Impact vs. Scale for Direct Primary Care

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The above video is from Shawn Martin, executive director the AAFP. I’ll give credit where credit is due because he does mention DPC. Point #3 is “Establish regulatory frameworks that support independent physician-led models, specifically Direct Primary Care.”

I have written about my concerns with getting the government involved (“regulatory frameworks”) with DPC in any way, so I won’t rehash that. But there is also something else. DPC should not only be a physician-led model, but a physician-owned model as well. That’s a very important distinction, as the topic of scaling DPC keeps coming up.

The wrong people have been hovering over Direct Primary Care for a while, ready to pounce. Venture capitalists and private equity have dabbled over the years (and failed), but they are not giving up. For them to succeed and get 10x their money, they need to water down the concept by increasing volume and not using physicians. That’s not DPC.

This is where I want to point out a distinction. Making an impact with DPC is not the same as scaling it. What’s the difference?

Here is where a little AI search helped:

Impact refers to the depth and quality of change created for beneficiaries, while scale refers to the breadth, volume, or number of people reached

Scaling impact means increasing positive outcomes, not just growing an organization’s size, budget, or staff. Effective strategies often involve partnering, policy advocacy, or replicating models to achieve exponential results. 

Key Differences Between Impact and Scale

  • Impact (Depth): Focuses on the magnitude of change, quality of service, and solving specific problems.
  • Scale (Breadth): Focuses on increasing the number of users, beneficiaries, or geographical reach.
  • Growth vs. Impact: Growing an organization (more staff/budget) does not always translate to greater impact per person.
  • Scaling Impact (Goal): Aims to maximize social or environmental benefits, often requiring a shift from direct service to systemic change. 

Common Pitfalls

  • “More” does not equal “Better”: Increasing the number of people served (scale) without maintaining the quality of the solution (impact).

My thoughts:

Depth and quality of change for beneficiaries (patients) = physician-owned, small Direct Primary Care offices.

Increasing patient volume and geographical reach, which does NOT translate into greater impact per patient = scaling by VC/PE

Let’s not SCALE Direct Primary Care, but continue to grow in the right way so that Direct Primary Care makes a real IMPACT for both doctors and patients.

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About Douglas Farrago, MD

Dr. Farrago is a retired family physician based in Forest, Virginia. Since 2021, he has run DPCnews.com, a leading resource for the Direct Primary Care (DPC) movement. He is the author of three best-selling books on Direct Primary Care: The Official Guide to Starting Your Own Direct Primary Care Practice The Direct Primary Care Doctor’s Daily Motivational Journal Slowing the Churn in Direct Primary Care (While Also Keeping Your Sanity) In 2016, Dr. Farrago conceived the idea for the Direct Primary Care Alliance and co-founded the organization alongside other pioneering DPC physicians. He is widely recognized as a leading expert in the DPC model and frequently lectures to medical students, residents, and practicing physicians on how to successfully start and run their own DPC practices.Dr. Farrago sold his Direct Primary Care practice in October 2020 but continues to receive care there as a patient.