JAMA Just Described the DPC Funding Model. They Didn't Call It That.

More than one in three Americans lacks access to primary care. Four physician-researchers just published their proposed fix in JAMA: treat it as a public utility, pay practices directly, cut out insurance as the intermediary.

DPC physicians have been running that model for over a decade. Nobody in the article called it that.

What JAMA Is Proposing

The article, published online May 20 in JAMA, is co-authored by Zirui Song, Wayne Altman, Renee Crichlow, and Kevin Grumbach. All four are practicing physicians. Song is an economist and primary care doctor at Harvard. Grumbach has spent decades studying primary care access at UCSF. Altman practices family medicine at Tufts.

Their argument starts with a clear diagnosis: primary care “has increasingly become a commodity rather than the common good.” State-level fixes have hit structural limits. States can only regulate certain insurance markets, leaving self-insured employer plans, Medicare beneficiaries, and portions of the Medicaid population outside what most state legislation can reach.

The proposed solution is a common fund: a pooled mechanism that consolidates public and private purchaser spending and pays primary care practices directly, bypassing insurance intermediaries. Practices get compensated for maintaining patient relationships, not for billing individual visits. Administrative overhead drops because there’s one payment rail instead of dozens. Consumer choice stays intact. Everything outside primary care delivery stays unchanged.

The only thing that moves is where the money goes first.

The Structural Overlap With DPC

The financing logic in that JAMA proposal looks like DPC.

DPC practices already collect payments directly from patients or employers, outside the insurance system. The monthly membership replaces fee-for-service billing. Overhead from coding, claim submission, and denial management drops. The practice and the patient are the two parties in the transaction.

Average DPC panels run 400 to 800 patients, compared to roughly 2,500 in traditional fee-for-service. That ratio is what makes same-day appointments possible. It’s also what makes the economics work: a smaller panel of patients paying directly is financially stable in a way that a large panel billed through insurance usually isn’t.

The JAMA authors aren’t proposing DPC by name. Their common fund would apply across all primary care practice types and would sit alongside existing insurance structures rather than replacing them. But the payment logic — direct to practices, outside insurance — is the same logic DPC has been testing since 2010.

Sixteen years of DPC practices provide real-world data on what that model does to practice economics, physician burnout, and patient access. The researchers are proposing a federal version of the same experiment.

The Questions JAMA Doesn’t Answer

The article makes a case for the policy direction. It doesn’t write the implementation plan.

Who sets the rates in a common fund? In DPC, each practice sets its own membership fee based on local costs and patient population. A federal common fund would have to set rates centrally, which reintroduces some of the administrative machinery the model is trying to eliminate. Rate-setting is a feature of every public utility. Primary care wouldn’t be exempt from those fights.

What happens to existing DPC practices? A federal common fund paying all primary care directly could formalize the DPC payment model at scale. Or it could absorb DPC practices into a new regulatory structure with its own requirements and rate caps. Those are very different outcomes, and the article doesn’t address either.

These aren’t objections to the argument. They’re the next round of questions that a policy proposal at this stage should expect.

What This Means

For DPC physicians, a JAMA special communication describing your financing model as the solution to the primary care access crisis is a different kind of validation than a trade publication covering your practice opening. Four researchers published a peer-reviewed argument, with citations, in the most-read medical journal in the country. The payment model they described works like DPC.

That changes the conversation in rooms where DPC skepticism runs high. A hospital system or insurance-aligned medical group that treats DPC as a boutique arrangement for high-income patients is harder to argue with on your own. A JAMA citation for the underlying payment logic is harder to dismiss.

For physicians still weighing DPC, the article frames the access problem clearly and without qualification. More than a third of Americans lacks primary care access. DPC practices carry panels a fraction the size of traditional practices, which means each DPC physician is serving a smaller group of patients with more time and attention. The access contribution isn’t incidental to the model. It’s a direct result of the panel size.

The common fund proposal would require federal legislation, years of negotiation, and political will that rarely arrives quickly. DPC doesn’t require any of that. Practices are opening now, seeing patients now, collecting membership fees now.

Establishment medicine is starting to describe the solution. The practices already running it are well ahead of the policy conversation.