The Future of Primary Care: Why Prospective Models Like DPC Are Growing
Primary care is at a crossroads.
On one side is the system most of you are working in now. It’s a bloated, insurance-driven system that is collapsing under its own weight. On the other side is the kind of medicine patients are begging for: accessible, personal, and relationship-centered.
The big question is: which way will we go?
The System We’re Leaving Behind
Right now, most primary care looks like this:
Panels of 2,000+ patients per clinician.
Appointments crammed into 10–15 minutes.
Mountains of coding, billing, and prior authorizations.
Rising burnout rates, with clinicians leaving primary care altogether.
Patients are paying more than ever, yet feel like they’re getting less. Clinicians are working harder than ever, yet feel like they’re drowning.
That’s not sustainable.
The Push Toward Prospective Payment
Nationally, there’s growing recognition that the fee-for-service model is broken. In fact, the National Academies of Science, Engineering, and Medicine (NASEM) recently concluded that FFS undervalues the full scope of high-quality primary care. This includes essential services like care coordination, team-based services, and non-visit work. The NASEM has called for hybrid models that include prospective payments.
The Medicare Payment Advisory Commission (MedPAC), which advises Congress, has also highlighted that Medicare’s current FFS payment system is unsustainable and has urged reforms to introduce prospective or hybrid payment structures .
Why? Because prospective payment:
Rewards prevention, not volume.
Supports smaller patient panels and continuity of care.
Lowers administrative waste.
In short, it gives primary care the resources to actually do its job.
Direct Primary Care: A Private-Sector Parallel
While policymakers debate reforms, clinicians don’t have to wait. Direct Primary Care (DPC) is already putting these principles into practice:
Monthly membership fees give clinicians predictable, recurring revenue.
Lower overhead (no insurance billing) makes practices sustainable on smaller panels.
Stronger access and continuity create better outcomes and happier patients.
In my opinion, DPC is the future of primary care made available right now.
Why This Matters for PAs
For Physician Associates especially, the future of primary care isn’t something to sit and watch unfold. It’s something you can step into today.
You don’t need to wait for scope-of-practice reform because DPC works within current laws.
You don’t need six figures in startup capital. You can start lean like I did. Low-overhead models are possible.
You don’t need permission from a system that undervalues you because you can build your own.
DPC offers a pathway to reclaim our profession’s original mission: accessible, continuous, patient-centered care.
The Bottom Line
Primary care in the U.S. is shifting away from volume-based, insurance-controlled medicine toward models that pay for value, continuity, and prevention.
For patients, that means care they can trust.
For clinicians, that means careers they can sustain.
For PAs, it means a chance to finally reclaim the profession’s future.
The future of primary care is clear. The only question left is: will you wait for it or will you build it?
Ready to step into the future of medicine now? Take Direct Primary Care - Direct Impact: The PA’s Roadmap to Freedom course to gain the step-by-step plan to launch your own DPC practice in less than 90 days with confidence!
References
National Academies of Sciences, Engineering, and Medicine. Improving Primary Care Valuation Processes to Inform the Physician Fee Schedule. Washington (DC): National Academies Press; 2025. Available from: https://nap.nationalacademies.org/catalog/29069/improving-primary-care-valuation-processes-to-inform-the-physician-fee-schedule
Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Medicare and the Health Care Delivery System. Washington (DC): MedPAC; June 2025. Available from: https://www.medpac.gov/wp-content/uploads/2025/06/Jun25_MedPAC_Report_To_Congress_SEC.pdf
Milbank Memorial Fund. The Health of US Primary Care: 2025 Scorecard Report — The Cost of Neglect. New York (NY): Milbank Memorial Fund; 2025. Available from: https://www.milbank.org/publications/the-health-of-us-primary-care-2025-scorecard-report-the-cost-of-neglect/
Centers for Medicare & Medicaid Services. CMS Innovation Center’s Strategy to Support High-Quality Primary Care. Baltimore (MD): CMS; 2022. Available from: https://www.cms.gov/blog/cms-innovation-centers-strategy-support-high-quality-primary-care
