The First Comprehensive Survey of Pediatric DPC Physicians Reached 73 Practices in 26 States. Ninety-Four Percent Report Being Happier Than in Their Prior Practice.

Analysis by DPC Insider
#pediatrics#pediatric-dpc#research#physician-satisfaction#access#telehealth
Sources: Current State of Pediatric Direct Primary Care: A National Cross-Sectional Survey of Pediatricians — Cureus, May 27, 2025 · Current State of Pediatric Direct Primary Care — PMC / NCBI (PMC12198928) · Impact of Telehealth on Pediatric Direct Primary Care: Is Virtually Showing Up Valuable? — Cureus, June 16, 2025 · Impact of Telehealth on Pediatric Direct Primary Care — PMC / NCBI (PMC12265844) · 2026 State of Direct Primary Care Report — DPC Alliance · Zest Pediatric Network — For Physicians

Until recently, pediatric direct primary care had no comprehensive peer-reviewed national overview of what the physicians practicing it actually look like. A survey published in Cureus in May 2025 — the first comprehensive national overview of the specialty — changed that. The data is worth examining closely, because several of its findings are counterintuitive.

Researchers at Case Western Reserve University contacted approximately 130 pediatricians practicing DPC, received 79 initial responses, and after applying eligibility criteria — including excluding physicians whose patient panels were less than 75 percent pediatric — analyzed data from 73 physicians representing distinct practices across 26 states. The study’s authors note explicitly in the limitations section that the national total of pediatric DPC practices is unknown, and they estimate it at “slightly over 100” at the time the survey was conducted — meaning this is a substantial but incomplete sample of the specialty.

What the survey found

The satisfaction numbers are the headline. Ninety-four percent of the pediatricians surveyed reported being happier in DPC than in their prior practice. Eighty-nine percent cited reduced moral injury — that specific, grinding experience of knowing what a patient needs and being structurally unable to provide it.

The practices that produced those outcomes have a recognizable structure: 85 percent were single-physician operations, and 79 percent managed fewer than 200 patients, with 45 percent managing fewer than 100. The panels are small relative to the broader DPC respondent pool. The DPC Alliance’s 2026 State of Direct Primary Care report found that among its 465 physician respondents, those reporting full panels clustered between 400 and 700 patients.

The Belt et al. study notes that 40 percent of the surveyed practices were less than one year old at the time of the survey. Small panels in a new practice reflect practice age as much as deliberate capacity decisions, so the under-200 numbers should be read partly as a snapshot of a young specialty.

What care looks like from the family’s side

A companion study from a multi-physician pediatric DPC network in northeast Ohio — affiliated with Zest Pediatric Network based on the study’s author disclosures — offers a patient-side data point on what the direct-access model looks like in practice. Researchers distributed a survey to 155 enrolled families; 59 responded, a 38 percent response rate. Among those respondents, 100 percent had texted questions directly to their child’s physician. Ninety-three percent had sent photos. Eighty-eight percent had called directly. Twenty-two percent had used video chat.

Those same respondents reported concrete effects from the direct access: 98 percent said it had prevented at least one in-person office visit; 92 percent said it had prevented an after-hours or weekend urgent care visit; and 69 percent said it had prevented an emergency department visit. These are associations reported by respondents — not controlled outcomes data — and the 38 percent response rate limits what can be inferred about the full enrolled population. But the pattern is consistent with what DPC advocates have argued for years, and the pediatric data is more specific than most.

Where the practices are

The survey’s geographic findings should be read carefully. The three most represented states were Florida with 13 practices, Texas with 11, and Ohio with six. Across all 73 respondents, 73 percent of practices were in suburban settings, 17 percent were in rural areas, and 10 percent were urban. The study reports state distribution and practice-setting distribution as two separate findings — it does not cross-tabulate which states the suburban practices are concentrated in.

Respondents came from 26 states. No respondents came from the other 24, though the study’s own estimate of slightly over 100 practices nationally, against 73 respondents, implies that practices in those states may simply not have participated. The absence of respondents from a state is not the same as absence of practices.

Among the 465 physician respondents in the DPC Alliance’s 2026 report, 6.4 percent identified as pediatric. Family medicine accounted for 76.3 percent, internal medicine for 11.4 percent.

The access question — and one finding that complicates it

The monthly membership structure that removes the billing cycle for physicians also sets limits for some patient populations. The Belt et al. survey found that 11 percent of pediatric DPC practices charged under $100 per month; the majority reported fees in the $101–$150 range — above the general DPC market average and an open affordability question for Medicaid-insured families — how those fees interact with their coverage is exactly what the survey does not analyze.

Here is the finding that cuts against a simple access narrative: 70 percent of the 73 surveyed practices reported serving some Medicaid-insured children. The study identifies this as a reported fact, not an analyzed one — it does not describe how those families cover the monthly membership fee, whether through reduced or waived fees, employer or organizational sponsorship, or out-of-pocket payment. What it establishes is that Medicaid-insured children are present in the majority of pediatric DPC practices in this survey. The mechanisms for how that access happens are the open research question.

The study explicitly notes its third limitation: “the financial demographics of patient populations were not comprehensively analyzed in this study.” The concentration of respondents in suburban settings and the 24 states with no survey representation point to real gaps. The 70 percent Medicaid figure means those gaps are more complicated to characterize than a straightforward “this model only serves families who can pay.”

What This Means

Pediatric DPC has its first peer-reviewed national snapshot. The data shows a model with exceptionally high physician satisfaction, lean and simple practice structures, and a care relationship built around direct digital access. Ninety-four percent satisfaction is a number that doesn’t emerge from structures where the work itself is broken.

The research gaps are significant. The Belt et al. study calls for future outcomes research on pediatric DPC patients; what these two studies contribute is self-reported satisfaction and utilization data. The national practice count is estimated, not measured. And the mechanisms by which the 70 percent of practices that serve Medicaid-insured children make that work financially — for the practice and the family — is documented only as a data point, not yet analyzed as a model.

Those are the questions a growing specialty needs to answer if it is going to make a case beyond the physicians who are clearly thriving inside it. For now: 73 responding practices across 26 states, the majority suburban, most single-physician, and their physicians substantially happier than before. And 70 percent of them reporting that at least some of their patients are on Medicaid.