By Sherami Tsai
For months, Trampus Braaten was trapped in a cycle of dizziness, headaches, and anxiety. A sudden bout of vestibular neuritis—an inner ear condition—left him unable to drive, struggling to function, and desperate for answers. Even his wife, a doctor, couldn’t cut through the long waits, rushed appointments, and slow-moving referrals.
For nearly three months, he saw his primary care doctor, but the visits were brief, and progress stalled. An MRI and neurology consult—both critical for his diagnosis—had to be scheduled within his doctor’s system, leading to further delays.
Then, he switched to direct primary care (DPC). For $100 a month, he gained unlimited visits, 24/7 access to a doctor, and faster referrals. His new physician spent over an hour with him on their first visit and personally followed up on his case. Within weeks, he had the scans and specialist appointments he had been waiting months for.
For the first time, Braaten felt like someone was truly invested in his recovery.
“The biggest thing for me is access,” he told The Epoch Times. “It’s medicine simplified. It’s what medicine was meant to be.”
His story is part of a growing shift in American health care. Frustrated by long waits, rushed visits, and insurance bureaucracy, more patients are paying out of pocket for membership-based care.
These models—DPC and concierge medicine—bypass traditional insurance. Instead, patients pay a monthly or annual fee for direct access to their doctor, longer appointments, and fewer bureaucratic hurdles. DPC typically charges monthly fees and doesn’t bill insurance, while concierge medicine often combines annual membership fees with insurance billing for covered services.
Supporters say these models make health care more personal and effective. Critics worry they could worsen the physician shortage and deepen disparities between those who can afford better access and those left behind.
Critics call DPC a luxury for the wealthy, but Braaten disagrees. “If you put it into perspective, it isn’t much more expensive than your internet provider.”
Why Physicians Are Leaving Traditional Care
Primary care has become a numbers game. Doctors juggle 2,000 to 3,000 patients, racing through 18-minute appointments—barely enough time to diagnose, let alone build relationships. By one estimate, primary care clinicians would need 27 hours a day to provide all recommended preventive, chronic, and acute care for their patients.
Instead of focusing on care, they’re buried in insurance codes and prior authorizations—hoops they must jump through just to get approval for tests, medications, or specialist referrals—plus endless paperwork.
“The constant pressure to see one patient after another made me realize I was only treating immediate problems,” Dr. David Wright, an internist who transitioned into a direct pay model after 35 years in traditional medicine, told The Epoch Times. “I went into medicine to improve lives, not just manage disease.”
The result? Burnout, frustration, and a growing exodus from traditional practice. More than half of primary care physicians report feeling burned out, citing insurance red tape as a major factor. The American Medical Association estimates doctors spend 20 hours per week on insurance preauthorizations.
Doctors now spend more time on paperwork than patient care. Research shows that nearly half of a primary care physician’s workday—about 4.5 hours—is spent on electronic health records, handling documentation, billing, and insurance-related tasks. Another 1.4 hours often spills into after-hours work. With so much time spent on clerical duties instead of patients, burnout is on the rise.
“I probably spent a third of my workweek just on charts,” Wright said. “The rest was actually seeing patients.”
Frustrated by bureaucracy, more doctors are turning to direct primary care. Instead of battling insurance, DPC physicians charge a flat monthly fee—typically $50 to $150—for unlimited visits, longer appointments, and direct phone, text, or video access.
“I went from 10 or 15-minute visits to 45-minute conversations,” Wright said. “That changes everything.”
For many doctors, this shift restores the job satisfaction they had lost. According to the American Journal of Lifestyle Medicine, between 2015 and 2021, DPC practices grew more than tenfold. Today, more than 2,300 DPC practices serve more than 300,000 patients across 48 states and Washington, D.C.
More Time, More Attention–And Better Care
For doctors, membership-based care offers a major advantage: time. With fewer patients, they can spend more time with each individual, focus on prevention, and bypass insurance-related hurdles.
“The biggest change was how much time I got back,” said Wright.
With an average of 413 patients per doctor, DPC practices offer same-day visits, personalized follow-ups, and even the occasional house call—perks rarely found in traditional primary care.
Dr. Dorothy Cohen Serna, who shifted to a concierge model in 2017, describes her practice as “everyday concierge,” a more affordable alternative to luxury concierge care. Like DPC, concierge medicine prioritizes longer visits and direct doctor access, but it allows patients to use insurance for covered services.
Serna describes it as a model built on relationships, not quick fixes. “Patients want a doctor who truly knows them and partners with them long-term,” she told The Epoch Times. “Real health care isn’t just about handing out pills. It’s about prevention, coaching, and behavior change. And that takes time.”
Both models reduce unnecessary urgent care and specialist visits. Research suggests that patients in membership-based care make fewer ER trips. One study found a 40 percent lower ER visit rate among DPC patients than those in traditional insurance-based care.
“When patients can text or video chat their doctor, they don’t panic and rush to the ER over minor concerns,” Dr. David Hyatt, an emergency physician who opened up his own DPC practice, told The Epoch Times.
Empowering Patients
For many patients, the benefits of DPC and concierge medicine go beyond convenience. With more time to spend with their doctor, they become active participants in their health rather than passive recipients of care.
Hyatt has seen how better access to physicians leads to better outcomes.
“I had a patient who put off a colonoscopy for years, but after an hour-long conversation, he finally scheduled it.”
This level of engagement extends to everyday health decisions. Hyatt recalled another patient who initially refused lab work, feeling anxious about the results. Instead of pushing him, Hyatt let the patient set the pace.
“He told me, ‘I don’t want you to order any labs yet.’ I said, ‘Okay. When do you want to come back?’ He set his own timeline, came in three weeks later, and then decided on his own terms to get them done. He feels like he’s in control.”
The extra time doctors spend with patients allows for deeper conversations about lifestyle and prevention, sometimes reducing the need for medication.
“I have patients who were on the verge of needing blood pressure medication, but with lifestyle changes, they didn’t need it. That’s the kind of care we can provide when we’re not racing through appointments.”
Serna agrees, noting that many chronic conditions, such as Type 2 diabetes and hypertension, are largely lifestyle-driven.
“The difference is that in our model, we have the time to talk about real solutions,” she said. With direct physician access, patients also stay more engaged in tracking their health—from monitoring weight loss to optimizing cholesterol and sleep.
“This is health care the way it should be,” Hyatt said. “Not just treating problems, but preventing them.”
The Doctor Shortage Debate
Critics argue that membership-based care models, with their drastically smaller patient pools, could worsen the country’s physician shortage, leaving millions without access to care.
“If all physicians migrated over to DPC, we would need literally five times as many physicians as we have today,” Dr. Edmond Weisbart, a family physician and health policy expert, told The Epoch Times. “The country cannot afford the cost—or multi-decade delay—of training up that many more physicians.”
At the same time, fewer medical students are entering primary care, instead choosing higher-paying specialties with better work-life balance. According to a 2022 study, only about 30 percent of U.S. medical graduates enter primary care, a number that has remained stagnant despite rising demand.
Some argue that membership-based care could actually help reverse this trend. Hyatt thinks that if primary care doctors were fairly compensated and allowed to focus on patient care instead of paperwork, more students would enter the field.
“If doctors could actually do the job they went to medical school for—seeing fewer patients but providing better care—you wouldn’t have a shortage. In 20 years, there’d be no shortage.”
Supporters also say that DPC’s emphasis on prevention and early intervention could ease the overall strain on the health care system.
“If we can prevent the epidemic of avoidable chronic diseases, we reduce the overall demand on the health care system,” said Wright. “In the long run, that could help ease the physician shortage rather than worsen it.”
Weisbart remains unconvinced.
“This is intuitively attractive, but I’ve not come across any well-controlled economic data validating this.”
Who Gets Left Behind?
Beyond concerns about the physician shortage, some fear that membership-based care will deepen inequalities in health care access.
The American College of Physicians warns that DPC and concierge medicine could create a “two-tiered” system—one where wealthier patients receive personalized care while lower-income individuals remain in overcrowded traditional practices. A JAMA commentary echoed this concern, suggesting that these models may unintentionally favor healthier, higher-income patients while leaving those with greater medical needs behind.
Serna pushes back against the idea that DPC worsens disparities.
“People already pay a lot of money for insurance, yet they still can’t get the care they need,” she said. “If you offer people a way to see their doctor and get the care they need, that’s better—not worse.”
She also argues that membership-based care isn’t as financially out of reach as critics suggest. “$100 to $200 a month for unlimited primary care isn’t unrealistic for most families, especially compared to everyday expenses like dining out or entertainment.”Ultimately, Weisbart sees DPC as a symptom of a broken system, not a cure.
“It’s easy to understand DPC as a solution that provides physicians with a more sustainable lifestyle. But it’s hard to envision it as a solution that aligns with broad population goals of universal access to first-dollar coverage of high-quality, comprehensive health care.”
Cost Savings?
One of the biggest questions surrounding membership-based care is whether it truly saves patients money. While some see it as an added expense, others consider it an investment in better care.
Allen Begnoche, a longtime patient in traditional primary care, switched to a concierge doctor after his physician of 42 years abruptly closed his practice. “I see it as more of an investment in my own health care,” he told The Epoch Times.
For many, the savings start with everyday care. With no copays for office visits and many practices offering lab work and medications at wholesale prices, patients can avoid inflated fees and surprise bills. For those with high-deductible insurance plans, a flat monthly fee may cost less than paying out-of-pocket for multiple visits each year, explained Hyatt.
Hyatt negotiates directly with labs to secure lower prices for his patients, offering a full panel of annual blood work for just $41. By contrast, when his wife had similar tests done under their traditional insurance plan, their out-of-pocket cost was $75—even after meeting their deductible. “It costs the patient $41 for the entire yearly testing that we would do,” he said, highlighting how DPC can eliminate inflated pricing and unexpected bills.
Still, membership-based care isn’t a replacement for insurance. Patients remain responsible for hospitalizations, surgeries, and specialized care. A heart attack, cancer diagnosis, or major injury could leave them facing steep out-of-pocket costs without additional coverage.
“Most of my patients still carry some form of insurance, usually a high-deductible or catastrophic plan,” Hyatt said. “They use DPC for everyday care, but if something serious happens—like a hospitalization or surgery—they have coverage for that. It’s a way to keep premiums low while still having access to quality primary care.”
For some, the financial trade-off makes sense. However, for others, the added cost of both a membership fee and insurance makes the model impractical. While it simplifies primary care, it doesn’t eliminate the need for traditional coverage—leaving some patients priced out.
Begnoche acknowledges the affordability concern but sees it as more nuanced. “If you include out-of-pocket costs for office visits and include a price for your time away from work to make appointments, etc., then perhaps the difference is not as acute.”
Gaining Momentum
Membership-based care is expanding beyond individuals. Employers are beginning to offer it as a health care benefit, betting that better access to primary care will reduce costly ER visits, hospitalizations, and specialist referrals.
According to Hint Health, companies structure these benefits in different ways. Small businesses with fewer than 50 employees may offer DPC as a standalone benefit or alongside cost-sharing plans. Larger, self-insured employers use these models to curb health care spending while boosting employee health and retention. Even fully insured companies are adding membership-based care to help workers manage high out-of-pocket costs.
Policymakers and insurers are also taking notice. The Affordable Care Act allows these practices to be included in insurance exchanges, but only when paired with a high-deductible health plan.
New legislation could broaden its reach. A bill in Congress—the Primary Care Enhancement Act—aims to let patients use health savings accounts to pay for membership-based care, making it more accessible to those with employer-sponsored insurance. While similar bills have stalled since 2015, the latest version has bipartisan support and may gain traction under the current administration.
For now, membership-based care remains largely unregulated, operating outside the traditional insurance system. This independence is part of its appeal but also raises concerns about long-term sustainability and whether it could widen disparities in health care access.
Yet for those who have made the switch, the appeal isn’t just about shorter wait times or longer appointments—it’s about restoring a sense of trust and familiarity in medicine.
Hyatt compared the model to something deeply familiar. “It’s like having a doctor in the family. Someone who cares, picks up the phone when you call, and is there when you need them.”
