The Benefits and Pitfalls of Entering the World of Concierge Medicine/Direct Primary Care

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A half-decade ago, my primary care doctor left the practice where he had worked for several years and opened his own concierge medicine business. A few years later, I ran into him, and he said he had made a great decision. He seemed to be loving his new job and loving his new life. Each doctor in his practice cares for only 50 families, and patients are allowed multi-hour visits and direct access to the physician’s personal cell phone.

A few months ago, my latest PCP made the same decision. Within a few weeks of sending out letters to her patients announcing she was starting a direct primary care practice, she announced she had filled her census and that she had started a waiting list.

This is not new news. It seems like a couple of times a year, somebody on my Facebook feed is giving up their employee status at their physician job and opening and/or joining a direct primary care practice. And why is that? As my former PCP (the latest one to leave, not the first one) wrote in a letter announcing the change,

“Unfortunately, the current state of healthcare does not provide doctors enough time. We need time to provide the high quality, individualized care every person deserves. Demands from insurances and regulatory agencies have eroded the access to physicians and interaction between patients and their doctor. To regain control from these outside forces, I am transitioning my practice to a membership medicine model. This new model will help us invest more in our precious patient-physician relationship. I will have more time to be directly involved in every level of your care and help to empower you to achieve wellness. We will have more time for consultation, education, and follow up support, which is vital to rendering excellent medical care.”

For the physician, the idea of having more control over their practice, keeping burnout at bay, and potentially earning more money has to feel like salvation, especially if they’re beginning to hate their employee job.

But is transitioning from working for somebody else or some other medical system to working for yourself (and for your smaller patient population) truly the right move for a doc? Will the relationships to your patients improve? Can you stay sane even after you’ve given out your private cell number to 100+ patients?

Will you be loving your new job and loving your new life?

The Benefits and Pitfalls of Being a Direct Primary Care Doctor

Dr. Patrick Mullen, a family and obesity medicine physician in Florida, discussed all of it in his WCICON26 presentation, Debunking the Myths of Concierge and Direct Primary Care: A Real-World Perspective (which you can watch in its entirety in our Continuing Financial Education 2026 course). Though Mullen initially believed he would be an academic physician forever, he received an offer from one of his best friends to join the medical office that doctor was starting. Mullen and his wife, who was seven months pregnant, quit their jobs and moved on to a new adventure in the land of concierge medicine.

When he announced to his colleagues that he was joining a DPC practice, he said some people told him, “I didn’t know you were into that type of medicine,” while others ignored him and didn’t talk to him for months. Despite the idea that more doctors are moving more into the DPC/concierge medicine setup, many others aren’t happy about those trends.

In his presentation, Mullen laid out some of the myths of DPC/concierge medicine and if he believes they’re true. A quick note: I know differences exist between concierge medicine and direct primary care, but for this column, I’m interchangably using those terms.

#1 You’re Going to Get Paid So Much Money

It’s certainly true that DPC physicians can earn extra money, but the risks of owning your practice are also much higher. Mullen said that people don’t necessarily consider the startup business risk, the fixed costs (fewer patients doesn’t mean less overhead), the marketing that is required for acquiring patients, the risk of patient churn, and the lack of employee safety net.

But the math is tempting. As Dr. Josh Umbehr, a family physician who opened his DPC practice in 2010, explained in this Medical Economics piece:

“The arithmetic [Umbehr] lays out for prospective DPC physicians is straightforward: 600 patients paying $50 a month over 12 months comes to $360,000. With overhead running 20%-25%, one staff member per 1-2 physicians, and one or two exam rooms, the doctor keeps the vast majority as salary. ‘Add on another 100 patients or change your prices by $10, that’s another $60,000, $70,000 right there,’ [Umbehr] said. ‘The math works so well that you don’t have to even charge a lot to be a very successful physician in this space.’

His own panel sits around 700 patients—a deliberate departure from the 200-400 patients concierge medicine popularized in the model’s early days. Those practices, he said, often struggled to grow because their price points were unaffordable to all but a sliver of patients. Lowering the fee, he reasoned, meant more patients could be covered while still right-sizing the workload to what one physician can handle in a day.”

Of course, you still need to actually find those patients to make that money.

As one anonymous poster who had just become a DPC doctor wrote on the WCI Facebook page in 2024:

“Currently things are slow,” they wrote. “Almost all inquiries are from patients who want to use insurance. I did get a few cash-paying patients but not enough to even cover the overhead. Practice has been up and running for about two months now.”

Just like your portfolio, trying to make major money comes with major risks.

More information here:

• Doctors Don’t Owe Society Anything
• Are Physicians Who Retire Early Abusing the System That Made Them Rich?

#2 It Fixes Physician Burnout

After Mullen told his colleagues about his DPC plans, one of them told him how wonderful it would be not to have to deal with RVUs, prior authorizations, and coding audits. All the insurance headaches, they assumed, would disappear.

“Unfortunately, they’re replaced by some of your business pressures and the emotional loads,” said Mullen, whose practice still takes some insurance cases. “You’re increasing sometimes that business load.”

Concierge medicine also doesn’t allow for shift-type medicine. You’re not clocking in or clocking out. You’re not working seven days on, seven days off. If you’re giving somebody 24/7/365 access, it’s difficult to go on vacation and not be bothered by somebody wanting answers. You’re not giving up your email inbox burden. You’re trading that for more relationship burden. Patients expect same-day answers, Mullen said, meaning you have to manage patient expectations before they become your patients so you can still have a life. If not, your cell phone might become your mortal enemy.

“This is more CrossFit style medicine,” he said. “You have to work hard all the time [and get] as many reps as possible.”

Still, many of those working in DPC models say they’re more satisfied. As noted by the American Academy of Family Physicians, 94% of DPC doctors were satisfied with their overall practice (as compared to 57% of those who weren’t in a DPC practice), and 49% said they weren’t experiencing any level of burnout (compared to just 14% of non-DPC physicians).

#3 Patients Are Happier and Easier

This one is easy to dispel, Mullen said. With an insurance model, you might have thousands of patients that you’re managing, and maybe 5% of them are taking up 50% of your energy. These are the high-maintenance patients with higher needs and higher expectations.

“Out of 200-300 concierge patients,” Mullen said, “they are all the 5%.”

And the physician has to fully embrace that style of medicine, especially if the patients are paying thousands of dollars per year to join your concierge practice. Yet, the physician still has to set boundaries, and they can’t overpromise the patients on what they’ll be receiving from the physicians. But it’s also difficult to blame the patients for their desires. They, Mullen said, have been let down by the medical system. They don’t have enough time in a 15-minute visit to get their questions answered or to get their feelings soothed. The patients who gravitate toward this model want more attention and more care. They want somebody who truly wants to work with them.

“If you’re really low on empathy and in a burnout state, this is not a soft landing for that,” Mullen said. “These patients can demand a lot of your time.”

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#4 You’ll Become a Worse Doctor

When Mullen announced to his academic physician colleagues that he was joining a new practice, he said the most hurtful comments were the ones that said he was going to be doing “Yelp-style” medicine and that he would become a drug dispenser while deskilling himself at the same time. “Patient volume,” they told him, “is what creates mastery.”

But Mullen said that the DPC model really just amplifies the physician you already were. You see the same problems in patients, but you catch them earlier because there’s no six-week wait to get them an appointment. You have more time to think deeper thoughts about your patients’ maladies. Less time pressure, he said, equals better decisions.

DPC also can give doctors the ability to create care that aligns with their own values and goals.

“Concierge medicine doesn’t turn physicians into vendors,” Mullen said. “It gives them the space to act like physicians again.”

Perhaps you can make more money (a lot more?) working in a concierge practice. But Mullen cautioned that it wouldn’t be an “Instagram-style” workplace existence. It’s hard work, just a different “hard” than you’d get as an employee with thousands of patients in your practice.

As Mullen said during his presentation, “Concierge and DPC aren’t the grass being greener. They’re just a different field, with different weeds.”

More information here:

• A Step-by-Step Guide to Starting a Medical Practice
• The Wealth-Building Lessons That Doctors Can Learn from Dentists

Money Song of the Week

As we say a fond farewell to Jennifer Finch, the bassist of punk/grunge group L7 who died last month at the age of 59 from brain cancer, let’s take a listen to some of the band’s early work.

We’ve written before about songs that take down the music industry and the unfairness it provides, but it’s not every day you get a song from a group of musicians who are trying to take down their fellow musicians and calling them out on the way they became successful.

But that’s what L7 is going for in its 1990 tune Just Like Me. The band namechecks Faster Pussycat’s Taime Downe and Guns N’ Roses’ Axl Rose and Slash and obliterates them on their drug habits, sex symbol status, and the lack of dignity they show. Interestingly, the all-female L7 shares some of its most cutting lyrics for all-female hair metal band Vixen.

At the time, glam metal was reaching its highest level (as far as popularity, not necessarily by the height of their luscious locks), and some club owners forced bands to buy an allotment of tickets to their own shows before the club would book them. It was known as pay to play, and apparently, L7 didn’t think much of that idea (supposedly because you could win a slot on a club show by paying for it yourself instead of cultivating a fan following that would pay to see you).

As L7 sings,

“Well Vixen are love gods/Just like me/Pretty pretty sex things/Just like me

Dressed up and to pay to play/I couldn’t live that way/Hair spray and bustier/Can’t fool me.”

Harsh? Yes. But that didn’t matter to L7. As guitarist-vocalist Suzi Gardner once said, via Drowned in Sound: “Our generation was about identifying the authentic.”

Clearly, L7 and Finch made an impact on their fans. After the band announced Finch had been diagnosed with brain cancer in mid-July, a GoFundMe was set up for her. Although she died only a few days later, nearly $400,000 had already been raised.

More information here:

• Every Money Song of the Week Ever Published

Have you thought about going into DPC or concierge medicine? Does anything give you pause? If you have already made that jump, how’s it going? What are the pros and cons for you?

The post The Benefits and Pitfalls of Entering the World of Concierge Medicine/Direct Primary Care appeared first on The White Coat Investor – Investing & Personal Finance for Doctors.

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