DPC Myth #3: DPC Cannot Work in Rural America
If I had a dollar for every time someone told me Direct Primary Care would not work—especially in rural Maine—I could fund a small nation’s entire healthcare system. Yet here I am, 12 years into running a DPC practice just outside Bangor, Maine. I am still seeing patients, still paying my bills, and still enjoying my work. That inevitable collapse so many well-meaning colleagues assured me was just around the corner? Never came.
But those colleagues? Most of them are still seeing 25 patients a day and wondering why they cannot remember the last time they actually enjoyed medicine.
The Failure Myth
This pessimism comes in several flavors: “You cannot make a living on membership fees alone.” “Not enough people will pay out-of-pocket for primary care.” “It sounds good in theory, but it will not work in practice.”
The reality? DPC works. After 12 years, the financial model is viable. The clinical outcomes are excellent. The lifestyle is sustainable. Patients show up and pay their membership fees month after month, year after year. It is almost as if when you provide value to people and they can actually afford it, they are willing to pay for it. Revolutionary concept.
The key misconception is confusing “different” with “impossible.” Yes, you will need to think as a small business owner. Yes, you will do things not covered in medical school—such as marketing, accounting, and occasionally unclogging a toilet.
But different does not mean doomed to fail. The physicians who succeed in DPC treat their practice as a business, provide consistent value to their patients, and adapt when something is not working.
The Rural Impossibility Myth
The argument goes: “Rural areas are poorer, older, and more dependent on Medicare. People will not pay out-of-pocket. The market is too small. You need a wealthy, urban population—ideally in Brooklyn or San Francisco, where everyone drives a Tesla and has strong opinions about their chakras.”
I practice just outside Bangor, Maine. We are not Manhattan. Our population is not particularly wealthy. We have nine months of winter. We have zero Whole Foods stores. And yet, my practice has thrived for over a decade.
Why? Because the supposed disadvantages of a rural practice are often actually advantages.
First, rural patients are dramatically underserved. Wait times are measured in months. When you offer same-day appointments, unhurried visits, and direct access via phone or text, you are solving real problems. People will pay for value, time and a more personal relationship with their physician.
Second, rural communities have a sensible relationship with healthcare spending. They already pay out-of-pocket for veterinary care, equipment repair, and well maintenance. They are more often uninsured or have high-deductible plans—meaning they are already paying cash for healthcare anyway, just at hospital prices with worse service.
Third, competition is less soul-crushing. You are not fighting dozens of other practices for market share. You may be one of the only options offering comprehensive primary care with reasonable access.
Fourth, rural patients are loyal. If you show up, do good work, and treat people with respect, they will stick with you, refer others, and become advocates for your practice. Rural communities are built on relationships, and DPC is fundamentally a relationship-based model.
The Bottom Line
After 12 years in rural Maine, I can say with confidence: these myths are just that—myths. They are stories told by people who have not done it, based on assumptions that do not hold up in the real world.
Will every DPC practice succeed? No. But the same could be said for traditional practices. The question is whether it is viable, whether it can provide a sustainable living and satisfying career while delivering excellent care.
And the answer, based on 12 years of lived experience, is yes.
If you are a physician considering DPC—rural or otherwise—do not let these myths stop you. Do your homework, understand your market, build a solid business plan, and be prepared to work hard. But do not let unfounded pessimism from people who have never done it convince you that it cannot be done.
Because it can be done. It has been done. And I have got 12 years to prove it.
This DPC Mythbuster Series aims to debunk the most common fears, misconceptions, and half-truths that deter doctors from embracing Direct Primary Care. These opinions are from each individual blogger. You may or may not agree with them, but either way, leave a comment with your thoughts.
Ha! I spit my coffee across the room when I saw the title. I’ve been DPC in a rural Texas town of 3000 people for eight years. My clinic continues to grow, we recently hit 2000 members. Putting this clinic in Llano was like putting a match on dry grass. Anyone that wants to set up in a rural community should feel free to give me a call. Have to go clean up now.
But………………. It won’t work everywhere. I like to vomit when I read stuff like this. If there is a large practice in town that accepts public aid, there are employers around who pay for office visits and the docs do hospital work because their patients accept it, one WILL GO BUST with trying to setup DPC in the same area. PERIOD! Especially if there are NO hospitalists!
Don’t get me wrong, I like the concept of DPC but one needs to be very, very careful if they setup in a rural area and be successful. If you consider an area with DPC docs already there who want your help, it could be fine. If they look at you askance and consider you a potential competitor, I wouldn’t consider the place. If there’s a bunch of poverty, look elsewhere as these people are used to handouts.