80% of Primary Care Doctors Are Worried About Money. One in Four Already Offers Membership Care.

You don’t need a survey to know that running a primary care practice feels harder than it used to. But now there’s data to back up what you’ve been saying at every medical conference, every residency happy hour, and every practice owner group chat.

Elation Health just published its Primary Care Pulse survey, and the headline number is blunt: 80% of primary care physicians are concerned about their long-term financial sustainability. Among 280 clinicians surveyed, 64% pointed to reimbursement from government and commercial payers as their single biggest financial pressure.

That’s not surprising. What is surprising is what these doctors are doing about it.

They’re Not Waiting for Permission

The conventional narrative about primary care is one of slow decline. Reimbursements shrink, panels grow, visits get shorter, and doctors either consolidate into health systems or leave medicine entirely.

This survey tells a different story. Among physicians who accept insurance, 27% already include membership or cash-pay models in their practice. Another 18% have adopted value-based payment arrangements. And 69% say they’re actively developing plans to diversify revenue through new payment models, new locations, or expanded care offerings. Two-thirds of those plan to act within two years.

“Independent primary care physicians aren’t waiting for the system to change; they’re taking action,” said Dr. Sara Pastoor of Elation Health.

That 27% figure deserves a closer look. More than one in four independent PCPs are already offering some form of direct-pay or membership care alongside their insurance-based practice. A few years ago, that would have been a rounding error. Now it looks like a structural shift.

The Burnout Paradox

National physician surveys regularly report that 40-50% of doctors are considering leaving clinical practice. In this survey, that number is 2%.

The difference might come down to who was surveyed. These are independent physicians on a platform designed for independent practice. They’ve already opted out of the hospital employment track. And despite the financial pressure, 80% report feeling joy in their work daily or throughout every week. 93% say they’re committed to primary care.

Financial stress and professional satisfaction can coexist, apparently. Doctors who maintain control over how they practice can love the work even when the economics are difficult. That tracks with everything DPC physicians have been saying for years. Autonomy matters more than most people in healthcare administration want to admit.

The Infrastructure Is Catching Up

Elation published this survey on the same day Hint Health announced the launch of Hint Marketplace, an app-store-style platform that lets direct care practices discover, purchase, and manage tools from within Hint’s system.

“Direct care is growing rapidly, but the tools and partners needed to support that growth have often been fragmented,” said Hint CEO Zak Holdsworth.

That fragmentation is real. Many DPC practices still run on a patchwork of separate tools for billing, charting, messaging, and scheduling. A marketplace approach signals that the DPC technology ecosystem is maturing. When the support infrastructure starts acting like a platform instead of a collection of workarounds, it lowers the barrier for every physician who’s part of that 69% actively planning their next move.

What This Means

Physicians running the numbers on a membership model should take note. You’re not early anymore. More than a quarter of independent PCPs are already doing some version of what you’re considering.

For residents watching the fee-for-service treadmill from the inside, the trend line matters too. The doctors who report the highest satisfaction are the ones who took control of their practice model. Financial uncertainty doesn’t disappear in DPC, but the relationship between effort and income gets more direct.

The bigger picture for DPC as a whole: this movement is crossing from early adoption into mainstream. The real bottleneck now is whether the infrastructure, regulations and education pipeline can keep up with the doctors who are ready to move.