Slate Asks a National Audience If Doctor Membership Fees Are Worth It

Slate put a question in front of its national audience this morning that most DPC physicians have only ever fielded one exam room at a time: is a doctor’s membership fee worth it? The answer the piece assembles, from growth data, patient interviews and one sharp critic, says a lot about where membership medicine now sits in the public imagination.

Slate covers consumer technology and culture. Its readers are patients, not physicians. Direct primary care spent its first fifteen years explaining itself to doctors. This piece is written for the people deciding whether to pay.

The numbers that reached a national audience

Writer Lynda Lin Grigsby anchors the piece in a Health Affairs finding that the number of clinicians working in direct primary care and concierge practices grew 78.4% between 2018 and 2023. She sets that against the arithmetic of conventional practice. Slate puts most primary care doctors at more than 2,000 patients each, and the research it draws on measured the average visit at 18 minutes across 21 million of them. The average DPC panel runs 402 patients, per AAFP data.

Dr. Jane Zhu, an associate professor of medicine at Oregon Health & Science University, describes what a 2,000-patient panel does to the work: “It’s really hard to give each of those patients personalized attention, the time that they need, the effort that it takes to manage chronic medical conditions, to engage in preventative care, to answer questions that patients have about their health.”

The patient side of the piece is concrete. Ashley Bates, 41, pays a $600 annual fee for her Los Angeles doctor because, as she told Slate, “this is someone who, actually, I think, loves me.” Slate does not name the practices it describes, but the price points are easy enough to check. Forward Family Medicine in Wayne, Pennsylvania lists an individual membership at $200 a month, and its own comparison table puts appointment times at one to two hours.

Behind all of it sits supply. The Association of American Medical Colleges projects a shortage of 20,200 to 40,400 primary care physicians by 2036. The wait for an appointment is structural.

One growth number, two different models

The 78.4% figure counts direct primary care and concierge clinicians together, and the two models charge in different ways. A DPC membership replaces insurance billing at the practice: one flat fee, most commonly in the $50 to $100 per month range that Slate cites from the AAFP, though fees vary by practice and location. Concierge practices charge a membership fee and may keep billing insurance on top of it, often at a much higher price point.

A reader who prices “membership medicine” off a concierge fee will overestimate what DPC costs, and Slate’s own examples show the spread: $600 a year in Los Angeles, $200 a month in Pennsylvania. The models get lumped together in coverage because both charge a fee. They part ways on everything after that.

The piece also lands on a policy detail that changes the consumer math. Federal legislation that took effect this year allows health savings account funds to pay DPC membership fees. A separate dollar limit governs something different. Above $150 a month for an individual, or $300 for a membership covering more than one person, the arrangement stops letting the patient keep contributing to an HSA. Paying the fee out of an HSA already funded stays allowed at any price. For a model sold one household budget at a time, that is a real change in the sales conversation.

The Counterargument

Ed Weisbart, a retired family physician in St. Louis, gives the piece its strongest objection: “We’re setting up a system where people of better financial resources can get physicians who can spend more time with them. And people who have fewer financial resources will be the ones who are unable to do that.”

Take the strongest version of that argument seriously. A physician who trades a 2,000-patient panel for a 402-patient panel removes capacity from a system already projected to be short by tens of thousands of doctors. If the model keeps growing, the other 1,600 patients have to land somewhere. That is arithmetic, and no amount of enthusiasm for the model makes it go away.

Two things push back. Physicians who burn out and leave medicine take their entire panel with them, and burnout in U.S. primary care runs higher than in nearly all of the 10 peer countries surveyed. Slate notes that physicians in these practices report much lower burnout, which suggests some of that 78.4% growth is capacity retained rather than capacity removed. And employers now fund the majority of DPC memberships, which puts the model in front of warehouse workers and line cooks who never shopped for it.

None of that reaches the patient with no employer sponsor, no HSA and no slack in the monthly budget. For that patient, Weisbart’s critique holds as written. The model’s answer so far has been employer funding for most memberships, plus a tax break for the patients who pay their own fee. Whether that reach grows faster than the physician shortage deepens is the number the next Health Affairs study should chase.