DPC Is Going Mainstream. The Doctors Who Built It Are Starting to Feel Left Out.

“We didn’t know you existed.”

That’s what an organizer told Dr. Angela Andrews at an invite-only healthcare summit — after she asked why solo DPC practitioners weren’t in the room.

Andrews, a Direct Primary Care physician and writer, published a piece this week in DPC News that’s worth reading slowly. It describes a moment that felt small but wasn’t: a physician who built her practice from nothing, who believes in the DPC model deeply, walking into a room full of people working on DPC’s future — and discovering she was invisible to them.

Not excluded. Not unwelcome. Just unknown.

The Summit That Revealed the Gap

Andrews attended what she describes as a serious, high-quality gathering aimed at solving real problems in healthcare. The energy was good. The values felt right. DPC was front and center.

But the version of DPC on display was a specific one: large practices with employer contracts, established referral networks, and the infrastructure to offer 24/7 access. The invited practitioners were mostly the ones who had already scaled. The conversations assumed a model built for growth.

When she raised her hand and asked where the solo practitioners were — the ones running intentionally small practices, the ones serving patients without employer benefits packages — she got her answer.

The organizers didn’t know to invite them. That wasn’t a snub. It was something more uncomfortable: they hadn’t entered the field of vision.

The Visibility Trap

Andrews names the dynamic clearly: “The most visible version of Direct Primary Care quietly becomes the version of Direct Primary Care.”

This is how institutions define categories. Not by deliberate decision, but by default. What gets cited in conference programs shapes what funders replicate. What funders replicate shapes what employers adopt. What employers adopt shapes what residents hear about when they’re trying to picture a different path.

DPC has, by any measure, entered a new phase. There are now more than 2,300 practices across the country. Employers fund the majority of active memberships. The model has moved from the margins of medicine to the center of serious conversations about healthcare reform.

That growth is worth celebrating. But it’s also producing a narrowing.

A DPC practice that works for a 400-person rural panel — no employer contract, no 24/7 team, no investor deck — is doing the same fundamental thing as a multi-site employer-facing clinic. Direct relationship. Monthly fee. No insurance in the room. But it doesn’t look like the practices that get featured at summits or profiled in employer benefits case studies. So it doesn’t get counted in the conversation about what DPC is becoming.

The “Partner Up” Problem

One exchange in Andrews’ account stands out. When she questioned whether 24/7 access was really a universal requirement of DPC — and it isn’t; many thriving practices don’t offer it — a panelist suggested that practices unable to meet that standard should “partner” with larger organizations.

That’s a reasonable-sounding suggestion. It’s also a quiet redefinition.

The whole premise of DPC, for many of the physicians who built it, was to practice without institutional dependencies. The model was designed around physician autonomy — the freedom to set your own panel size, your own hours, your own fee structure. The moment “partner with a larger organization” becomes the default answer for a solo practice that doesn’t fit the scaling narrative, you’ve replaced one form of institutional constraint with another.

Andrews is a woman of color in medicine. She draws a deliberate parallel: the feeling of being in rooms where decisions are made around you, not with you, is familiar in ways that go beyond DPC. That parallel is worth taking seriously. The practices that aren’t visible at summits are often the ones run by physicians who are already underrepresented in leadership conversations.

Who Gets to Tell the Story

Andrews invokes Hamilton’s famous lyric — who lives, who dies, who tells your story — to frame what’s actually at stake. It’s not just about conference invites. It’s about which practices get turned into blueprints.

The DPC movement was built by physicians who opted out of the existing system because it wasn’t working. They did it without playbooks, without legal frameworks in most states, without employer infrastructure. They figured it out. The model they built has now attracted enough institutional attention to be shaped, replicated, and potentially standardized.

That’s the critical moment Andrews is pointing to. Standardization in service of growth is inevitable and not necessarily bad. But standardization that erases the practices that don’t fit the growth template is a different thing.

Her conclusion isn’t retreat. It’s the opposite: “Maybe the greater risk is when the rebels stop showing up.”

What This Means

For physicians considering DPC, the model is more diverse than any single summit suggests. The version you see profiled in employer benefits packages — large, employer-facing, scaled — is one real version. There are hundreds of practices running on a completely different axis: solo, intentionally small, without corporate partnerships, and working fine. Both are DPC. You don’t have to scale to do it right.

For existing solo and small-practice DPC physicians, Andrews is naming something that’s probably felt familiar for a while. As the movement professionalizes, the conference circuit expands, and industry infrastructure builds around the most scalable models, it gets easier to feel like you’re doing a lesser version of something. You aren’t. But showing up in those rooms — even uncomfortable ones — may be the mechanism that keeps the definition from narrowing around your absence.

For the DPC movement broadly, this is the conversation worth having before it gets harder to have. The model’s core promise — physician autonomy, direct patient relationships, no insurance in the room — doesn’t require a certain scale or an employer contract. The flexibility is a feature. Growth that erases that flexibility isn’t really protecting the thing that made DPC worth building.

The rebels who built this don’t need to be celebrated. They need to be in the room.