The Consultant in the Room

A piece ran recently on KevinMD arguing that DPC physicians who resist employer-aligned models are ideologically naive — economic purists clinging to an identity that doesn’t scale. The author has more than twenty years of experience across payers, providers, and health systems. An MBA. A JD in progress.

Not a physician. Which raises a question worth sitting with: why are so many articles about what physicians should do written by people who have never been one? MBAs, JDs, healthcare consultants, benefits advisors, policy strategists — the genre is crowded and the bylines are telling. The people most eager to explain how medicine should be restructured are almost never the ones who went to medical school, stayed up through residency, and built a practice from scratch. That asymmetry isn’t incidental. It’s the whole story.

Not a neutral analyst. A vendor.

A colleague here at DPC News called out this author’s pattern back in October. Doug Farrago said what needed to be said, and I won’t repeat it. But the latest piece warrants its own response — because the argument has gotten more sophisticated, and the stakes are worth engaging directly.

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The core argument: individual consumer demand can’t sustain DPC at scale because median-income households can’t afford a $100–150/month membership on top of their catastrophic coverage. Therefore, the employer channel is the path forward, and physicians who refuse to engage are letting brokers and PE firms design those structures without clinical input.

The data cited is real. The logic isn’t wrong on its face. But it starts from the wrong question.

The article asks: *how do we scale DPC?*

The more important question is: *why did physicians leave in the first place?*

The answer isn’t billing model complexity. It’s the slow accumulation of administrative weight — every metric, every productivity benchmark, every prior authorization — that arrived not as a hostile takeover but as a series of reasonable-sounding negotiations. Someone was always at the table. The guardrails got negotiated. And then the guardrails became the cage. The article acknowledges this risk briefly, then moves on — as if naming the danger is sufficient protection against it.

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Let me try an analogy, and brace yourself for the objections.

Does your grocery store need to partner with local employers so their workers can afford food? Does it need a TPA between the produce section and the customer? Of course not. The store sets its prices. The customer decides if they can afford them. Nobody wrings their hands about whether the grocery store can “survive” without an employer partnership program.

I already hear the objection: healthcare is different. Healthcare is a right. You can’t compare medicine to buying groceries.

Here’s the thing — if you believe healthcare is a right in the same way food is a right, then the logical conclusion is more direct access and fairer pricing, not more administrative layers extracting margin between the patient and the physician. The analogy doesn’t fail because healthcare is special. It fails for some people because it implies physicians should be able to operate like competent professionals in a functioning market — and that idea is threatening to everyone whose livelihood depends on the current complexity staying exactly as complex as it is.

Some will read this and reach for the word “purist.” Fair enough. A peanut butter and jelly sandwich is simple. It’s also been feeding people reliably for over a century without a supply chain consultant, a governance framework, or a third-party intermediary taking a cut between the bread and the jar. Simplicity isn’t a flaw in a model. It’s often the proof that the model is sound. What gets called purity in DPC is usually just clarity — about who the physician works for, who sets the terms, and who the practice actually serves.

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Here’s what gets lost in the “physicians should be at the table” framing: without physicians, there is no table. TPAs don’t see patients. MBAs don’t manage chronic disease. Consultants don’t answer the phone at 10pm. The physician is the product. Everything else is overhead. And DPC proved — practice by practice, panel by panel, year by year — that the overhead is optional.

So why is this conversation framed as physicians needing to earn a seat? They built the seat. They are the seat. The people who actually need the relationship are the ones selling access to it. At what point did we agree that people who never went to medical school, never carried a panel, and never signed their name to a clinical decision get to write the terms under which physicians operate? We didn’t. It accumulated — through exactly the kind of reasonable-sounding negotiations being recommended here. That’s not a partnership. That’s a different kind of employment with extra steps.

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The article closes with four questions it calls “more productive.” Here they are, with the prior question each one skips:

*Which partnership structures preserve physician autonomy and panel discipline?* — Which model gives the physician unilateral authority to set panel size without a contract renewal?

*Which contracting models maintain price transparency?* — Which model lets the physician change a price or walk away without a 90-day notice clause and a non-compete?

*Which employer arrangements expand access without recreating administrative burden?* — Which model puts the patient’s payment directly in the physician’s account with no middleware taking a cut?

*Where does new infrastructure add clinical value?* — Which model has actually been running in rural and underserved markets since the early 2010s without employer subsidy?

The answer to all four is the same. And it isn’t the employer channel.

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One more thing the article doesn’t address: maybe the problem isn’t the cost of DPC. Maybe it’s the cost of the catastrophic insurance that sits on top of it. Employer family premiums now average nearly $27,000 a year — a 26 percent increase over five years. Nobody writing these “DPC must partner with employers” pieces seems particularly exercised about that number. The $150 monthly membership isn’t the access problem. It’s one of the solutions. The $27,000 annual premium — the one flowing through the very employer channel being recommended — that’s the problem. Funny how that never makes the headline.

You can read the original piece HERE and decide for yourself.