What's holding direct primary care back, with Kenneth Qiu, M.D.

A third of the single-physician direct primary care practices in a national survey have no staff at all, according to Kenneth Qiu, M.D., the survey's lead author.

Medical Economics Senior Editor Richard Payerchin sat down with Qiu, a family physician and founder of EuDoc in the Richmond, Virginia, area.

Qiu describes what changes as a practice grows: compliance and paperwork obligations that kick in at certain employee counts, more documentation and tracking, and greater cybersecurity demands. He says many practices stop growing around five physicians rather than hire legal, compliance, accounting and bookkeeping help.

He also covers how new practices build a patient panel, how pricing varies by region and the Medicare billing rule that affects practices whose physicians moonlight.

Don't miss our recent episodes on unanswered patient calls, defamatory online reviews, patient access to medications and value-based care.

Music Credits:

Midnight Serenade by MORRIX Holyhold - 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 – 0:32 | Cold open Qiu on how his model differs from concierge medicine.

0:32 – 1:23 | Introduction Austin Littrell introduces the episode and the guest.

1:23 – 2:55 | Meet Kenneth Qiu, M.D. Qiu describes opening his practice straight out of residency and first learning about the model as a fourth-year medical student.

2:55 – 4:48 | Why the alliance ran the survey Figures on pricing and panel size had circulated by word of mouth with no hard data behind them.

4:48 – 6:57 | Reaching physicians outside organized medicine How the committee pushed the survey through every network it could find.

6:57 – 10:07 | What the survey found Practices in 49 states, average pricing near $98, full panels of roughly 400 to 700 patients and a large share of solo practices.

10:07 – 12:02 | How many practices are out there Qiu explains where the estimate of about 3,600 practices nationwide comes from.

12:02 – 15:46 | Will your patients follow you? Building a panel, moonlighting while a practice grows and the Medicare billing rule that slows new practices.

15:46 – 18:46 | Removing barriers Repealing certificate-of-need laws and letting patients apply cash prices toward their deductibles.

18:46 – 19:39 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

19:39 – 22:10 | Not concierge medicine Why Qiu says criticism aimed at concierge practices doesn't fit his model.

22:10 – 25:12 | Wearing every hat The business demands of a solo practice and why growth often stalls around five physicians.

25:12 – 27:57 | Primary care's image problem How academic medicine looks down on family medicine and how the alliance reaches students and residents.

27:57 – 30:42 | The next generation Qiu credits the survey's collaborators and explains why physicians starting out of residency may push the model further.

30:42 – End | Closing thoughts and outro Payerchin thanks Qiu, and Littrell wraps the episode.