Membership Medicine Grew 80% in Five Years. The Equity Question Won't Go Away.

Industry News by DPC Insider
#concierge medicine#direct primary care#primary care shortage#membership model#health equity#research
Sources: For a fee, the doctor will see you now · Concierge doctors are increasing at a much faster rate than predicted, new study found · How Much Are Concierge Medicine and Direct Primary Care Growing?

A family nurse practitioner in Waterbury, Vermont, used to see 20 patients a day in 50-hour weeks. She couldn’t talk to them about prevention. She couldn’t dig into what was actually going on. So she quit and started a membership practice where she charges $20 to $90 a month.

Three of her colleagues at a Burlington community health center have done some version of the same thing since 2023.

This pattern is playing out across the country. And new research puts a number on it that’s hard to ignore.

The Numbers Are In

A study published in Health Affairs by researchers from Harvard Medical School, Johns Hopkins, and Oregon Health & Science University tracked the growth of membership-based primary care from 2018 to 2023. The findings are striking.

The number of clinicians working in concierge and DPC practices grew by 78%, from roughly 3,900 to more than 7,000. Practice sites grew by 83%, from about 1,660 to over 3,000. Corporate-affiliated membership practices saw a nearly six-fold increase over the same period.

That growth rate is more than double what previous estimates had predicted. Both doctors and patients report higher satisfaction with these models, according to lead researcher Zirui Song, a physician economist at Harvard Medical School.

But Song also flagged the tradeoff that makes this complicated. “In the short run, this does exacerbate the primary care workforce crisis and the access crisis,” he told Vermont Public.

The Equity Critique

This is the part of the conversation that DPC physicians can’t afford to skip.

Vermont is short approximately 100 primary care doctors, and that gap is expected to widen as providers retire. About 20% of practices in the HealthFirst network now operate some form of concierge or membership model. MDVIP alone has six Vermont doctors, and half of them joined within the past year.

When a physician like Lorissa Segal leaves Mt. Ascutney Hospital to join MDVIP and cuts her patient panel by more than half, that’s a real loss for the patients left behind. Her MDVIP membership runs $2,000 to $3,000 a year. Not everyone can pay that.

“They are our most vulnerable patients,” Stephanie Winters, deputy executive director of the Vermont Medical Society, told Vermont Public.

Michelle Dorwart, a family physician at Community Health Centers of Burlington, put it plainly: “I totally get why physicians would take that route.” But she added, “I can’t figure out a way to see how we can take care of the whole community if everyone were to do that.”

These aren’t bad-faith criticisms. They deserve a serious response.

The Distinction That Keeps Getting Lost

Here’s what the public conversation consistently misses: concierge medicine and direct primary care are not the same thing.

MDVIP charges $2,000 to $3,000 a year and bills insurance on top of the membership fee. Corporate concierge programs at large health systems charge $5,000 to $10,000 annually. These models serve affluent patients who want VIP access.

Most DPC practices charge $70 to $100 a month for individuals. They don’t bill insurance at all. The monthly fee covers everything. Many DPC physicians specifically design their practices to be accessible to working families, and some offer sliding-scale pricing or employer-sponsored memberships that bring the cost to zero for employees.

When a Harvard study reports 78% growth in “concierge and direct primary care” as a single category, that framing matters. It groups a $90-a-month nurse practitioner in Waterbury with a $10,000-a-year concierge program in Manhattan. The economics, the patient populations, and the access implications are completely different.

The six-fold growth in corporate-affiliated membership practices tells you where the real consolidation pressure is coming from. It’s not from independent DPC doctors charging $75 a month.

What This Means

The growth data is real and it validates what DPC physicians have known for years: the membership model works for doctors and for patients. Nearly 80% clinician growth in five years is not a fad. It’s a structural shift in how primary care gets delivered.

But the equity critique is also real, and DPC practitioners should own their part of the answer rather than deflecting it. If you’re running a DPC practice that’s genuinely more affordable than fee-for-service with insurance, say so. If you’re offering employer-sponsored plans that give hourly workers access to 30-minute visits, tell that story. The data won’t make the distinction for you.

The primary care shortage existed before DPC and it’s getting worse regardless. There are not enough new graduates entering primary care to meet demand, with or without membership models. The question isn’t whether DPC causes the shortage. It’s whether DPC practices can be part of the solution by keeping burned-out doctors in medicine and making primary care accessible at price points that actually work for normal people.

That’s a question worth answering out loud.