Two Thirds of the DPC Physicians in a National Survey Say Their Panels Aren't Full. Hint Health's Answer Is a Menu.

More than two thirds of the direct primary care physicians in the model’s most recent national survey said their panels aren’t full. Nearly half run fewer than 200 patients. About a third of the single-location practices have no support staff at all.

Hint Health has published a whitepaper arguing that those practices should build lifestyle and functional medicine into their care model and sell part of it as an add-on service. Medical Economics reported on the document on September 1.

Set the pitch against what that survey says about these practices and the two describe different problems.

What the document argues

The whitepaper is anchored in a single clinic. Keystone Natural Family Medicine in Mesa, Arizona, founded by Kristen Bishop, N.M.D., a naturopathic physician whose practice markets four locations around Phoenix, three of them open and a fourth listed as opening in early 2027.

Bishop sells IV therapy, acupuncture and similar services as add-ons. Members get them at a discount, non-members pay more, and she describes that price gap in the whitepaper as an incentive to join. “You don’t have to choose between practicing good medicine and running a sustainable practice,” she said.

The demand case is that patients are already buying this elsewhere. Use of complementary health approaches among U.S. adults rose from 19.2% in 2002 to 36.7% in 2022, and an earlier federal survey supplement, fielded in 2012, put out-of-pocket spending on those approaches at $30.2 billion. Both come from federal survey data the whitepaper cites. It sets those numbers beside a 43% U.S. obesity rate against a 26% OECD average, and the finding that 42% of adults 65 and older take five or more medications.

Where the outcome evidence was collected

Three figures carry the clinical argument. None of them were produced inside a direct primary care practice.

The claim that 31% of functional medicine patients reported a clinically meaningful improvement in global physical health comes from a Cleveland Clinic analysis published in JAMA Network Open in October 2019, comparing its own functional medicine center against its own family health center.

The 58% reduction in type 2 diabetes risk comes from the Diabetes Prevention Program, published in the New England Journal of Medicine in 2002. That trial tested an intensive, structured lifestyle intervention against metformin and placebo in adults with impaired glucose tolerance. It is strong evidence for structured lifestyle intervention. It says nothing about IV therapy or acupuncture, and nothing about what a practice should charge for either.

The 90% professional satisfaction figure comes from a 2019 survey of 482 American College of Lifestyle Medicine members. Those are clinicians who had already chosen lifestyle medicine, and only 64% of them were physicians. The rest were nurses, dietitians, therapists, PAs and NPs, plus a bucket the survey files only as other clinical degrees. Asking people who selected into a practice style whether they enjoy it tells you very little about what happens when someone else adopts it under different conditions.

Who is being pitched

The State of DPC report, published in July 2026 by the Direct Primary Care Alliance’s Member Insights Committee, collected 465 responses to a survey aimed at physicians, fielded in October and November 2024. Single-location practices were 89.3% of the sample. Full ownership was reported by 82.4%, and 80.7% have opted out of Medicare entirely.

Two limits sit inside those numbers. The denominator, an estimated 3,600 DPC practices nationwide, came from Hint Health, which also helped distribute the survey through its own platform. And 63.8% of respondents were alliance members. The committee presents that figure as breadth, since it means a third of the responses came from outside the alliance. Read the other way, the sample still tilts toward one organization’s roster.

So the audience for this pitch is small, solo, mostly under-full and often unstaffed. That is a specific operating condition, and there is more than one prescription for it.

Josh Umbehr, M.D., co-founder of Atlas.md in Wichita, reads the same practices and reaches the opposite conclusion. Six hundred patients at $50 a month runs $360,000 a year against overhead he puts at 20% to 25%, one staff member per one or two physicians, and 700 to 1,000 square feet per doctor. Growth of 40 to 50 patients a month fills a practice in six months and reaches a full physician income within a year. At 10 to 20 a month, he says the panel takes two to two and a half years to fill and six to eight years to recover the lost revenue. Membership pricing varies by practice, market and panel size.

“It’s the practices that charge the least that make the most, and that counterintuitive point is very difficult for doctors,” Umbehr told Medical Economics. “We see more growth than we ever have, but we also see more closures than we ever have.” He attributes part of that to practices trying to reach a full income on 100 or 200 patients.

That is the collision. An add-on menu raises revenue per patient. The measured shortage in this population is patients.

The Counterargument

Bishop runs three open locations in metro Phoenix and has a fourth on the way. That is a real business, and the strongest version of the whitepaper’s case is that she built it, it works, and she is describing how.

The add-on structure also answers something the survey documents. A practice charging what its market will bear, in a town that won’t bear more, needs revenue from somewhere other than the membership line. Selling ancillary services to non-members at a higher price brings money in from outside the panel, which is exactly what a 150-member practice doesn’t have.

And the time argument holds. An hour-long visit can carry a nutrition and sleep and movement conversation that a seven-minute one cannot, and seven minutes is the figure both Umbehr and Keystone’s own site use for a standard primary care visit. DPC’s overhead structure is what produces that hour. Hint Health is right that the room exists.

What the document doesn’t establish is sequence. This piece works from the Medical Economics summary of the whitepaper, and that summary describes no practice that added a service menu before it filled its panel and then survived on that basis. Bishop’s clinic is the end of a path the whitepaper never traces, and Umbehr’s closure warning describes the practices most likely to reach for the menu first.

If you’re sitting at 150 members with no staff and reading this whitepaper as a plan, the honest state of the evidence is that nobody has compared the two routes. Picking one right now means picking a story rather than a finding.