Concierge and direct primary care practices surge nationwide

The landscape of American medicine is undergoing a fundamental shift as physicians increasingly move toward alternative practice models to reclaim their autonomy. According to a study published in Health Affairs, the number of concierge and direct primary care (DPC) practice sites in the U.S. surged by 83.1% between 2018 and 2023. During this same period, the number of clinicians participating in these models grew by 78.4%.

This growth comes as independent physicians face an unlevel playing field characterized by flat reimbursements, escalating administrative demands, and the growing dominance of large hospital systems.

Understanding the differences between concierge and DPC

While often grouped together, concierge and DPC models have distinct financial structures. As outlined in the Health Affairs study, concierge practices typically charge an annual retainer fee while continuing to bill insurance for visits and procedures. Approximately 60% of clinicians in the study sample billed Medicare, suggesting they operate under a concierge or hybrid model.

In contrast, direct primary care practices operate entirely outside the insurance system, charging patients a monthly or annual fee for a predetermined set of services. This model allows physicians to opt out of the "prior authorization nightmares" and coding requirements that often drive burnout.

The surge in corporate ownership

Despite being originally viewed as a way to preserve independent ownership, the Health Affairs study found a 576% increase in corporate-affiliated practices. Conversely, independent ownership in these models declined from 84.0% to 59.7% as private equity firms and for-profit entities entered the space.

Medical experts in a recent Physicians Practice panel suggest this evolution is a response to the massive capital required to grow an operation today. To remain viable without selling to large systems, many physicians are joining management services organizations (MSOs), which provide an administrative backbone while allowing doctors to maintain clinical autonomy.

Workforce shifts and policy headwinds

The primary care workforce in these models is also changing. The share of physicians in these practices fell to 59.7%, while the proportion of advanced practice clinicians (APCs), such as nurse practitioners and physician assistants, rose to 40.3%.

Panelists from the Physicians Practice discussion noted that these transitions are fueled by several systemic challenges:

• Medicare payment cuts: Physicians face declining inflation-adjusted payments, including a nearly 3% cut to Medicare reimbursements at the start of 2025.
• Prior authorization burden: The average physician completes roughly 39 prior authorizations per week, a "huge time drain" that many seek to escape through DPC.
• Burnout: Physicians are increasingly dissatisfied with corporate health models and are seeking better work-life balance and deeper patient relationships.

Practical strategies for practice viability

For practices that remain within the traditional fee-for-service system, experts recommend maximizing revenue through chronic care management and remote telemonitoring. Others suggest adopting AI-assisted documentation to reduce "charting at home" and allow for more mindful patient interactions.

As Rebekah Bernard, M.D., noted during the panel, independence is not becoming extinct; rather, it is evolving into models that prioritize the physician-patient relationship over volume-based metrics.