What If Direct Primary Care Became the Dominant Model?
A thought experiment for physicians
My son listens to those “What if…?” videos on YouTube Kids – the ones that ask questions like What If It Rains Bananas for a Single Day? or What if the Earth stopped spinning?
They’re playful, a little absurd, and oddly effective. They strip a system down, change one variable, and let the consequences unfold.
It got me thinking: What if we did the same thing with primary care?
So let’s run a thought experiment.
What if Direct Primary Care stopped living on the margins of medicine and became the foundation of primary care itself?
Pause the current system.
Imagine we designed primary care on purpose.
First, the obvious things
Panel sizes shrink—meaningfully. Not 2,500 patients per physician, but hundreds. Visits get longer. Not because someone allows it, but because time is no longer the liability to profit margins.
Documentation thins. The note supports the visit instead of being the visit.
The inbox still exists— but fewer messages start with “patient requesting referral due to access issues.”
None of this is revolutionary. Most physicians already know this part.
Then the second-order effects
When primary care has time, fewer problems drift.
Hypertension is addressed earlier or prevented all together.
Weight gain isn’t explained away with a 60-second impersonal lifestyle recommendation.
Fatigue isn’t automatically labeled as anxiety or depression.
Referrals still happen—but they’re better timed and better framed. Specialists receive patients are prepared to advocate for themselves and speak confidence about the reason for the referral.
Burnout doesn’t disappear—but it changes shape – it’s not driven by moral injury because we get to do more actual medicine.
Then come the uncomfortable effects
Hospital systems feel it first.
Not because DPC opposes hospitals, but because fewer late-stage problems flow downstream.
Revenue models built on volume strain.
Procedure pricing faces more scrutiny.
Insurance doesn’t vanish—but drifts forward catastrophic coverage instead of gatekeeping.
Training models feel pressure.
RVUs look increasingly misaligned.
Young physicians increasingly choose primary care because of it’s intellectual challenge and independence.
Some institutions adapt.
Some resist.
Some quietly rebrand pieces of the model
That’s how systems change.
What wouldn’t magically improve
Workforce shortages wouldn’t disappear.
Rural access would still require policy solutions.
DPC would not mean unlimited access and it would not replace all primary care.
Not every physician would choose this model.
Not every patient would want it.
DPC isn’t a utopia.
It’s a constraint-based redesign.
And that is okay!
Why this matters
The value of a thought experiment isn’t prediction—it’s clarity about the big picture value of direct care.
The real question isn’t whether Direct Primary Care could become dominant.
It’s this:
When it does—what parts of medicine will finally work the way we always hoped they would?
