Many of us turned to Direct Primary Care (DPC) to escape the rat wheel of insurance-based medicine—the rushed visits, the administrative overload, and the emotional exhaustion of trying to deliver high-quality care in a system that undervalues it. Yet, in our well-intentioned efforts to offer accessible care and grow our practices, there’s a danger that we may unknowingly recreate the very grind we sought to escape.
In the insurance-based primary care world, physicians are often forced to cram 20–30 (or more) patients into a single day just to stay financially afloat. This is not a reflection of inefficiency or poor time management—it’s a reflection of a broken system that devalues primary care. While specialists are often able to focus on one organ system or a narrow set of problems, primary care physicians are expected to manage the entire human being—every system, every concern, every nuance of their patients’ lives. And yet, our time is typically reimbursed at the lowest rate on the healthcare hierarchy.
This structural devaluation pushes insurance-based PCPs into survival mode, sacrificing depth for volume and compassion for speed. That’s what we fled when we stepped into the DPC model. But if we’re not careful, we can fall into a parallel trap of our own making.
When Low Fees Lead to High Volume
In DPC, we have the freedom to set our own prices. But some physicians, often out of a deep desire to serve their communities or fear of not being “affordable,” underprice their services. The consequence? They must increase their patient panels beyond a sustainable level. As volume grows, time shrinks—and with it, the quality of care, the depth of connection, and the joy of practicing medicine.
This isn’t just a financial miscalculation; it’s a threat to the very soul of the DPC model.
Know Your Worth—and Design for Sustainability
The reality is, high-quality primary care is intellectually demanding, emotionally taxing, and fundamentally vital. Our time and expertise deserve to be valued accordingly—not just by others, but by ourselves.
To avoid rebuilding the rat wheel, consider the following:
- Run the Numbers Honestly: Calculate how many patients you can reasonably see per day and per week while maintaining the kind of care you want to provide. Back-calculate from your income goals, overhead, and ideal panel size to determine what your monthly membership fee needs to be.
Example: Dr. A is still raising a young family and would like to work 4 clinical days per week, plus one half day devoted to administrative tasks. She would like to work mostly during the hours her children are in school which equates to about 6 hours per day. This means she can see patients for about 24 hours per week. She has estimated that she can handle a patient load of 250 patients at an average membership fee of $100 per member per month. This means that she would be bringing in $300,000 in revenue yearly, with approximately one third going toward overhead costs (such as rent, malpractice, supplies, and a part-time assistant). She would therefore be making a gross income $200,000 per year – minus 30% in taxes, that would be about $140,000 per year in take-home income. Given the flexibility she would enjoy with her new schedule, she decides she would be content with that income level.
Dr. B, however, is her family’s primary breadwinner and needs to earn more in order to make ends meet with her household expenses and student loans. She calculates she needs to bring in about $400,000 yearly, which would bring her take-home income to about $196,000 yearly.
- Price for Value, Not Just Access: Patients aren’t just paying for time—they’re paying for trust, continuity, access, peace of mind, and specialized expertise in some cases. That has immense value. Don’t be afraid to charge accordingly.
Example: Dr. C initially priced her memberships at $50 per member per month in an effort to be as accessible as possible to families in her community. Her practice grew quickly, but within six months, she noticed a concerning trend—many of her patients didn’t fully utilize the services she offered, and some even missed appointments or failed to follow through on recommendations. She realized that her patients weren’t clearly connecting the dots between the low monthly fee and the premium-level care they were receiving.
After surveying a few of her most engaged patients, Dr. C learned that what they valued most wasn’t just the ability to schedule longer visits—it was the peace of mind that came from knowing they could text her directly with urgent concerns and get a thoughtful, informed response quickly. They appreciated the relationship-based care, proactive support, and low-stress environment, all of which were impossible to replicate in a traditional practice.
Dr. C increased her membership fee to $85 per month and began emphasizing these intangible but critical benefits in all her patient communication—from her website to her onboarding process. Rather than losing members, she attracted new ones who deeply valued what she was offering and were more likely to engage respectfully and consistently in their care.
- Design for Margin, Not Just Survival: A sustainable DPC practice should create enough margin for professional development, administrative time, creative pursuits, and—crucially—rest. Without this, we return to burnout in a different outfit.
Dr. D followed the advice of many DPC doctors online and initially calculated that at an average membership fee of $75 per member per month and 300 members, she would be bringing in $270,000. Given what she’d heard about starting lean and minimizing overhead costs, she estimated that overhead would only cost about $4,000 per month, or $48,000 yearly, leaving $222,000 of yearly gross profits (and take-home income of about $155,000). However, opening her practice and beginning to grow, she realized that many of her patients were coming to her with questions about behavioral and developmental conditions that she didn’t feel adequately prepared to address. She discovered an online pediatric functional psychiatry fellowship that she felt would benefit her and her patients immensely. There were also one or two conferences a year that she felt would benefit her. The cost of these educational opportunities collectively would amount to approximately $20,000 per year, which she hadn’t budgeted for initially. She calculated she would need to increase her per-member-per-month cost by only $5.50 on average to cover these expenses. She decided to increase her fees by an average of $10 instead in order to create more cushion for these types of expenses in the future.
- Communicate Transparently with Patients: When you charge what you’re worth, patients are more likely to understand and respect your boundaries. Educating your patients on what they’re receiving—more time, more access, more thoughtful care—helps align expectations and value perception.
When Dr. E announced her first price increase after 18 months in practice, she was nervous about patient backlash. She had started at $65/month but realized that in order to maintain reasonable visit volumes and take on one additional staff member to handle growing administrative needs, she would need to raise prices to $85/month.
Instead of sending out a terse email or implementing the change quietly, she chose to be proactive and transparent. She drafted a thoughtful message to her patients explaining that the increase was not just due to inflation, but a reflection of her desire to maintain the quality of care, personal attention, and fast response times they had come to rely on. She included a breakdown of how the funds would support continued services, including same-day visits, personalized wellness plans, and extended appointment availability.
To her surprise, not only did the majority of her patients stay, but several emailed back expressing their gratitude for the clarity and openness. Some even mentioned they had expected to pay more given how often they used her services and how meaningful the relationship had become. By clearly communicating the why behind her pricing, Dr. E built trust and strengthened her patient relationships—even during a fee change.
Reclaim the Dignity of Primary Care
We didn’t become DPC doctors just to swap one grind for another. We chose this path to practice medicine the way it was meant to be practiced—with time, presence, and purpose.
So let’s not underprice ourselves, overburden our schedules, and rebuild the rat wheel we worked so hard to escape. Instead, let’s build practices rooted in respect—for our patients, yes—but also for ourselves.
Because when we value our time, we teach others to value it too. And that’s the foundation of a truly sustainable DPC practice.
