The Case for Direct Primary Care: Compassion Over Complexity

In 2008, as a drug rep covering Pennsylvania, I had the privilege (and sometimes misfortune) of calling on hundreds of physicians. What I witnessed over two and a half years deeply shaped my perspective on the state of healthcare. Independent practices were being squeezed out, consumed by larger payor-provider conglomerates ("payvidors") that have continued to dominate the landscape. In fact, nearly 70% of U.S. physicians are now employed by hospitals, health systems, or corporate entities, such as private equity firms or health insurers(ThePCC). This consolidation has had significant consequences for patient care, driving many of these acquired practices to serve as feeders into expensive hospital services like labs, imaging, and procedures(Levin Associates). I would often walk into waiting rooms where physicians, particularly in rural areas, were on a treadmill, seeing patient after patient from 7 a.m. to 6 p.m. With this assembly-line approach, one had to wonder—what kind of care was really being delivered?

An Early Decision: Why I Didn't Become a Doctor

My healthcare journey started years before that as a pre-med student at California University of Pennsylvania. I remember the intense grind of Organic Chemistry I and II—an endurance test that ended with an A and a B, but also with tears (ya feel me?). Some of my classmates from those days became brilliant doctors—Dr. Olga Gonzalez, Dr. Carl Jay, Dr. Bobby Hogan, to name a few. I, however, veered off the path. One reason was a candid conversation I had with my doctor at the time, Dr. Lisa Chadwick. She didn't sugarcoat it: the business of practicing medicine, especially in family practice, was a struggle. Independent doctors faced towering medical school debt and constant battles with insurance reimbursement, leaving little room for what they had originally set out to do—care for people.

It was this conversation that ultimately led me away from practicing medicine myself, but it planted the seed for my career advocating for transparent, patient-centered healthcare. The challenges Dr. Chadwick described are precisely why so many physicians are now moving toward Direct Primary Care (DPC), a model designed to eliminate unnecessary complexity and restore compassionate care at its core.

The Flaws of Fee-for-Service

The current fee-for-service system exacerbates many of the problems I saw while in the field. Under this model, doctors are paid based on the volume of services provided rather than the value of care. This misaligned incentive structure drives up costs while often delivering inadequate care.

The issue isn’t just that patients receive inflated bills. The problem is that fee-for-service can lead to over-treatment for some, under-treatment for others and flat-out wrong treatment in far too many cases. Accountability is often lost in a sea of finger-pointing between doctors, hospitals, insurance companies, and pharmaceutical companies. And the people who suffer the most? The patients.

But there’s an alternative—one that is growing in popularity: Direct Primary Care.

The Rise of Direct Primary Care

Direct Primary Care eliminates the insurance middleman. It removes the administrative burdens that distract doctors from their patients and allows them to focus on what matters: delivering high-quality, compassionate care. By charging a monthly subscription fee, DPC practices provide affordable, unlimited access to primary care services without the barriers and complexities of insurance.

Practices like PeopleOneHealth, Dr. Kenneth Richter’s Scotland Family Practice, Dr. Theresa Burick’s Burick Center, Covenant MD, Core Family Practice with Drs. Haug and Yerkes are perfect examples of DPC done right. These physicians are reconnecting with their patients and delivering better care at a fraction of the cost. Danish Nagda of Rezilient is another practitioner making waves in the DPC space, particularly with his forward-thinking, technology-driven approach to care delivery. Danish is a part of every Level Health plan built by Adam Berkowitz, RHU and his team. There are even medical providers doing house calls just like they did in the old days, like Michael Cole with Tectonic.

The Numbers Don’t Lie

In a typical fee-for-service practice, doctors are responsible for 2,000 to 3,000 patients, leaving them with limited time to offer personalized care. In contrast, DPC doctors generally maintain patient panels of just 600 to 800 patients, allowing for longer appointments—often lasting up to 30 minutes, compared to the rushed 3-15 minutes seen in traditional models.

Additionally, DPC patients report 15-30% savings on healthcare costs compared to traditional fee-for-service models. This is because DPC eliminates the need for billing insurance companies and reduces unnecessary medical procedures and referrals. Physicians benefit too, reporting significantly lower levels of burnout and higher job satisfaction, largely due to the reduced administrative burden and deeper patient relationships.

The Future of Compassionate Care

Direct Primary Care is not just a model for delivering healthcare; it’s a return to the core values of medicine: compassion, trust, and patient-centered care. As a former drug rep, I witnessed firsthand how the current system often falls short. We need more models like DPC, where doctors can do what they were meant to do—care for their patients.

The visualization of DPC reminds me of a Norman Rockwell painting—think of a doctor coming to visit your home. It's that personal and intimate, with no rush, no stress, just care in its purest form.

Bringing DPC Into Employer-Sponsored Plans

For employers and plan sponsors looking to adopt DPC, the integration depends on your plan's structure. My good friend and Benefits Collective partner, Tom DiLiegro , breaks this down beautifully in his blog.

1. DPC and Fully Insured Plans: When you're fully insured, you're essentially buying a pre-packaged product from the insurance carrier. While the idea of sponsoring a DPC membership might seem like an added benefit, it's technically in violation of your carrier agreement because you're incentivizing employees to visit non-network physicians. Essentially, it’s a valiant effort but won't impact your plan in any meaningful way—like getting a Diet Coke with your Big Mac.

2. DPC and Carrier-Administered Self-Insured Plans: If you're self-insured but using one of the big five carriers for administration, you're in a better position for transparency, but you still face network restrictions. DPC may serve as a great value-add for employees, but without negotiating concessions with your carrier, you won’t see much in terms of cost savings or plan satisfaction improvements.

3. DPC and Unbundled Self-Insured Plans: This is where DPC shines. By "unbundling" your plan and working with administrators, reinsurance carriers, and benefits advisors who understand DPC, you can significantly bend the cost curve. When all these components align, you'll begin to see the true fruits of your investment in DPC.

A Pill This Drug Rep Can Swallow

The U.S. healthcare system has a long way to go, but DPC offers a glimmer of hope. It puts patients first, provides more affordable care, and restores the doctor-patient relationship to what it should be: a partnership based on trust and compassion—and that is a pill this former drug rep can swallow.