Why More DPC Clinics May Start and Fail: The Flip Side of Growth
Author: Landen Green, DO
Inspired by a true story.
The Direct Primary Care movement is growing faster than ever. More doctors are looking for ways out of the system and more patients are finding care that actually feels like care. Communities are being served in more personal, convenient, accessible, and affordable ways.
It’s everything we hoped for, right? Even the government is finally giving DPC credit for being awesome.*
With this expansion, I worry that as more DPC clinics start, a higher percentage will also struggle, stall, and then shut down. That’s not a critique of the model; it’s a reality of rapid growth. DPC is the popular kid in school, we are trending on social media. In the words of legendary Ron Burgundy, we are ‘kind of a big deal.’ Patients want to be with us and doctors want to be us.
Okay, enough cheesy quotes – as the popularity of DPC continues, we should face it with awareness and open arms.
DPC as a Trend
For years, DPC was something you had to seek out. It was born from burnout, desperation, and the drive to reconnect with why we became doctors in the first place. But now, DPC is gaining popularity—and with that comes visibility.
Doctors are hearing about DPC through word of mouth, social media, podcasts, conferences. They’re seeing success stories and feeling inspired (or just desperate for something better). But the easier it becomes to discover DPC, the easier it becomes to jump in without fully understanding what you’re jumping into.
And that can be dangerous.
It’s a Business. A Real Business.
DPC isn’t just an escape route from traditional practice—it’s a full-blown small business. A lean startup. A solo flight. You’re the CEO, the marketer, the IT department, the office manager, the billing department, the fix-it person, and (I almost forgot) the doctor.
If someone falls in love with the idea of DPC but isn’t ready to build and run a business, disillusionment can come fast. It’s becoming more common to see clinics open without a clear plan, a defined value proposition, a budget runway, or even a full understanding of Direct Primary Care. That’s not bravery—that’s a recipe for burnout 2.0.
Half-Retirement Isn’t Half the Work
I am also seeing more doctors approach DPC as a “soft landing” or an early step toward part-time retirement. While the idea is understandable—low overhead, smaller panels, fewer hours—starting a DPC from scratch is rarely that gentle.
It takes time, energy, and full engagement to grow a practice, especially in the first year. Without that commitment, the engine never really turns over. “Build it and they will come” only works if you also market, educate, and hustle. The advantage here is with those who can bring a full panel with them from their prior practice, which is never a guarantee and always a potential legal risk. I have talked to doctors who told me they were 100% sure certain patients would follow them who didn’t and patients they never thought would who did. It’s difficult to estimate, high variable, and unpredictable.
Other Reasons DPC Startups May Struggle
There are a few more common pitfalls we’re seeing:
- Inadequate Market Research: Launching in a community that doesn’t understand or value DPC can be an uphill battle, especially when the doctor doesn’t fully understand the value proposition themselves. As more doctors jump into DPC without market research, they’re less likely to find that sweet spot for their price point.
- Lack of Community Engagement: A DPC clinic without local trust is just another building with a sign. Doctors need to be willing and able to get out in the community and be a consistent figure, with a likable personality.
- Burnout from Isolation: Trading system-wide dysfunction for solo stress isn’t a fix—it’s a different kind of strain.
- Financial Missteps: Underestimating budgeting due to lack of planning and research can sink even the most well-intentioned clinic.
What This Isn’t
This isn’t a doom-and-gloom warning. It’s not meant to scare anyone off. DPC is still one of the most rewarding ways to practice medicine—and more doctors choosing this path is a beautiful thing. I am reminded daily that a ‘bad’ day in my DPC is so much better than a ‘good’ day in the system.
But DPC isn’t for everyone. It’s not automatically easier. And it’s certainly not simple. It’s for those willing to grind, build, market, educate, and lead. It takes preparation, clarity, and a deep “why” that lasts longer than the first slow quarter… or year. I am sure there are outliers that ‘wing it’ to success and that’s awesome but I worry that this method will become even less effective.
Dr. Farrago gave a great presentation at the 2024 DPC Summit in Dallas, TX where he revealed his evidence-based conclusion to why DPC practices fail at that time. The big hitters, as I recall, were unexpected life events, lack of support, and lack of money. While those will continue to be there, new big hitters will break through and the overall success rate of DPCs will decline.
I hope I am wrong.
So, What Do We Do?
We keep answering the questions (yes, even the same ones, over and over again…. and over again). We keep sharing the hard lessons and the unfiltered stories—not just the Instagram-worthy wins. We keep reminding new DPC docs that this is real work, really hard work, but it’s work worth doing when you know what you are getting into.
Most of all, we support each other. Because a thriving DPC movement doesn’t just mean more clinics—it means better clinics. Sustainable clinics. Clinics that know who they are, who they serve, and why it all matters.
The future of DPC is bright. Let’s make sure it’s also built to last.
*A special thank you to the group leading this charge! I don’t want to list names for fear I might leave someone out, but I sincerely appreciate the blood, sweat, and tears each of you have put into the push for supportive DPC law.
great great post.
DPC= the hardest work I’ve done in medicine + the most rewarding.
Great post!
I am in the middle of the slow, slow first quarter of my clinic. I am definitely in a position to outlast but it is hard. I also have good support of surrounding DPC physicians. Just hoping it changes sooner rather than later. Serving out a 2 year noncompete did not help.
Phenomenal post. Phenomenal. POST. I couldn’t say it better if I tried 100 times. Launching a DPC is not easy, wasn’t designed to be easy, and requires grinding. That’s not to say it’s not completely worth it. There’s a reason we all say #nevergoingback. And it’s completely true that our worst day in DPC is better than our best day on the inside. But that doesn’t make it all gravy. There is no free lunch and that is true in DPC. I always say that If work on the inside was the equivalent of 10 SEUs (Stress Equivalency Units), then DPC is maybe 3-5,depending on your ability to be resilient and hustle to nip new small problems in the bud before they become big hassles, and of those 3-5 SEU’s in DPC, only one point is a similar stress than on the inside (needy patients, etc.) the other 2 are new and unique stressors that truly suck (HR issues, the hassles of running a business, etc.) So I took on 2-4 new units of stress in DPC. BUT released 10 units, so this was 10 steps forward and 3-4 steps back, which is still a nice net 6-7 step improvement.
And although the autonomy of DPC means zero moral injury, now there is the risk of burnout (pure overwork,the real burnout, not the moral injury we used to incorrectly label as “burnout”.) Starting a DPC has to have a runway not just for financial success getting the plane off the ground, but you need to have a runway for your ability to hustle for the first years, because without doing so, and treating DPC like a vacation of some kind is doomed to leave your business with insufficient revenue and the plane will crash.
This was great! Loved the reality. DPC isn’t your solution when you want to run away from something. You have to want to run TO it.