From 2018 to 2023, the number of concierge and direct primary care practices grew, and there was a substantial shift away from independent ownership.
So finds a new study published in Health Affairs this month. It aimed to analyze and define the characteristics of concierge and direct primary care practices, doing so based on a sample of national provider-level data. The number of concierge and direct primary care practices grew by 83% and the number of clinicians participating in them by 78%.
“We observed substantial growth in the number of both practices and clinicians participating in concierge and direct primary care models, which has potential ramifications for the workforce and access to care,” the researchers wrote.
Meanwhile, when it comes to ownership, the share of independently owned practices dropped from 84% to 60%, while the number of corporate-affiliated practices grew by a whopping 576%. Corporate owners were defined in the study as for-profit groups that do not include hospitals and health systems.
The U.S. is projected to face a shortage of up to 86,000 primary care docs by 2036. Clinicians are worried about the traditional primary care model’s shortcomings, the study noted, including growing admin burdens, growing patient complexity and low reimbursement rates. Newer models that have emerged include smaller practices and more personalized care, which the study calls concierge and direct primary care.
These practices were the focus of the study. As defined in the paper, concierge practices, which have smaller patient panels, more availability and more personalized services, charge an annual retainer fee and bill insurance. By contrast, direct primary care practices— while generally having similar characteristics—operate entirely cash-pay.
The study found that the portion of doctors in these practices declined over time, while the number of advanced practice clinicians increased. It also found that nearly 30% of the entering doctors came from health systems or integrated delivery networks. A smaller, still notable share came from corporate-owned or affiliated settings and independent practices. Relatively few came from federally qualified health centers. This may be due to structural factors like loan repayment obligations, but may also “reflect the relative durability of the safety-net workforce” despite burnout and staffing issues, the study said.
Physicians’ interest in these practices has been linked to dissatisfaction with traditional primary care settings, the study noted. The newer models offer burnt-out clinicians smaller patient panels, fewer admin burdens around billing and more clinical autonomy. The rapid growth in these types of practices suggests “sustained and notable workforce interest in these models of care,” the researchers concluded.
But at the same time, the model was originally conceived as a way of preserving independent practice, the study acknowledged, and the finding about the meteoric rise in corporate ownership is a sharp contrast to that. This “could alter some of the elements that most attract clinicians” to these types of practices.
President Trump’s One Big Beautiful Bill Act includes provisions that expand the use of HSAs to direct primary care, which may increase access to primary care, the study said. Some states have also enacted specific laws to regulate direct primary care models. More evidence is needed to help inform policies about these models as they continue to expand, per the study.
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