By World Health Innovation Summit (WHIS)
Primary care in the United States is undergoing a profound shift. New research shows a dramatic increase in concierge medicine and direct primary care (DPC) practices—membership-based models that promise more personalised, accessible care for patients and reduced administrative burden for clinicians. While these approaches may improve experiences for some, they also raise important questions about equity, access, and the sustainability of primary care for all Americans.
Rapid Growth of Fee-Based Primary Care
A recent study published in Health Affairs, led by researchers from Johns Hopkins University, Harvard Medical School, Oregon Health & Science University, and the Johns Hopkins Bloomberg School of Public Health, highlights this trend.
Between 2018 and 2023:
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The number of concierge and DPC practices increased by 83.1%
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The number of clinicians working in these models grew by 78.4%
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Practice sites rose from 1,658 to 3,036
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Clinicians expanded from 3,935 to 7,021 📄** Original Study: Polsky D. et al.,* Health Affair*s (2025) DOI**: 10.1377/hlthaff.2025.00656** Source**: Johns Hopkins University
What Defines These Models?
Both concierge and direct primary care aim to deliver more personalised, patient-centred services:
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Concierge medicine typically involves an annual retainer fee, which can range from several thousand to tens of thousands of dollars, while still billing insurance for clinical services.
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DPC practices charge a monthly or annual membership fee and operate entirely outside the insurance system. Patients often benefit from:
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Longer, unrushed consultations
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Ready access to their clinician
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Enhanced continuity of care For clinicians, these models often mean:
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Smaller patient panels
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Reduced administrative work
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Greater professional autonomy
Drivers of Change: Burnout and Professional Satisfaction
The study suggests that clinician burnout and dissatisfaction in traditional primary care are key drivers of the shift toward fee-based practices. As co-author Dan Polsky, professor at the Johns Hopkins Carey Business School and Bloomberg School of Public Health, observes:
“Concierge and direct primary care models, in comparison to traditional primary care settings, offer clinicians smaller patient panels and increased clinical autonomy, which may improve job satisfaction and extend career longevity.”
For clinicians seeking greater control over their schedules and work-life balance, these models are increasingly appealing.
Concerns About Equity and Access
Despite potential benefits, researchers warn that the expansion of concierge and DPC could contribute to widening inequities in primary care access. Because these practices often cater to higher-income patients who can afford membership fees, they may draw clinicians away from traditional practices that serve broader, insurance-dependent populations.
Polsky cautions:
“We have to consider how the growth of these models may affect access to primary care for the vast majority who can only afford the care covered by their insurance plan.”
This trend could deepen the already significant shortage of available primary care physicians in conventional care settings.
Corporate Ownership and Future Implications
Another key finding is the growing influence of corporate ownership: practices affiliated with larger corporate entities increased by 576% over the study period. While corporate backing may enable lower membership fees and broader reach, it could also transform the personalised character that defines these models.
Global Perspectives: What This Means Beyond the U.S.
From a global health innovation standpoint, the U.S. experience offers valuable lessons about new care delivery models, workforce wellbeing, and the balance between personalisation and equitable access.
Gareth Presch, CEO of WHIS and the Global Social Prescribing Alliance, reflects:
“The rise of concierge and direct primary care highlights a universal truth: people and clinicians both want health systems that are personal, respectful, and supportive. But innovation must not come at the cost of equity. Around the world, we need models that bring personalised care into communities — not away from them. Approaches like social prescribing and neighbourhood health demonstrate that you can deliver whole-person care that is both accessible and preventative. The challenge now is to ensure that new models enhance health for all, not just a privileged few.”
From Fee-Based Models to Community-Centred Care
While concierge and DPC practices reflect important innovations—such as smaller patient loads and emphasis on relational care — they also underline the risk of fragmentation if adoption is not paired with broader system reform.
In contrast, models like neighbourhood health and social prescribing demonstrate how personalised, community-anchored support can expand access to holistic care without creating parallel systems that leave the most vulnerable behind.
Neighbourhood health emphasizes:
- Addressing social determinants of health
- Connecting people to community resources
- Supporting prevention and wellbeing alongside medical care These approaches, championed globally through the GSPA Playbook, offer a blueprint for systems seeking to balance personalisation, equity, and sustainability.
Conclusion
The rapid expansion of concierge and direct primary care in the U.S. reflects deep pressures and unmet needs within primary care. As health systems worldwide navigate workforce burnout, rising demand, and cost pressures, it is essential to explore innovations that enhance care without sacrificing equity and access.
By learning from diverse models—including fee-based practices, neighbourhood health initiatives, and social prescribing—policymakers and practitioners can help shape health systems that are equitable, sustainable, and truly person-centred.
References
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Polsky D. et al. (2025). Health Affairs. DOI: 10.1377/hlthaff.2025.00656
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Johns Hopkins University