Is Direct Primary Care Contributing to the Primary Care Shortage?

Is direct primary care contributing to the primary care shortage? This criticism can certainly give doctors pause, especially those considering opening a DPC practice.

As physicians, we’re no strangers to scrutiny. I’ve personally encountered criticism from peers throughout my medical career. For instance, in medical school, classmates accused us of “taking the easy way out” when 20 of us opted for community-based clinical rotations at a satellite campus instead of traditional academic ones. They perceived our experience as “easier” despite us acquiring the same knowledge and skills. When I was finishing residency, I was criticized for taking a newborn hospitalist job instead of going into general pediatrics. And when I opened my pediatric DPC practice in 2018, I faced condemnation from colleagues in the form of public criticism and withholding referrals. 

Other physicians face scrutiny from colleagues as well. More recently, I witnessed a doctor in a physician-only Facebook group condemn specific physicians for using social media for public medical education. He even went as far as posting screenshots of their faces and calling them “annoying” for maintaining a presence on social media.

These instances highlight a recurring theme: physicians are often quick to criticize each other, especially when someone veers from conventional paths.

DPC is Not for Everyone

Direct primary care brought me much joy in practicing medicine as a pediatrician. It has also improved my own health as a patient of a DPC practice for the last 7 years.  However,  I acknowledge that it is not for everyone. Not every doctor wants their patients to have direct access to them and not every patient wants to pay out of pocket for medical care. 

Venturing outside of the box as a physician invites criticism. In my opinion, the perception of direct primary care “contributing to the primary care shortage” is often another form of this criticism. It is frequently leveled by those who have no desire or are not brave enough to forge a new path in medicine. 

In this article, we will look at how to better quantify this statement and understand how direct primary care fits into the overall picture of medical care in this country. 

Quantifying The Primary Care Shortage

According to the Health Resources and Services Administration (HRSA) state of the primary care workforce report:

• In 2022, there were 279,194 primary care physicians in the U.S. In 2022, there were an estimated 270,660 NPs delivering primary care. In 2023, 28,282 PAs worked in primary care. 

• There is a projected shortage of 87,150 full-time equivalent (FTE) primary care physicians by 2037, which will be particularly acute in nonmetro areas. 

• Burnout has increased in many healthcare occupations, but especially among primary care physicians. More than half reported feeling burnout in 2022.

It is understandable to see why people would think that DPC was contributing to the primary care shortage. Patient panels in direct primary care range anywhere from 100-500 (or more depending on the practice) patients per physician. In the traditional insurance based system, PCPs maintain panels of 1500 or more patients. This is a large difference in volume that we must acknowledge. 

Defining Direct Primary Care 

Direct Primary Care (DPC) is a healthcare model where patients contract directly with their doctor, typically through a recurring membership fee. Often paid monthly, this fee gives patients direct access to their physician for appointments, as well as communication via text, phone, or email between visits. The goal is to provide patients with predictable healthcare costs while ensuring doctors have a stable income that covers the time needed for comprehensive patient care.

Because DPC emphasizes direct, often more intensive, patient-physician interactions, doctors in this model generally manage smaller patient panels. This closer relationship, free from the administrative layers of traditional insurance-based systems, allows for more personalized care. However, it also means that a single DPC physician can care for a limited volume of patients compared to those in conventional practices.

DPC Keeps Doctors in Practice

While direct primary care doctors see less patients on average than physicians in the traditional system, one could say that it actually saves doctors from quitting medicine altogether. This was my story. After being burned out by the system, I started my pediatric DPC in 2018 so that I could love practicing medicine again. And I am not alone. I have spoken with many other doctors who have told me something similar. Many say that they would have quit medicine without the ability to start their own direct primary care practice. 

Even though this is hard to quantify and is based almost exclusively on anecdotes, it is something to take into consideration. Reasons why people make certain decisions are often complicated and not perfectly straightforward. Same goes for doctors who choose direct primary care. There are many reasons why it is difficult to quantify whether dpc was solely responsible for saving someone’s medical career.

• Lack of direct causality: It’s difficult to isolate DPC as the only reason a physician stays in medicine. Other factors like personal circumstances, financial situations, and alternative career opportunities also play a role.
• Self-reported data limitations: Even if surveys asked physicians directly, their responses about hypothetical scenarios (“would you have quit?”) can be subjective and difficult to verify.
• Small percentage of DPC physicians: DPC still represents a relatively small segment of the overall primary care workforce. Small numbers make things difficult to quantify. Even though DPC can have a tremendous effect on an individual physician’s career path, it may not dramatically change the overall stats of primary care physician retention on a larger scale.

DPC Answers the Symptom 

In my opinion, DPC isn’t a primary cause of the primary care shortage. Its inception and growing popularity is a symptom of deeper systemic flaws in traditional healthcare. Issues like unsustainable payment models, excessive administrative tasks, reduced physician autonomy, and impersonal patient care drive doctors and patients toward DPC as an alternative. 

These underlying problems create an environment where many physicians experience burnout and dissatisfaction. Many physicians find themselves seeking an alternative model vs leaving medicine altogether. 

In addition, patients feel the pain of the system that prioritizes volume over value and access. As a patient with a chronic illness myself, I can tell you that the system is lacking. Consequently, DPC emerges as a compelling solution for both physicians seeking to reclaim professional fulfillment and patients desiring more personalized, accessible, and affordable care outside the constraints of insurance-driven models.

DPC is Small but Mighty 

Despite DPC’s growth, it remains a small fraction of primary care. Few physicians practice in DPC compared to the national total. It has not caused a mass exodus from traditional practices. Many primary care physicians still practice within the traditional medical system. 

According to the DPC mapper, there are more than 2500 DPC practices across the country. This mapper is a self reporting mechanism where practices can put their information to be discovered by potential patients. Therefore, it has limitations, but it gives us an idea of how many practices there are. For pediatrics specifically, DPC Pediatrician maintains a mapper where pediatricians can self-report their pediatric DPC practice locations. 

Even though the movement is growing, DPC’s limited and niche appeal does not seem to be contributing to a significant decrease in primary care physicians in the traditional medical system.

Enhance Physician Satisfaction and Retention

Paradoxically, DPC may ease the primary care shortage by boosting physician satisfaction and retention. As we have looked at earlier, many doctors face burnout in traditional models due to heavy workloads and administrative burdens. Direct primary care with its smaller patient panels, longer appointments, and focus on relationships can significantly reduce these stressors. While owning your own practice is by no means easier than being employed in the system, the model itself brings us back to the way medicine used to be. Many physicians find this way of practicing more fulfilling. They are able to focus on their relationship with patients and their medical care rather than navigating a system that is more focused on profits. 

This more sustainable and fulfilling environment potentially encourages experienced physicians to stay in primary care longer and even attract those considering leaving. Indirectly, this combats the shortage by keeping primary care physicians in the workforce.

Primary Care Shortage: No Simple Answer

The question of whether DPC contributes to the primary care shortage isn’t a simple “yes” or “no.” It’s clear that DPC isn’t the root cause of the shortage. Rather, its rise puts a spotlight on the problems within traditional healthcare that drive both doctors and patients to seek alternatives. DPC offers a model that prioritizes physician autonomy, predictable costs, and personalized patient care which is a vital solution for doctors and patients alike.

While DPC practices naturally care for smaller patient panels due to their high-touch approach, this doesn’t inherently worsen the broader shortage. Instead, it highlights the need for innovative solutions across the entire healthcare landscape to address the underlying challenges that lead to physician burnout and patient dissatisfaction. Ultimately, DPC stands as a testament to the enduring desire for a healthcare system that truly serves both those who provide care and those who receive it.