DPC Doctors Have More Leverage Than They Think. One Physician Is Telling Them to Use It.
A DPC physician argues that practices have real bargaining power with aggregators, and shouldn't act like the smaller party in their own market. Qiu says outside interest in the model has grown, which makes the argument timely.
DPC Insider 4 min read Analysis
If you run a DPC practice, you’ve probably had this experience in the last year: a pitch from an aggregator. A new platform that wants to plug your panel into a network. An employer broker offering to bring you fifteen lives at a rate you didn’t set.
The instinct, especially for solo doctors, is to feel small. To assume the bigger party in the room is the one who sets the terms.
Dr. Kenneth Qiu wants you to stop doing that.
In a recent essay on DPC News, Qiu, a Richmond, Virginia DPC physician who started his practice straight out of residency, makes a case that ought to land more often than it does: DPC physicians have more leverage than they act like they do.
The argument
Qiu’s framing is simple. “The supply side is the product which means the supply side gets to set the terms.”
The new aggregators and connectors depend on DPC practices. “These companies cannot exist without participating practices,” Qiu writes. “An aggregator with no clinics in its network is an empty shell with a sales deck.”
“Walking away is not a last resort; it is a baseline option.”
That’s the line in the essay that does the most work. It reframes contract negotiation from “what will they let me have” to “what am I willing to accept.”
Most physicians don’t think this way. Years of employed practice train doctors to take the contract that’s offered, push back at the margins and sign. DPC was supposed to break that pattern.
Plenty of people in DPC worry that it won’t. “The predominant worry circulating is that middlemen are creeping back in,” Qiu writes. He calls that worry understandable and also, “in an important way, backwards,” because it underestimates how much leverage practicing DPC physicians have right now.
One reader added a warning. A commenter on Qiu’s piece, Jerry Purcell, wrote that recent DPC social media chatter has been about some of these companies “NOT paying well, holding payments, or requiring more work for payments,” which he said sounds more and more like insurance.
Both can be true. The leverage is real, and a practice that doesn’t use it can sign its way back into the payer friction it left.
Why this matters now
Two trends are worth watching here.
Hint Health’s 2026 trends report, covered here on April 24, draws on data from more than 2,700 DPC clinicians and 1.4 million members. It found that 60% of active DPC memberships in that data are employer-paid. More employer contracts means more intermediaries, more aggregators and more situations where a DPC physician is asked to fit a practice into someone else’s pricing structure.
Public payers are in the picture too. “Government programs cover roughly a third of Americans, employer-sponsored plans cover about half,” Qiu notes. Medicare’s Advanced Primary Care Management codes, covered here on April 26, already pay for primary care by the month.
In both cases, the DPC physician sits across the table from a much larger entity. The temptation to say yes is enormous. Qiu’s advice is to decline the ones that feel wrong.
The Qliance lesson
Qiu doesn’t pretend the history is clean. Engagement with employers and government, he writes, “has been part of DPC history from very early on.” And: “Some of those early efforts went badly and went badly in public. Qliance is the obvious example.” Qliance, the Seattle-based DPC company, shut down in 2017.
His conclusion is to engage carefully. “The lessons from those failures are inputs now, not warnings to stay home.”
That position is harder to hold when you’re a one- or two-doctor practice and an aggregator is dangling a hundred lives at you. Which is exactly why the leverage point matters.
What this means for DPC practices
Three things are worth taking from the essay.
First, set your floors before you take the meeting. Know the per-member rate, the panel cap, the carve-outs and the cancellation terms you’ll accept before the conversation starts. The pressure to compromise mid-meeting is real, and decisions made under that pressure rarely favor the smaller party.
Second, remember that the aggregator’s pitch deck is selling your access. Without your panel, they have nothing to package. Pricing your engagement as if your participation is the scarce resource is closer to the truth than pricing it as if their distribution is.
Third, treat walking away as the baseline option, as Qiu does. If a contract feels financially or morally wrong, he writes, “the right answer is to decline it.” A DPC practice that fills its panel through direct-to-patient enrollment and employer relationships it built itself is not at the mercy of aggregator math. The leverage is real because the alternative is real.
The model’s advantages (small panels, time-rich visits, predictable cash flow, no payer mediation) only last if the contracts that come into the practice protect them. Qiu’s essay is a reminder that protection mostly comes from the physician’s own willingness to say no.
You might not feel like the bigger party in your next aggregator meeting. But on the question of who actually delivers the care, you are. The contract should reflect that.
