The Model Is Not the Secret Sauce
A third-year medical student spent half a day with me recently.
He told me he had entered medical school wanting to be a primary care doctor, but his family medicine rotation had jaded him.
He thought, If this is primary care, then I don’t want anything to do with it.
Now entering his fourth year of medical school, he reached out to our practice after hearing me speak at some medical school event, likely glowing with excitement about Direct Primary Care and how it has restored my love of medicine.
He had just half a day to spare.
I took my first meeting and a patient phone call from home and then met him at the office for my only in-person visit that particular morning.
After we were done, I asked him the same question I ask all of my students:
How did this differ from what you have experienced—or come to expect—from primary care so far?
Like most students who have never experienced DPC in real life, he pointed out the time.
Sixty minutes of patient-facing time versus seven to ten.
Open-ended questions, sharing, and discussion versus questions designed to quickly get through an agenda. Collaboration versus directives. Buy-in and patient engagement versus a patient feeling like something is simply being done to them.
But there was more.
He personally felt hope.
After just one encounter, he saw what primary care could be instead of what he had begun to believe it had to be.
The Patient May Leave With the Same Prescription—but Not the Same Experience
He recounted experiences that went something like this:
The blood pressure is still elevated. What have you been doing? The patient answers. Increase the medication and recheck later.
The patient is still smoking. Are you ready to quit? No? Document it and move to the next issue.
Now, this patient wasn’t there for blood pressure or smoking cessation, but here is the gist:
She might ultimately have left with the exact same prescription she would have received somewhere else.
But in our scenario, it was ultimately her choice.
She understood why we were making the decision. She was part of it. And she was empowered to work toward a different solution—maybe no medication or less medication—at our follow-up.
She felt heard.
There is a difference between leaving a doctor’s office with instructions and leaving with buy-in.
Incentives Determine What a System Makes Possible
Afterward, we sat in my office dissecting the visit and then talking about his future.
What would primary care look like for him now that he was optimistic about it again?
Would he start a DPC practice right out of residency? Would he join an established one? Would he go into fee-for-service medicine to get some experience and then take the leap?
He expressed concern about being isolated right out of residency. He wanted to be around other, more experienced doctors.
And then we landed on something important:
Just choosing to work in a DPC model doesn’t mean the experience will be the same for him—or for the patient.
Our current healthcare system often rewards patient volume, billing codes, and productivity targets.
Relationships require time, continuity, curiosity, and conversation.
Those priorities are often in direct conflict.
DPC changes some of those conditions. By removing visit-based billing and creating more space in the schedule, it can realign the physician’s work with the patient’s needs.
But the model does not provide the care.
People do.
The DPC model creates room for curiosity and relationship.
The physician still determines what happens inside that room.
The People Are the Secret Sauce
That may have been the most important insight from our conversation.
The DPC model is not the secret sauce. The people doing the work within it are.
But as DPC grows, I’m realizing that not everyone is drawn to the model for the same reasons I was.
I met a DPC-curious physician at the Summit this year who made that particularly clear to me. As he talked about the possibilities of DPC, he sounded more like a venture capitalist than a physician—working through all the ways the model could be scaled and financial returns maximized.
My spidey senses told me his motivations for exploring DPC might not be the same as mine were.
And to be clear, there is nothing wrong with making money. A DPC practice has to be financially viable. Physicians should be paid well for the work we do. And there is nothing inherently wrong with building multiple locations or creating a large organization.
He may build a DPC practice with multiple locations. He may hire other doctors, grow a large membership base, and be incredibly successful by every financial metric.
But I found myself wondering:
What if my student goes to work for this guy?
Will his experience be the same as what he experienced in our office?
Will he have the time and freedom to practice the kind of medicine that made him hopeful again?
Or will it eventually feel like just another job?
I don’t know.
I can only speculate.
But I think that is exactly the point.
The Model Doesn’t Protect the Mission
My call to action is really for the new doctors—and even the experienced ones—who are looking at DPC and thinking, This is it. This is the answer.
Maybe it is.
But don’t assume every DPC practice is going to be the right fit for you as a physician, just like patients shouldn’t assume every DPC practice will be the right fit for them.
As this model grows, that distinction is going to become increasingly important.
Look beyond the model.
What does the practice actually value?
How is success measured?
How much autonomy do physicians have?
Is there mentorship?
Is curiosity valued?
Are relationships actually protected when they compete with growth, efficiency, or financial goals?
What are the people building the organization trying to accomplish?
Even this student was astute enough to recognize after half a day that the model does not automatically protect the mission.The people who design the practice decide what it will prioritize—and what it will protect as it grows.
The model just makes it possible.
And that is worth protecting.
