A New Hampshire Internist Built Her Whole DPC Practice Around Women's Health. Menopause Care Needs the One Thing Insurance Won't Give It: Time.

Practice Spotlight by DPC Insider
#womens-health#menopause#midlife-care#direct-primary-care#new-hampshire
Sources: New Concord clinic focuses on women's primary care — Concord Monitor · New Study Identifies Gaps in Menopause Care in Primary Care Settings — The Menopause Society · HLTH25: Oscar Health, Elektra Health launch ACA plan for women navigating menopause — Fierce Healthcare · Unlocking the menopause market: A defining opportunity in women's health — PwC

Women’s health has a time problem. Perimenopause, thyroid disorders, the slow grind of an autoimmune workup: these are the visits that need forty minutes and a doctor who remembers what happened last month. A typical insurance-based primary care appointment gives them seven to ten.

Dr. Sana Siddiqui watched that gap widen for years. She left Concord Hospital in 2024, and this spring she opened VitalCare Internal Medicine, a direct primary care practice in Concord, New Hampshire built around the patients that short visit fails most: women.

She told the Concord Monitor why, and there was nothing complicated about it. “The visits are getting smaller, patients are frustrated, there’s no continuity of care.”

What a women-centered DPC practice looks like

The model is standard direct primary care. Patients pay a flat monthly membership for direct access to their physician, with no copays and no insurance billing in between. Siddiqui compares it to “paying a gym membership for your health.”

What she has built around it is specific. VitalCare charges $100 a month for members ages 20 to 44 and $125 for those 45 and up, with lab work billed separately, according to the Concord Monitor. Those figures sit close to the going rate for individual DPC memberships nationally, roughly $70 to $100 a month, though pricing varies by practice and region (source: DPCA, DPC Frontier).

Patients get her cell phone number. Visits happen at a round table by a window instead of across an exam-room desk, and Siddiqui is pursuing menopause certification while adding Pap smears and mammograms to the practice. The added services matter less than the time behind them. A woman sorting through perimenopause can book a real appointment with a doctor who already knows her history.

“What I’m building is a trust and long-lasting relationship with them,” she said.

Why menopause is the case study for the whole DPC pitch

Midlife women’s health is exactly the kind of care a rushed system handles poorly. Perimenopause alone can bring sleep disruption, mood changes, shifting cardiovascular and bone-density risk, and a hormone-therapy decision that takes a real conversation to get right. A study from the Menopause Society found that primary care settings routinely miss the mark on menopause care, in part because clinicians don’t have the time or the training to manage it well.

The rest of the industry has noticed the same gap. Oscar Health and the virtual-care company Elektra Health launched an ACA plan this year aimed at women going through menopause, with $0 primary care and gynecology visits. Consulting firms now describe menopause as a defining opportunity in women’s health, a market big enough to build companies around.

Most of those bets are virtual, insurer-backed, or both. VitalCare is the in-person version, and it doesn’t need a new product to deliver it. Longer visits and the same doctor every time are already the structure. DPC gives away, as a byproduct of how it’s built, the thing the venture-backed entrants are trying to sell back to women.

The economics that make a focused practice work

A solo physician can build around one population because DPC panels are small on purpose. The typical DPC doctor carries 400 to 800 patients, against roughly 2,500 in a fee-for-service practice (source: DPCA, DPC Frontier). You don’t need volume when revenue comes from predictable monthly memberships instead of coded visits.

That math is why niche DPC practices keep appearing. A doctor can go deep on women’s health or pediatrics and still keep the lights on. Siddiqui left a hospital system where the panel size and the pace were set for her. Now she picks both.

What This Means

If you’re a resident or a physician weighing DPC, VitalCare is a useful picture of what the model actually buys you. You get to decide who you serve and how much time you spend with them, rather than absorbing whoever the schedule assigns in ten-minute blocks. A practice built around perimenopause care would be hard to run inside fee-for-service. Under DPC, it is a choice about how to spend your day.

For DPC physicians already in practice, the trend data is worth a look. Employers and insurers are pouring attention into midlife women’s health because the demand is real and largely unmet. Serving it takes time, continuity, and a doctor who picks up the phone, which a lot of DPC practices already offer. It takes no new platform at all.

The big players have decided menopause care is a market. In Concord, one internist is running the version that already works, one patient at a time.