned. Same-day and next-day appointments are the norm rather than the exception, so a problem gets handled while it's still small. And there are no copays — you're not doing arithmetic in your head about whether a symptom is worth the charge, which is exactly the calculation that turns a manageable problem into an expensive one.

Then there's something people underestimate until they've had it: you can just text me. Think about what that replaces. In the conventional system, when something comes up, you call a number and describe your symptoms to someone who is not clinically trained, working from a script, who has never met you. That person decides whether you get an appointment, whether you're told to go to urgent care, or whether you're sent to the emergency room. Triage — one of the most consequential decisions in medicine — is being made by someone with no clinical training and no knowledge of your history. When you text your own doctor instead, the person deciding what happens next is the person who knows your history, knows what's normal for you, and can often resolve it in three messages.

That difference has real financial consequences downstream. Somewhere between 13 and 27% of emergency department visits could be managed in a primary care setting instead — a gap estimated to cost the system billions annually. Every one of those visits is someone who couldn't reach a doctor, or didn't know they could. Chronic disease is the same story at a slower pace: diabetes, hypertension, and thyroid disease are managed well through consistent contact with someone who knows you, and managed badly through fifteen-minute visits twice a year. The complications are what cost money — and the complications are what continuity prevents.

So the framing of DPC as "an extra expense on top of insurance" has it backwards. The spending you're trying to avoid isn't the membership fee. It's the hospitalization that didn't have to happen.

Why Sustainability Matters

This is the part of DPC that I think gets undersold. Sustainability means that's less likely to happen to you. Those of us doing this aren't doing it halfway — we came back to the thing that gave us a charge in medicine in the first place: meaningful relationships, and the room to bring some creativity to our work. And when your family doctor, internist, or pediatrician actually leans into the full scope of what they were trained to do, something useful happens — you stop needing as many other doctors.

In the system, time constraints meant I referred people to dermatology for skin biopsies, to psychiatry for ADHD management, to gastroenterology for IBS — all things I'm trained to handle, and all things I've leaned back into now that I'm practicing real primary care again. On top of that, there's the part that gives my practice its particular flavor: a focus on midlife care, hormone optimization, and a genuine willingness to learn about and explore functional approaches and peptide therapy. Care for perimenopause and menopause delivered in primary care, which is exactly where it belongs. And gender-affirming care, without judgment.

So Here's Where I Land

You still need coverage for a catastrophic event. I'm not going to pretend otherwise — see my last video on this. Talk to a broker, or talk to a health share advisor. Need to find one? Text me and I'll share some information. And if you're in Colorado and looking to break out of a healthcare system that keeps getting more restrictive and pulling you further from anything resembling authentic wellness — get in touch, and let's talk about DPC.

Still on the fence? I'll wait.

My patients know I'm not going anywhere. :)

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