\n<\/p>\n
A half-decade ago, my primary care doctor left the practice where he had worked for several years and opened his own concierge medicine business. A few years later, I ran into him, and he said he had made a great decision. He seemed to be loving his new job and loving his new life. Each doctor in his practice cares for only 50 families, and patients are allowed multi-hour visits and direct access to the physician\u2019s personal cell phone.<\/p>\n
A few months ago, my latest PCP made the same decision. Within a few weeks of sending out letters to her patients announcing she was starting a direct primary care practice, she announced she had filled her census and that she had started a waiting list.<\/p>\n
This is not new news. It seems like a couple of times a year, somebody on my Facebook feed is giving up their employee status at their physician job and opening and\/or joining a direct primary care practice. And why is that? As my former PCP (the latest one to leave, not the first one) wrote in a letter announcing the change,<\/p>\n
\n\u201cUnfortunately, the current state of healthcare does not provide doctors enough time. We need time to provide the high quality, individualized care every person deserves. Demands from insurances and regulatory agencies have eroded the access to physicians and interaction between patients and their doctor. To regain control from these outside forces, I am transitioning my practice to a membership medicine model. This new model will help us invest more in our precious patient-physician relationship<\/em>. I will have more time to be directly involved in every level of your care and help to empower you to achieve wellness. We will have more time for consultation, education, and follow up support, which is vital to rendering excellent medical care.\u201d<\/p>\n<\/blockquote>\n
For the physician, the idea of having more control over their practice, keeping burnout at bay, and potentially earning more money has to feel like salvation, especially if they\u2019re beginning to hate their employee job.<\/p>\n
But is transitioning from working for somebody else or some other medical system to working for yourself (and for your smaller patient population) truly the right move for a doc? Will the relationships to your patients improve? Can you stay sane even after you\u2019ve given out your private cell number to 100+ patients?<\/p>\n
Will you be loving your new job and loving your new life?<\/p>\n
The Benefits and Pitfalls of Being a Direct Primary Care Doctor<\/h2>\n
Dr. Patrick Mullen, a family and obesity medicine physician in Florida, discussed all of it in his WCICON26 presentation, Debunking the Myths of Concierge and Direct Primary Care: A Real-World Perspective (which you can watch in its entirety in our Continuing Financial Education 2026 course<\/a>). Though Mullen initially believed he would be an academic physician forever, he received an offer from one of his best friends to join the medical office that doctor was starting. Mullen and his wife, who was seven months pregnant, quit their jobs and moved on to a new adventure in the land of concierge medicine.<\/p>\n
When he announced to his colleagues that he was joining a DPC practice<\/a>, he said some people told him, \u201cI didn\u2019t know you were into that<\/em> type of medicine,\u201d while others ignored him and didn\u2019t talk to him for months. Despite the idea that more doctors are moving more into the DPC\/concierge medicine setup, many others aren\u2019t happy about those trends.<\/p>\n
In his presentation, Mullen laid out some of the myths of DPC\/concierge medicine and if he believes they’re true. A quick note: I know differences exist between concierge medicine and direct primary care, but for this column, I’m interchangably using those terms.<\/p>\n
#1 You’re Going to Get Paid So Much Money<\/h3>\n
It\u2019s certainly true that DPC physicians can earn extra money, but the risks of owning your practice are also much higher. Mullen said that people don\u2019t necessarily consider the startup business risk, the fixed costs (fewer patients doesn\u2019t mean less overhead), the marketing that is required for acquiring patients, the risk of patient churn, and the lack of employee safety net.<\/p>\n
But the math is tempting. As Dr. Josh Umbehr, a family physician who opened his DPC practice<\/a> in 2010, explained in this Medical Economics<\/a> piece:<\/p>\n
\n\u201cThe arithmetic [Umbehr] lays out for prospective DPC physicians is straightforward: 600 patients paying $50 a month over 12 months comes to $360,000. With overhead running 20%-25%, one staff member per 1-2 physicians, and one or two exam rooms, the doctor keeps the vast majority as salary. \u2018Add on another 100 patients or change your prices by $10, that’s another $60,000, $70,000 right there,\u2019 [Umbehr] said. \u2018The math works so well that you don’t have to even charge a lot to be a very successful physician in this space.\u2019<\/p>\n
His own panel sits around 700 patients\u2014a deliberate departure from the 200-400 patients concierge medicine popularized in the model’s early days. Those practices, he said, often struggled to grow because their price points were unaffordable to all but a sliver of patients. Lowering the fee, he reasoned, meant more patients could be covered while still right-sizing the workload to what one physician can handle in a day.\u201d<\/p>\n<\/blockquote>\n
Of course, you still need to actually find those patients to make that money.<\/p>\n
As one anonymous poster who had just become a DPC doctor wrote on the WCI Facebook page<\/a> in 2024:<\/p>\n
\n\u201cCurrently things are slow,\u201d they wrote. \u201cAlmost all inquiries are from patients who want to use insurance. I did get a few cash-paying patients but not enough to even cover the overhead. Practice has been up and running for about two months now.\u201d<\/p>\n<\/blockquote>\n
Just like your portfolio, trying to make major money comes with major risks<\/a>.<\/p>\n
More information here:<\/b><\/p>\n
#2 It Fixes Physician Burnout<\/h3>\n
After Mullen told his colleagues about his DPC plans, one of them told him how wonderful it would be not to have to deal with RVUs, prior authorizations, and coding audits. All the insurance headaches, they assumed, would disappear.<\/p>\n
\u201cUnfortunately, they\u2019re replaced by some of your business pressures and the emotional loads,\u201d said Mullen, whose practice still takes some insurance cases. \u201cYou\u2019re increasing sometimes that business load.\u201d<\/p>\n
Concierge medicine also doesn\u2019t allow for shift-type medicine. You\u2019re not clocking in or clocking out. You\u2019re not working seven days on, seven days off. If you\u2019re giving somebody 24\/7\/365 access, it\u2019s difficult to go on vacation and not be bothered by somebody wanting answers. You\u2019re not giving up your email inbox burden. You\u2019re trading that for more relationship burden. Patients expect same-day answers, Mullen said, meaning you have to manage patient expectations before they become your patients so you can still have a life. If not, your cell phone might become your mortal enemy.<\/p>\n
\n\u201cThis is more CrossFit style medicine,\u201d he said. \u201cYou have to work hard all the time [and get] as many reps as possible.\u201d<\/p>\n<\/blockquote>\n