What most physicians get wrong about direct primary care, with Josh Umbehr, M.D.

Direct primary care has been around long enough that most physicians know the pitch: drop the billing, charge a monthly membership, keep a smaller panel and spend real time with patients. What takes longer to answer is whether the economics hold up once you're in it.

Josh Umbehr, M.D., co-founder of Atlas MD in Wichita, Kansas, moved into DPC straight out of residency in 2010 and has spent the years since helping other physicians make the same jump. He sat down with Medical Economics Associate Editor Austin Littrell to walk through the real math of a DPC practice, what happens when a patient needs a specialist and why he thinks the window for insurance-based primary care is closing fast.

Don't miss our recent episodes on site-of-service pricing, practice valuation, concierge medicine and physician compensation.

Music Credits:
Distant Memories by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:22 | Cold open Umbehr on putting the hospitality back in health care, and spending more on waiting-room coffee than on EKGs.

0:22 – 1:44 | Introduction Austin Littrell introduces the episode and Josh Umbehr, M.D., co-founder of Atlas MD.

1:44 – 3:40 | How Umbehr found direct primary care Billing and coding for a plastic surgeon in undergrad, a father whose simple trash-hauling business shaped how he saw the work, and a decade watching the early insurance-free and concierge movements before going all in.

3:40 – 6:38 | The basic math of a DPC practice Why it is simpler than physicians expect: roughly 600 patients at $50 a month across 12 months, 20% to 25% overhead, one staff member for every one to two physicians, and most of the revenue landing as income.

6:38 – 8:11 | Panel size, and why bigger isn't the goal Concierge's 200-patient panels were built for high fees; the DPC math rewards a fair price across a larger panel, right-sized to what one physician can handle in a day.

8:11 – 11:18 | Setting prices and the good-better-best tradeoff Pricing against what hospitals earn per physician, how a partner can nearly halve overhead, and why the clinics that push prices highest often struggle to grow while the affordable ones fill up.

11:18 – 13:50 | What low overhead actually looks like The shoestring-and-stethoscope start, an EKG and vitals machine over a billing department, and 700 to 1,000 square feet with one room and one staff member once a practice is full.

13:50 – 17:38 | Specialists, imaging and hospitalizations Keeping patients out of the system when possible, $30 doctor-to-doctor dermatology consults in a day or two, cash-pay imaging scheduled same day, and how paying cash can make a patient a better customer.

17:38 – 18:47 | P2 Management Minute Keith Reynolds shares practice management tactics and invites listeners to submit their own workflow ideas.

18:47 – 22:31 | The honest timeline and runway to convert Best case, a converting practice recruits 200 to 300 patients before the switch; 40 to 50 new patients a month means full and profitable within a year, while 10 to 20 a month stretches the ramp past two years.

22:31 – 26:38 | What AI changes about primary care AI as a tool that decreases the work of work, open-evidence lookups cutting referral volume, and why offloading documentation frees physicians for the parts of care that build trust.

26:38 – 29:42 | The biggest misconceptions physicians have The fear that DPC demands business genius or means abandoning lower-income patients, the pill-mill stigma around cash pay, and Umbehr's case that a physician's duty to do no harm should extend to doing no financial harm.

29:42 – 32:34 | How patient relationships change in DPC With no seven-minute visit and no staff buffer, hour-long conversations backed by calls, texts and emails, and why transparency turns a patient's default distrust into trust.

32:34 – 34:18 | Where DPC is headed, and 'peak insurance' Umbehr's prediction that insurance-free primary care becomes the default within three to five years, the 2026 rise in patients dropping coverage mid-cycle, and why he thinks the break comes fast.

34:18 – 36:54 | Closing thoughts and outro Umbehr on how much room is left to innovate, from hospital-at-home to physician-run outpatient care, and why he expects more change in the next five to 10 years than the last 20 or 30. Littrell wraps the episode.