By Andrew Hertz, MD | Co-Founder & President, Zest Pediatric Network
At Zest Pediatric Network, our mission is simple and urgent: Saving Pediatrics. Not just for the doctors who have dedicated their careers to children’s health — but also for the families who depend on them. This bold mission is why, for the second consecutive year, we led the National Direct Pediatric Care Survey — the only national survey of its type in existence. This year, 99 pediatricians across 30 states responded, representing an estimated 60%-70% of all pediatric DPC practices nationally. The results are simply extraordinary.
And yes — we call it Direct Pediatric Care. Not Direct Primary Care. Words matter. This model commands pediatric rates, pediatric respect, and a pediatric identity. The uniqueness of children, and the doctors who care for them, deserve it.
What Does a Direct Pediatric Care Practice Actually Look Like?
First, who is building this movement? The data is striking: 89% of Direct Pediatric Care physicians are women, and 83% are between the ages of 40 and 59. This is a movement being driven overwhelmingly by mid-career women — experienced, board-certified pediatricians who have seen what traditional practice looks like and chosen something better.
In Direct Pediatric Care, 48% of physicians have a goal panel of fewer than 200 patients. This is less than 10% of average fee-for-service panels. Seventy-three percent aim for under 250. This is intentionally small and fosters the deep, meaningful, impactful relationship core to the model.
Eighty-five percent of respondents provide home visits, often for newborns. This is unique to direct pediatric care.
Pediatrics is a specialty with unique training — and it shows. Sixty-four percent of respondents report that at least 10% of their panel consists of children with special healthcare needs or neurodivergence. These are pediatricians leveraging their specialty.
And here’s what that looks like at a full panel of 200–300 patients: physicians are working 31–40 hours per week, seeing fewer than 20–30 patients in the office per week, and — perhaps most surprisingly to those considering the leap — the after-hours burden is far lower than feared. 65% of all respondents answer 5 or fewer evening texts per week. 78% receive less than one evening phone call per week. 86% receive less than one call after 10 PM per month. Even among physicians with a full panel, those numbers barely shift. The “always on call” anxiety that keeps so many pediatricians from making the move? The data says it’s mostly a myth.
The Financial Reality: It Takes Time — But It Works
We won’t sugarcoat the early years. 89% of physicians in their first year report earning less than their prior job. However, the trajectory is clear and compelling: by years 3–4, 85% are earning the same or more than before. This includes income from side gigs that DPC’s flexibility makes possible.
Forty-two percent of Direct Pediatric Care physicians now have a side gig — up from just 23% before DPC. The change is statistically significant (p=.0005). DPC supports physicians who now have the time to pursue various professional interests.
Physician Satisfaction: The Numbers Are Stunning
Across all 7 measured satisfaction domains — including work-life balance, meaning and purpose, patient impact, and overall satisfaction — Direct Pediatric Care physicians showed statistically significant improvement compared to their prior job (Wilcoxon signed-rank, all p<0.0001). 96% are more or far more happy. 95% report less or far less moral injury. 85% would not return to fee-for-service medicine.
When asked what they love most about their practice, the top answer — by a wide margin — was relationships with patients and families (39% of all respondents). Followed by flexibility and schedule control (26%), time with patients (25%), and autonomy and freedom (22%).
These are physicians who intentionally chose a model that allows them to be the doctors they dream of in medical school.
What Families Are Experiencing
Zest’s own 2025 Member Satisfaction Survey tells the other side: 93% of families rate their membership as good or exceptional value. 86% report avoiding an unnecessary office visit. 70% avoided an urgent care visit. 38% avoided an emergency room visit. And the Net Promoter Score — a global benchmark of loyalty and enthusiasm — is 94. A world class rating. The data speaks for itself.
Zest Is Advocating for This Movement — Nationally
The 2025 National Direct Pediatric Care Survey results were not only presented at the Pediatric DPC Conference in Savannah, GA — they were also shared on a national stage when Andrew Hertz, MD represented the pediatric movement at the Hint Summit, bringing these findings to the broader DPC and employer community. Our 2024 survey data was published in the peer-reviewed journal Cureus and presented as a poster at the AAP National Conference. We are spreading the word of your incredible work.
Zest Pediatric Network is committed to sustaining this annual physician survey as the longitudinal backbone of the Direct Pediatric Care evidence base. And we’re taking the next step: working to coordinate a collaborative, consistent patient and family satisfaction survey across pediatric DPC practices nationally — so that the family story can be told with the same rigor and reach as the physician story. Stay tuned for more information.
Congratulations to everyone who participated in the survey. We are pediatricians. We are specialists. We are building something that has never existed before — a model designed for children and families.
Together, we are saving pediatrics.
_______The full presentation of results can be found HERE.
