The traditional fee-for-service model has pushed many primary care physicians to their limits—dozens of patients per day, mountains of insurance paperwork, and barely enough time to actually practice medicine. Direct Primary Care offers a fundamentally different path: a membership-based model that cuts out the insurance middleman, caps your patient panel, and lets you build the kind of practice you went to medical school to run.

If you’ve been thinking about making the switch—or starting fresh with a DPC model—this guide walks you through every major step, from the legal groundwork to your first 100 members.

What Is Direct Primary Care?

Direct Primary Care is a primary care delivery model in which patients pay a flat monthly (or annual) membership fee directly to their physician in exchange for unlimited or defined access to primary care services. There are no insurance claims, no co-pays at the point of care, and no per-visit billing.

Typical DPC membership fees range from $50 to $150 per month for adults, with lower rates for children and sometimes tiered pricing for seniors. In exchange, members get same-day or next-day appointments, direct access to their physician by phone or text, longer visits, and a more personal relationship with their doctor.

DPC practices typically cap their panels at 600 to 1,000 patients—compared to 2,000 to 2,500 in a traditional practice—which is what makes the model sustainable and the care genuinely different.

It’s worth distinguishing DPC from concierge medicine: concierge practices typically charge higher fees, bill insurance on top of the membership fee, and often cater to wealthier patients. DPC is designed to be affordable and accessible, with no insurance billing involved.

Is DPC Right for You?

Before you invest time and money into building a DPC practice, it’s worth doing an honest self-assessment. DPC is a strong fit if:

• You’re burned out on the volume and administrative burden of fee-for-service medicine
• You want longer, more meaningful appointments with fewer patients
• You’re entrepreneurially minded and comfortable with the business side of running a practice
• You can tolerate income variability in the early months while your membership base grows
• You believe in proactive, relationship-based primary care

It may not be the right fit if you’re risk-averse about income, uncomfortable with direct marketing and patient recruitment, or rely heavily on the referral volume and institutional support of a large health system.

Step 1: Learn the Legal Landscape in Your State

DPC operates in a legal gray area in some states. Because patients pay a monthly fee for medical services, some state insurance regulators have historically tried to classify DPC arrangements as insurance products—which would subject them to insurance licensing requirements that most physician practices can’t meet.

The good news: as of 2024, more than 30 states have passed DPC-specific legislation that explicitly exempts DPC agreements from insurance regulation. Before you proceed, you need to know where your state stands.

Actions to take:

• Search your state’s insurance department website or legislature for DPC-specific statutes
• Consult a healthcare attorney familiar with your state’s laws before drafting any membership agreement
• Review the Direct Primary Care Coalition’s state legislation tracker for an up-to-date map of state DPC laws

This legal foundation affects how you structure your membership agreement, how you price your services, and what services you can include in your membership versus what must be billed separately.

Step 2: Define Your Business Model

Once you understand the legal framework, you need to make several core business decisions before you spend a dollar on anything else.

Membership Pricing

Your pricing needs to cover your overhead, pay your salary, and remain attractive enough that patients choose you over traditional insurance-based care. Most DPC practices use age-tiered pricing:

• Children (0–17): $20–$50/month
• Adults (18–44): $60–$90/month
• Adults (45–64): $80–$120/month
• Adults (65+): $100–$150/month

Some practices offer family caps (e.g., no family pays more than $250/month regardless of size), which can be a powerful selling point for young families.

When setting your prices, work backward from your target income. If you want to net $200,000 annually and your overhead is $120,000, you need to generate $320,000 in membership revenue. At $75/month average per member, that’s about 356 members. At $100/month average, it’s 267 members. These numbers help you set realistic enrollment targets.

Panel Size

Determine the maximum number of members you want to carry. Most solo DPC physicians aim for 600–800 members at steady state. Starting lower—say 300–400—and growing intentionally is better than overloading your panel and losing the very thing that makes DPC worth doing.

Services Included vs. Billed Separately

Your membership fee covers primary care services. Be explicit about what’s included:

• Unlimited office visits (in-person and telehealth)
• Preventive care and annual physicals
• Chronic disease management
• Minor procedures (suturing, skin biopsies, joint injections—varies by physician)
• Care coordination and referral management
• Direct physician access by phone, text, or email

Things that are typically not included and should be billed separately or handled through insurance or a health-sharing plan:

• Lab work (though many DPC physicians negotiate deeply discounted wholesale lab pricing for members)
• Imaging and specialist visits
• Hospitalizations
• Prescriptions (though many DPC docs dispense generics at wholesale cost)

Ancillary Revenue Streams

Some DPC practices supplement membership revenue with:

• Employer contracts (small businesses pay membership fees for their employees)
• Wholesale medications dispensed in-office
• Negotiated lab and imaging pricing passed through to members at cost
• Occupational health services

Employer contracts in particular can be a powerful growth lever—a single employer with 20 employees can add significant monthly revenue and fast-track your path to sustainability.

Step 3: Handle the Business Formation and Compliance Basics

Starting a DPC practice means starting a business. You’ll need to work through the following before seeing your first patient.

Business entity: Most DPC physicians form a Professional Corporation (PC) or Professional Limited Liability Company (PLLC), depending on their state’s requirements for medical practices. An attorney should handle this.

Employer Identification Number (EIN): Obtain this from the IRS—it’s free and straightforward to apply for online.

Medical license and DEA registration: You likely already have these, but confirm they’re current and active in the state where you’ll practice.

Malpractice insurance: You’ll still need malpractice coverage. Tail coverage (if leaving a previous practice) can be a significant upfront expense—budget for it. Some DPC-friendly malpractice carriers offer lower premiums because DPC physicians have fewer patients, stronger relationships, and lower claim rates.

NPI number: You’ll keep your existing NPI. Even though you won’t bill insurance for primary care services, your NPI may still be needed for lab ordering, referrals, and e-prescribing.

Opt out of Medicare (if applicable): If you have Medicare patients, you’ll need to formally opt out of Medicare to practice DPC with them. This requires filing an affidavit with your Medicare Administrative Contractor (MAC) and having patients sign private contracts. This is a permanent decision for two years and should be made carefully. Consult a healthcare attorney before proceeding.

HIPAA compliance: Even without insurance billing, you’re still subject to HIPAA. Ensure your electronic communications, EHR, and data storage meet HIPAA requirements.

Step 4: Set Up Your Physical Space

One of the most liberating aspects of DPC is that you don’t need a large, expensive medical office. Many successful DPC practices operate out of surprisingly modest spaces—because you’re not trying to move 25 patients through the door every day.

Space considerations:

• 1,000 to 2,000 square feet is typically sufficient for a solo DPC practice
• You’ll want at least one exam room, a private consultation area, and a waiting area (though many DPC practices are minimalist on waiting room space—patients often aren’t waiting long)
• Some physicians start in shared medical office spaces or sublease from another practice to reduce overhead while building their panel
• If you plan to dispense medications or run a small lab in-house, factor in the additional space and compliance requirements

Location matters for visibility. Being on a main road, near a gym, near employers, or in a walkable neighborhood can meaningfully affect how many people discover your practice. Visibility and easy parking matter more for a DPC practice than they might for a referral-driven specialist. Being easy to find online matters just as much—patients searching for a primary care provider near them need to be able to find and book with you. How to find a primary care doctor is often the first search a potential new member runs—make sure your practice shows up.

Step 5: Choose Your Technology Stack

Running a DPC practice efficiently requires the right set of tools. The good news is you don’t need the bloated, insurance-billing-focused EHR systems that burden traditional practices. You need a lean, patient-friendly setup.

Electronic Health Record (EHR)

Choose an EHR designed for or compatible with DPC workflows. Popular options among DPC physicians include:

• Elation Health — widely used in DPC, strong on care documentation and patient communication
• Hint Health — a DPC-specific platform that combines membership management with clinical features
• Atlas MD — built specifically for DPC, includes medication dispensing and lab ordering features
• Spruce Health — used by some DPC practices primarily for secure patient communication

Avoid legacy EHRs built around insurance billing—they’ll add administrative complexity you don’t need.

While choosing the right EHR is important, many independent practices also need help with cloud hosting, managed IT services, cybersecurity, practice management software, medical billing, and ongoing technical support. Working with an experienced healthcare technology partner like Microwize Technology can simplify launching and managing a modern primary care practice.

Membership Management Software

You’ll need a system to manage memberships, billing, and payments. Hint Health is the most widely used DPC-specific platform. It handles recurring payments, membership agreements, and enrollment workflows, and integrates with many EHRs.

Patient Communication

DPC’s value proposition includes direct access to your physician. You need a secure, HIPAA-compliant way for patients to reach you by text or message. Spruce Health, OhMD, and similar platforms are purpose-built for this.

Online Scheduling and Visibility

Even in a membership model, you need a way for prospective members to find you and for existing members to book appointments easily. Being listed on a platform like Vosita gives your practice online visibility and lets patients book appointments directly—helping you attract and convert the new members you need to grow your panel.

Step 6: Draft Your Membership Agreement

Your membership agreement is the legal foundation of your DPC practice. It defines the relationship between you and your patients, what’s included and excluded, how billing works, and how either party can terminate the agreement.

Key elements to include:

• Services covered under the membership fee—be specific
• Services not covered and how those will be handled
• Monthly fee amount and payment terms
• Termination provisions — how either party exits the agreement and with how much notice (typically 30 days)
• Acknowledgment that DPC is not insurance — patients should understand they still need insurance or a health-sharing plan for hospitalizations, specialist care, and other services not covered by the membership
• Limitation of liability provisions
• HIPAA acknowledgment

Have a healthcare attorney draft or review this document before you use it with patients. Using a template from the internet without legal review is a significant risk.

Step 7: Build Your Patient Panel

Here’s the hard truth about DPC: the medicine is the easy part. Building a panel from zero is the part that trips up most new DPC physicians. You’re essentially building a small business from scratch, and growth rarely happens on its own.

Start With Who You Know

If you’re transitioning from a traditional practice and your patients follow you, you’re starting with a major advantage. Be transparent with your current patients about the transition—give them ample notice, explain the new model clearly, and make enrollment easy.

If you’re starting truly from zero, your initial patient base will come from:

• Personal network — friends, family, neighbors, colleagues
• Community presence — local events, talks at community centers, church groups, neighborhood associations
• Employer outreach — small businesses are underserved by traditional insurance and are often receptive to DPC as a benefit
• Referrals from existing members — once you have even 20–30 members who love the model, they will recruit for you

Market Your Practice Intentionally

DPC physicians often resist the word “marketing,” but patient acquisition doesn’t happen passively. You need:

• A professional, clear website that explains DPC and makes it easy to sign up or schedule a meet-and-greet
• An active Google Business Profile so you appear in local searches
• Positive online reviews from early members
• A presence on platforms where patients search for primary care providers

For more on this, see our guide on how to market your primary care practice.

Target Employers Early

Employer contracts can dramatically accelerate panel growth. A small business owner with 15 employees who covers DPC memberships as a benefit can add 15–30 members (employees plus families) in a single conversation.

Identify small and mid-sized employers in your area—especially those without group health insurance or with high-deductible plans—and offer to do a lunch-and-learn to explain the model. Pair the DPC membership with a health-sharing plan or catastrophic insurance, and you’ve created an affordable, comprehensive benefits package that beats what most small businesses can offer through traditional insurance.

Step 8: Plan Your Financial Runway

Most DPC practices take 12 to 24 months to reach financial sustainability. Plan accordingly.

Startup costs typically include:

• Legal fees (entity formation, membership agreement): $2,000–$5,000
• Office lease and build-out: highly variable; $0 if subleasing, up to $50,000+ for a full build-out
• EHR and technology: $200–$800/month in subscriptions
• Medical equipment: $5,000–$20,000 depending on what you already have
• Malpractice insurance: $5,000–$15,000/year
• Tail coverage (if leaving a previous practice): potentially $10,000–$50,000
• Marketing and website: $2,000–$10,000
• Working capital reserve: 6–12 months of personal living expenses

Revenue ramp: At $85/month average per member, 100 members generates $8,500/month—probably not enough to pay yourself and cover overhead. At 300 members, you’re at $25,500/month. At 600 members (typical steady-state), you’re at $51,000/month ($612,000 annually)—from which you subtract overhead to arrive at your take-home.

Plan for a lean first year. Many DPC physicians moonlight in urgent care, telemedicine, or locum work during the ramp-up period to bridge the income gap.

Frequently Asked Questions

Do DPC patients still need health insurance?

Yes—and you should make this very clear to members. DPC covers primary care only. Patients still need insurance, a health-sharing plan, or another mechanism to cover hospitalizations, specialist visits, surgeries, and other high-cost services. DPC pairs particularly well with high-deductible health plans (HDHPs), which have lower premiums and let patients use their DPC membership for the everyday care that would otherwise eat through their deductible.

Can I see Medicare patients in a DPC practice?

Yes, but with significant caveats. You must formally opt out of Medicare for your DPC services and have each Medicare patient sign a private contract acknowledging they cannot submit claims to Medicare for your services. Some DPC physicians choose not to see Medicare patients to avoid this complexity. Consult a healthcare attorney before making this decision.

Is DPC only for wealthy patients?

No—this is one of the most persistent misconceptions about the model. A DPC membership at $75–$100/month is comparable to a gym membership or streaming subscription. For patients with high-deductible plans or no insurance, DPC often costs less than what they’d pay for a single specialist visit. The model is designed to be accessible, not exclusive.

How is DPC different from concierge medicine?

Concierge practices charge higher annual fees (often $1,500–$10,000/year), typically maintain insurance billing alongside the membership fee, and often serve a smaller, higher-income patient population. DPC charges lower monthly fees, eliminates insurance billing entirely, and is designed to be broadly affordable. Learn more about what a membership primary care practice looks like and how the models compare.

How long does it take to build a full panel?

For most physicians starting from zero, reaching a sustainable panel of 400–600 members takes 18 to 30 months. Physicians who transition from an existing practice with patients following them can reach sustainability significantly faster—sometimes within 6 to 12 months.

The Bottom Line

Starting a Direct Primary Care practice is one of the most rewarding paths available to primary care physicians today—but it’s not a passive transition. It requires legal preparation, financial planning, deliberate patient recruitment, and a genuine comfort with running a small business.

The physicians who thrive in DPC are the ones who treat both the clinical and business sides of the practice with equal seriousness. Get the legal foundation right. Price your membership to be sustainable. Invest in technology that makes your practice easy to find and easy to join. And build your panel one relationship at a time.

If you’re ready to take the next step, start by making sure patients in your area can find you. Explore how other independent primary care physicians are growing their practices and what it takes to build a patient base that sustains the practice you actually want to run.