Burnout in medicine has been a hot topic in recent years, with rates peaking during the COVID-19 pandemic.
While depression and burnout among doctors eased slightly in 2024, according to a Medscape survey, career dissatisfaction remains a significant issue. Family medicine and primary care physicians have higher burnout rates than their peers in many other specialties, the American Academy of Family Physicians found.
Challenges that are especially prevalent in primary care include overwhelming patient numbers, dealing with insurance, endless paperwork, difficulty finding work-life balance, and lower pay compared to other specialties. The U.S. primary care physician shortage is expected to grow in the coming years, and aspiring physicians may wonder if becoming a doctor is the right path for those committed to hands-on patient care.
How can we incentivize physicians to join primary care, and to stay? One answer may lie in the direct primary care practice model. Med students may plan for a more patient-focused practice by taking an early interest in direct primary care and prioritizing clinical rotations and mentoring in the area.
What Is Direct Primary Care?
Most primary care in the U.S. is provided by doctors whose office or group contracts with an insurance provider. The insurance provider sets the rate at which the physician gets paid for an office visit. Often, this rate is very low, so in order for a group to make money, they have to see lots of patients.
Most doctors see around 20 patients a day, and on top of that they must take phone calls, answer emails, talk to insurance companies and — perhaps most time consuming of all — document their patient encounters. This leaves very little time to spend with the patient — about 18 minutes on average.
[READ: The Hidden Crisis in Primary Care Medicine]
Without a doubt, the doctor will be rushed to get everything in during this visit, and the patient may also feel rushed and that their concerns are not being fully addressed.
By contrast, in the direct primary care or concierge medicine model, the doctor typically takes out the middle player — insurance companies — and the patient instead pays a set fee or subscription. While direct primary care and concierge medicine differ slightly, the principle is the same: they remove the constraints imposed by insurance companies.
Pros and Cons of Direct Primary Care
Instead of relying on low reimbursement rates from insurance, doctors in direct primary care offices can set a fee schedule that provides ample compensation with many fewer patients.
The average panel size — that is, the total number of patients a doctor has — is much lower in direct primary care: usually around 400, compared with upwards of 2,000 patients in traditional practices, according to the American Association for Physician Leadership.
Seeing fewer patients, usually around 10 per day, a doctor in direct primary care can spend more time with each patient, addressing all of their concerns and providing comprehensive preventive care.
[Read: Why It’s Still Hard to Get Into Medical School Despite a Doctor Shortage]
Direct primary care patients also benefit by not only having more time with their doctor, but they get greater access — meaning that instead of possibly waiting months to see their physician, they can often get a same-day appointment.
In addition, without insurance billing, doctors carry a lower paperwork burden in direct primary care, leaving more time for patients and a better work-life balance.
One criticism of direct primary care is that it can limit access to care for people that cannot afford the monthly fees. However, most direct primary care clinics offer a range of payment options, and some companies will cover direct primary care fees for their employees.
Many direct primary care doctors also take on pro bono patients in an effort to improve access to care. Finally, with fewer administrative demands, DPC doctors will often volunteer their time working in free clinics or participating in other community medical events.
Do Doctors Like Direct Primary Care?
Yes — according to a 2024 AAFP study, 94% of doctors working in direct primary care said they were satisfied with their practice, compared with only 57% of those in non-DPC offices.
The same study found 98% of doctors felt that the quality of care they provide to their patients improved with working in direct primary care, and that direct primary care providers experience much less burnout than their counterparts in non-DPC practices. Not only are patients getting excellent care, but their doctors are happier.
[Read: How to Become a Doctor: A Step-by-Step Guide]
Prepare for Direct Primary Care During Med School
Primary care is an amazing area of medicine. Doctors provide care day to day, preventing illness and treating chronic disease, while forming relationships with patients that can last a lifetime. If you’re interested in primary care, it’s important to not let the statistics on burnout and income deter you.
To prepare for a direct primary care career while in medical school, look for opportunities to shadow DPC doctors, and seek out faculty members who are involved in direct primary care. Oftentimes, medical schools have teaching physicians who also work in private practice — allowing students to complete rotations at their clinics.
Organizations like DPC Alliance can help arrange rotations for students to work “alongside seasoned DPC physicians in real-world settings, observing and participating in patient care … helping you understand the day-to-day operations and patient interactions unique to the DPC model,” according to its website.
You may also consider using the DPC Frontier website, which offers resources including information on starting a direct primary care practice, career opportunities and discussion forums, or attending the annual DPC Summit, which offers discounted registration for med students.
Once you have completed medical school and your residency in family medicine or internal medicine, you can further explore direct primary care and concierge medicine. There are options for doctors to join existing practices or start a practice in their community.
Doctors should be happy in their practice and confident in the care that they provide to patients. Direct primary care is an excellent way to achieve both.
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How To Plan for a Career in Direct Primary Care originally appeared on usnews.com
