600 Patients Served Well, or 2,500 Served Badly: The DPC Shortage Debate

Analysis by DPC Insider
#physician shortage#panel size#Medical Economics#AAMC#burnout#workforce
Sources: Does direct primary care worsen physician shortages? · Are Direct Primary Care Practices Located in Health Professional Shortage Areas? · I knew choosing DPC would exacerbate primary care physician shortages, and I chose it anyway. Here's why. · New AAMC Report Shows Continuing Projected Physician Shortage · Q+A: Is the Growth of Direct Primary Care Expanding Health Care Access Where It's Needed Most?

“600 looked after well, or 2,500 looked after badly.” That’s Dr. Richard Berry of Maple Health Direct Primary Care in Mentor, Ohio, framing the question that Medical Economics asked this week: does direct primary care worsen physician shortages?

It’s not a new criticism. But it’s one of the most persistent. And now that DPC has grown past 1.4 million members and a mainstream physician publication is asking it out loud, the question deserves a real answer grounded in data rather than talking points.

The math that worries people

The surface-level argument is straightforward. A traditional primary care physician manages a panel of 2,000 to 2,500 patients. A DPC physician typically caps at 400 to 600. If every PCP switched to DPC tomorrow, the math says we’d need four times as many doctors to serve the same population.

The AAMC projects a shortage of 20,200 to 40,400 primary care physicians by 2036. About 83 million Americans already live in areas without sufficient primary care access, and HRSA has designated over 7,400 Health Professional Shortage Areas nationwide. Every doctor who shrinks their panel looks, from this altitude, like a net loss.

And the geographic picture isn’t perfectly reassuring either. A 2024 study in the Annals of Family Medicine by Neal Goldstein and colleagues at Drexel University found that while 44% of DPC physicians practice in designated health professional shortage areas, only 14% are in the highest-priority-need HPSAs. Traditional fee-for-service physicians practice in areas of greatest need at a rate of 20%.

The question nobody’s asking back

Here’s what the shortage framing consistently misses: it compares DPC panels to a fantasy where every burned-out doctor stays at their post indefinitely.

Dr. Marina Capella, a pediatrician who wrote openly about choosing DPC despite the shortage concern, put it bluntly: her real choice wasn’t between serving 500 patients and serving 2,000. It was between serving 500 patients and leaving medicine entirely.

She’s not an outlier. Research shows roughly 20% of physicians plan to exit the profession within two years. Between 300 and 400 U.S. physicians die by suicide annually. The 2026 Match saw family medicine fill rates decline again. The pipeline is contracting.

Hint Health’s 2026 trends report documented a 48% reduction in clinician burnout among DPC physicians. That’s not just a wellness metric. That’s a retention number. Every doctor who doesn’t burn out and leave is a doctor who keeps seeing patients.

The honest comparison isn’t “600 patients vs. 2,500 patients.” It’s “600 patients vs. zero patients.”

What the geographic data actually says

The Drexel study also found something critics tend to skip over: DPC practices are more likely to be in rural and partially-rural HPSAs than traditional fee-for-service physicians. 47% of DPC practices sit in rural or partially-rural areas, compared to 38% of traditional practices.

That matters because rural HPSAs are precisely the places where fee-for-service economics make independent practice unsustainable. A doctor in a small town who can’t generate enough billable volume to stay afloat has two options: close the practice, or find a different revenue model. DPC gives them the second option.

The gap in high-priority urban HPSAs is real and worth addressing. But framing DPC as a cause of shortages, rather than one response to the economics that created them, gets the causation backwards.

What This Means

The physician shortage is real, structural, and getting worse regardless of what happens in DPC. The question isn’t whether DPC makes it harder to staff 2,500-patient panels. It’s whether those panels were sustainable in the first place.

If you’re a physician considering the switch, the shortage argument will come up. Colleagues, health-policy commentators, and now mainstream publications will raise it. The honest answer isn’t that it doesn’t matter. It’s that the alternative to DPC, for many doctors, isn’t a full traditional panel. It’s leaving primary care altogether.

And if you’re already in DPC and practicing in a rural or underserved area, you’re part of the answer to a question the critics haven’t bothered to ask: what happens to access when the only financially viable option for an independent physician is a membership model?

The panel is smaller. The doctor is still there. That’s a trade-off worth understanding clearly.