The Risk of Forgetting the Rebels: A Reflection on DPC’s Next Chapter

But you got to be tough when consumed by desire 
’Cause it’s not enough just to stand outside the fire.”
— Garth Brooks, “Standing Outside the Fire”

When I entered the Direct Primary Care space, something clicked.

It was a familiar feeling. Like that lightbulb moment many of us experience when we finally choose a specialty that resonates so deeply it feels like home. The conversations make sense. The approach to problem-solving aligns. The values feel familiar.

You realize:

These are my people.

For many of us, DPC became more than a practice model. It became a reclaiming of medicine. A return to relationships. A place where physicians could practice in alignment with their values and reconnect with the kind of care many of us imagined when we first entered medicine.

This is what makes DPC feel a little magical: the people, practices, and stories begin to feel like family—not just in your hometown, but across the country. Shared history develops. We celebrate one another’s wins, grieve setbacks, exchange ideas, and quietly root for one another in a profession that too often leaves physicians feeling isolated.

Which is why it can feel strangely personal when you enter a space theoretically designed with you in mind and somehow still feel like an outsider.

Recently, I attended an invite-only healthcare event centered around solving some of healthcare’s biggest challenges. The premise, at least as presented, was admirable: bring together employers, insurers, healthcare systems, practitioners, and innovators to address what feels like an increasingly broken and unsustainable path in healthcare.

I went hopeful.

I was eager to hear new ideas about how independent practices like mine might better connect with employers and communities without losing what makes us different. I wanted to hear possibilities. Collaboration. Maybe even solutions to some of the heavy lifting smaller practices face when trying to expand employer partnerships or gain visibility.

But about two-thirds of the way through, the event began to feel less like Kumbaya—a room of people genuinely trying to solve hard problems together—and more like the familiar gravity of influence, proximity, and power.

As panel discussions unfolded and stories were told, I noticed something difficult to ignore: the version of Direct Primary Care being represented felt remarkably narrow. The physicians and organizations highlighted largely reflected practices with scale, employer relationships, larger spheres of influence, or strong existing professional networks.

Meanwhile, many of the grassroots physicians—the solo doctors, intentionally small practices, slower-growth models, and quietly sustainable clinics that have existed for years—seemed absent from the conversation.

I approached one of the cofounders afterward and asked directly: if Direct Primary Care is positioned at the center of a vision for healthcare transformation, why were so many established DPC physicians and practices not included?

The answer surprised me.

“We didn’t know you existed.”

I believe the statement was sincere.

But it stayed with me.

Because it raises an important question:

If organizations are positioning themselves as connectors in healthcare, who gets counted? Who gets invited? And ultimately—who gets to define what Direct Primary Care is?

Did they truly understand Direct Primary Care if the versions represented were primarily the ones already elevated onto a platform?

Perhaps it reflected who was easiest to find. Perhaps it reflected who already had visibility. But sitting in that room, I couldn’t help noticing that the diversity of DPC philosophy felt far narrower than the diversity of DPC itself.

For the sake of this event—and perhaps for many in the room—Direct Primary Care appeared to have a very specific identity: employer-facing, team-based, broadly networked, highly scaled, and built for expansion.

It was polished. Professional. Successful.

But it was also only one version of DPC.

Missing from the conversation were many of the physicians who intentionally chose something different: smaller panels, slower growth, deeper relationships, sustainable boundaries, and practices built less around scale and more around continuity.

If we are not careful, the most visible version of Direct Primary Care quietly becomes the version of Direct Primary Care.

That matters.

Because language matters.

At one point during the event, Direct Primary Care was described as offering “24/7 access to your doctor.” While that may be true for some practices, it is not universally true—and I think we should be careful about how we frame our model.

Afterward, I challenged one of the panelists on this point.

My concern was simple: if we present one model of DPC as universally true, we risk confusing patients and unintentionally narrowing expectations for physicians entering the space.

I shared my concern that not all Direct Primary Care practices are—or should necessarily aspire to be—24/7 physician access.

His response was direct:

“It is 24/7.”

And then:

“If you can’t do that, you can partner with us.”

To be fair, I understand the practicality of that suggestion for some practices.

But what stayed with me afterward was not the disagreement itself.

It was the implication.

That perhaps if your model looks different—smaller, more boundary-conscious, intentionally relational rather than scaled—then maybe your version is somehow incomplete.

And I’m not sure that’s true.

What if sustainability is not failure?

What if boundaries are not lesser DPC?

What if there is room in this movement for physicians who intentionally choose depth over scale?

Patients deserve clarity.

Physicians deserve sustainability.

And all of those models can still be authentically DPC.

I sat with these feelings for 24 hours. Talked them through with my husband and colleagues until I could finally put language to what felt so unsettling.

It was a familiar feeling.

There’s a particular kind of discomfort that comes from recognizing a pattern before you fully understand it. Your mind and body make connections before language catches up. You leave with a knot in your stomach and only later realize:

This feels familiar.

Perhaps part of why it felt familiar is because I have spent much of my career as a woman of color in medicine navigating rooms where influence and belonging did not always feel evenly distributed.

Not overtly.

Not maliciously.

Just familiar.

I left fee-for-service healthcare for many of the same reasons most of us did. But one thing I rarely say out loud is this:

I also left because I felt unseen.

I didn’t feel like I had a seat at the table. Decisions about how I practiced, who I saw, how long I had with patients, and what mattered were often made around me—not with me.

Influence frequently belonged to those with visibility, clout, reputation, or proximity to power. Too often, it felt like the people actually doing the work had little voice in shaping the system itself.

And sitting in that room, I found myself wondering:

Are we at risk of recreating some of the very dynamics many of us left behind?

If I’m being honest, I left feeling cynical.

I’ve practiced medicine long enough to recognize familiar patterns when they begin to emerge.

I’ve seen versions of this story before—visibility becomes influence, curated representation becomes expertise, and scale becomes synonymous with legitimacy.

And then there’s this uncomfortable truth:

Whether I participate or not, this is happening.

Organizations are forming. Employers are seeking solutions. Healthcare leaders are building networks. Direct Primary Care is becoming more visible, more organized, and inevitably, more institutionalized.

I may not love every aspect of where this appears to be heading.

But standing outside of the fire does not mean I won’t get burned.

Which leaves me wrestling with a harder question:

What responsibility do I have? What responsibility do we—the rebels—have now that this movement has become mainstream?

Because this is no longer a question of if.

Do we stay outside, protecting the purity of what we built?

Or do we step into rooms that make us uncomfortable in hopes of helping shape what comes next?

Because Direct Primary Care was built by rebels.

Not the loud kind.

Not the reckless kind.

The quiet kind.

The physicians who sat in exam rooms wondering if medicine had become unrecognizable. The ones who stayed late finishing charts, fought prior authorizations, apologized for rushed visits, and slowly wondered whether there had to be another way.

Then, often at considerable personal and professional risk, many chose differently.

We left security.

We rebuilt.

We practiced medicine rooted in relationship again.

As Direct Primary Care grows, change is coming whether we welcome it or not.

My hope is that we do not lose sight of the physicians who built this movement before it had momentum. That we make room for more than one version of success. That we resist reducing DPC into whatever model scales most easily.

Because growth matters.

Collaboration matters.

But soul matters too.

Perhaps the harder question for Direct Primary Care is not simply who built this movement.

As DPC grows, I can’t help hearing a line from Hamilton:

“Who lives, who dies, who tells your story?”

Because maybe the real question for this moment in DPC is not simply who helped build the movement.

It’s this:

Who stays in the room long enough to help write the next chapter?

I don’t fully know my answer yet.

Part of me wants to stand cautiously on the sidelines.

Part of me wonders whether stepping away means surrendering the opportunity to protect the very things that made Direct Primary Care desirable in the first place.

Maybe the risk is not only forgetting the rebels.

Maybe the greater risk is when the rebels stop showing up.