The Rise of Concierge and Direct Primary Care: A Growing Trend wiht Systemic Implications
The American healthcare landscape is undergoing a notable shift, marked by the increasing popularity of alternative primary care models like concierge medicine and Direct Primary Care (DPC).A recent study from researchers at Johns Hopkins Carey Business School, Johns Hopkins Bloomberg School of Public Health, Oregon Health & Science University, and Harvard medical School reveals a dramatic surge in these membership-based practices, raising both opportunities and concerns for the future of primary care access.
Exponential Growth in a Changing Healthcare Market
The study, published in Health Affairs, demonstrates a remarkable 78.4% increase in the number of clinicians working within concierge and DPC practices between 2018 and 2023. This translates to growth from 1,658 practice sites in 2018 to 3,036 in 2023,and a clinician base expanding from 3,935 to 7,021. This isn’t a niche trend; it’s a substantial reshaping of how primary care is delivered.
Understanding the Models: Concierge vs. Direct Primary Care
Both concierge and DPC models prioritize a more personalized patient experiance, offering benefits like increased access, smaller patient panels, and longer appointment times. However,their financial structures differ significantly:
* Concierge Medicine: These practices charge an annual retainer fee – ranging from a few thousand to tens of thousands of dollars – in addition to billing customary health insurance for office visits and procedures. This allows for enhanced services and a more focused doctor-patient relationship.
* direct Primary Care (DPC): DPC practices operate outside of the traditional insurance system, typically charging a smaller monthly or annual fee for a thorough range of primary care services. This model emphasizes a direct financial relationship between patient and physician.
Why the Surge? Clinician Burnout and the Appeal of Autonomy
The rapid growth of these models is largely driven by primary care clinicians seeking relief from the pressures of traditional healthcare settings. Years of increasing administrative burdens, challenging workloads, and a rising risk of burnout have led physicians to explore alternatives.
“The increasing interest clinicians are showing in fee-based practices may be telling of certain pain points clinicians face in traditional primary care settings,” explains Dan Polsky, co-author of the study and a professor at Johns Hopkins. These new models offer clinicians smaller patient loads, reduced administrative overhead (particularly related to insurance paperwork), and increased clinical autonomy – factors that contribute to improved job satisfaction and perhaps extend career longevity.
The Potential for Exacerbating Primary Care Shortages
While beneficial for participating patients and clinicians, the researchers caution that the growth of concierge and DPC practices could worsen the existing shortage of primary care physicians in traditional settings. As doctors migrate to these fee-based models,access to affordable primary care for the majority of americans who rely on insurance coverage may be compromised.
“We have to consider how the growth of these models may affect access to primary care for the vast majority who can only afford the care covered by their insurance plan,” Polsky emphasizes. This raises critical questions about equity and access within the healthcare system.
The Rise of Corporate Ownership: A New Layer of Complexity
The study also reveals a significant trend towards corporate ownership within the concierge and DPC space. Corporate-affiliated practices experienced a staggering 576% growth during the study period, indicating substantial investment from for-profit companies.
This shift is particularly noteworthy because it could alter the fundamental characteristics that attract both clinicians and patients to these models.Benefits like reduced administrative burden and personalized care could be jeopardized as corporate entities prioritize scalability and profitability. For example, corporate-owned practices might lower membership fees while simultaneously billing insurance, potentially diluting the individualized nature of care.
Looking Ahead: policy Implications and the Future of primary Care
The researchers emphasize the need for policymakers to carefully monitor the expansion of fee-based primary care models and address potential systemic consequences.
“Our research draws attention to the rapid expansion of these models,” Polsky concludes. “It’s our hope that by increasing awareness of the rise in fee-based practices, that we’re raising the necessary questions for policymakers to ensure that high-quality primary care remains available for all americans.”
This trend demands a proactive approach to ensure that innovative care models don’t inadvertently create further disparities in access to essential healthcare services. The future of primary care hinges on finding a balance between empowering clinicians, enhancing patient experiences, and maintaining equitable access for all.
Source: [https://hub.jhu.edu/2025/12/18/concierge-medicine-rising-hopkins-research/](https://hub.jhu.edu/2025
