A Mount Sinai Pulmonary Fellow Just Published a Blueprint for Subscription Specialty Care

Jared Dashevsky is an incoming pulmonary and critical care fellow at Mount Sinai. He’s also the founder of Healthcare Huddle, a medical newsletter that reaches more than 30,000 physicians. On July 7, he published an article on HLTH laying out his plan for a subscription-based pulmonary practice. No insurance billing. Monthly fee. A panel capped at 100 patients.

He calls it “direct pulmonary care.”

The Model

The structure mirrors what DPC practices already do. Patients pay a flat monthly retainer for unlimited consultations, largely virtual, with no per-visit charges and no insurance claims. The practice would cover three conditions: asthma, COPD and obstructive sleep apnea.

Dashevsky plans to run it alongside his ICU work at Mount Sinai. For payments, he names Stripe. For medications at lower cost, he points to Cost Plus Drugs and LillyDirect. For initial patient triage, he plans to use an AI platform called Aidify. The practice would be virtual. Low overhead means he can keep his hospital position.

The 100-patient cap is deliberate. Dashevsky draws the same contrast DPC physicians draw between their panels of 400 to 800 patients and the 2,500-patient loads common in fee-for-service primary care. Fewer patients means longer relationships. In a subspecialty where chronic disease management depends on ongoing communication, that tradeoff matters.

Why It Matters

DPC has been a primary care story. More than 3,000 practices operate in the U.S. according to Hint Health’s 2026 trends report, and the vast majority are family medicine or internal medicine. Specialists have mostly stayed on the sidelines.

That creates a familiar problem. A DPC physician can offer unlimited primary care access, but the moment a patient needs a pulmonologist or cardiologist, they’re back in the insurance system. Referral coordination is one of the most common operational headaches DPC practices report.

A single specialist building a subscription practice won’t solve that overnight. But the signal is hard to miss. A physician at a major academic medical center, writing to an audience of 30,000 doctors, is treating the membership model as a serious career path for subspecialists. If other specialists follow, the referral gap that every DPC practice contends with starts to narrow.

Dashevsky’s article also hints at a generational shift. He’s building the subscription model into his career from the start, during fellowship, before he’s finished training.

The Equity Question

Dashevsky doesn’t avoid the hard part. Boutique-care models tend to attract wealthier patients. A 100-member pulmonary practice might serve people with manageable asthma while patients with pulmonary hypertension or interstitial lung disease stay in the traditional system.

His response: he’ll keep doing ICU work. That means treating critically ill patients across socioeconomic backgrounds even while running a small subscription practice. He’s honest about the tradeoff, even if he doesn’t resolve it. The DPC movement has been working through the same tension since the model started.

What This Means

For DPC physicians, the expansion of subscription medicine into specialties could eventually produce the referral networks they’ve been missing. If patients can pair a DPC membership with direct-pay access to a pulmonologist or cardiologist, the “what happens when you need a specialist” question gets easier to answer.

For residents and fellows, this article is evidence that the membership model works beyond primary care. A fellow at one of the country’s top academic programs is publicly planning his career around it.

The practice doesn’t exist yet. Dashevsky is still in training. But a plan published to 30,000 physicians has a way of becoming real.