April 17, 2025
By Teresa Lovins, M.D., FAAFP
AAFP Board Member
As a family physician with more than 30 years of experience, I once thought I would have to retire earlier than expected — not by choice, but out of mounting frustration with the fee-for-service environment.
The practice of medicine had become overwhelming, with rushed patient visits, endless box-checking for “quality metrics,” and frequent referrals for simple conditions due to time constraints with my patients. I referred one patient to a dermatologist for a basic skin lesion removal, not because I lacked the skill but because my packed schedule did not allow me time to do it myself.
This was not the medicine I had trained for.
I missed doing that procedure, which is part of practice I enjoy. Worse, the patient was forced to make another appointment for another visit with another doctor and pay another bill.
The extra steps are so unnecessary.
At the time, I worked in a group practice owned by the local hospital. With that ownership came patient quotas. Each patient was limited in their visit complaints so I could move on to the next patient. Even without procedures, I was always falling behind and never seemed to catch up. I was overwhelmed, burned out and wavering on leaving clinical medicine when I was introduced to direct primary care.
In direct primary care, patients pay a reasonable monthly membership to have direct access to their physician. Longer visits, quicker access and comprehensive care replaced the rushed, impersonal encounters of my old FFS practice. With a smaller patient panel, DPC doctors can focus on whole-person care and minimize unnecessary referrals with a broad scope of practice.
Now in my DPC practice, I can truly care for my patients. If someone comes in for one issue but mentions a bothersome skin tag as an afterthought, I can take care of it on the spot. No need for a separate appointment or referral.
This is what medicine should be.
The roots of DPC trace back to the early 2000s, when a handful of primary care physicians sought an alternative to the traditional fee-for-service and insurance-based models. Frustrated by bureaucratic red tape and diminishing time with patients, these pioneers created a system where patients would pay their physicians directly through a flat monthly fee, eliminating the need for insurance billing.
One of the earliest and most notable DPC practices, Qliance, was founded in 2007 by Garrison Bliss, M.D., in Seattle. His vision was simple: Restore the direct patient-doctor relationship and make high-quality primary care more accessible. Around the same time, other physicians across the country were independently developing similar models. By the early 2010s, the terms “direct primary care” and “DPC” had gained traction, distinguishing itself from concierge medicine, which still involves insurance billing.
The passage of the Affordable Care Act in 2010 further legitimized DPC by explicitly recognizing it as a viable health care model. Since then, the movement has grown exponentially. Today, there are more than 2,500 practices across the United States.
Five years ago, just before the COVID pandemic, I left my job in an employee-based wellness clinic and founded my own DPC practice, Lovin My Health DPC, in my hometown of Columbus, Indiana. It was the kind of family medicine practice I had envisioned back in medical school — patient-centered, fulfilling and sustainable.
One of my first DPC patients was a young woman who said she was always sick. I asked more questions during that first visit than she had ever been asked about her health history. I recognized that there likely was something concerning in her immune system when her mom noted she had been diagnosed with chicken pox two times, with the second episode occurring after she received a second dose of varicella vaccine. I sent her to the lab for testing, and she was found to have a complete IgA deficiency. I would not have been able to investigate her history and help her without the time needed for a thorough evaluation. Time is what I wanted and needed for my patients and myself.
Building my own practice meant learning the business side of medicine, something I had been interested in but never had the opportunity to explore. Along the way to opening my new office, I connected with a community of physicians in the AAFP’s Direct Primary Care Member Interest Group eager to share their experiences and insights, helping me navigate this model of care.
Resources abound to help you get started in direct primary care. The AAFP has online resources, and the Academy is a co-sponsor of the DPC Summit.
Have you ever attended a medical conference where everyone is genuinely happy? That’s exactly what I found at the DPC Summit in Kansas City in 2022. The Summit is an incredible mix of learning, networking and celebration. I gained valuable knowledge on starting and growing my DPC practice. I heard success stories from fellow physicians and learned how to avoid common pitfalls. After the isolation of COVID, the event was a much-needed opportunity to reconnect with like-minded colleagues.
If I hadn’t discovered DPC, I might have left medicine altogether. Now, I can’t imagine practicing any other way. DPC has restored my passion for patient care, allowing me to provide personalized, flexible and sustainable medicine. I’m not alone — many physicians who turned to DPC say they would have otherwise left clinical practice.
DPC nearly eliminates any insurance involvement. Some hybrid DPC practices do continue to bill Medicaid and/or Medicare. The ability to remove insurance billing from my practice allows me to keep overhead costs low and maintain financial stability. I know exactly what my income will be — whether or not a patient visits my office.
Patients benefit from
The success of DPC has inspired a direct specialty care movement, where specialists also offer cash-pay services. During the past decade, DPC has grown exponentially, breathing new life into family medicine. Today, hundreds of family physicians across the country have transitioned to DPC, finding greater satisfaction in their work and a deeper connection with their patients.
If you’re curious about DPC, thinking of starting your own practice, or eager to share your expertise, I invite you to the DPC Summit July 24-27 in New Orleans. I will be there to share the experience and the community of direct primary care.
Let’s continue redefining what it means to practice medicine.
