Tarrant County Added Primary Care Doctors. Headcount Isn't Access

Tarrant County, Texas, had 1,563 primary care physicians in 2015. By 2025 it had 1,967, a 26% increase, while the county’s population grew 18%, according to state data reported by the Fort Worth Report.

On paper, that’s a county catching up. Dr. Stuart Pickell, who has his own primary care practice there, told the paper that new patients at his practice can wait three months before their first appointment.

Both things can be true at once. The gap between them is the useful part of the story.

What a headcount can’t see

Run the numbers per person and the trend holds up. By our arithmetic on the paper’s figures, the county went from about 79 primary care physicians per 100,000 residents in 2015 to about 85 in 2025.

That rate counts doctors. It doesn’t count hours.

Pickell, a former Tarrant County Medical Society president who teaches at TCU’s Burnett School of Medicine, made the point himself. The data doesn’t say how many of those physicians are older and working part time, he told the Fort Worth Report. It also doesn’t reflect that poorer residents may lack a way to get to a doctor at all.

“There’s a lot of variables that are in play when it comes to the actual delivery of care, as opposed to just the actual numbers of doctors,” he said.

Dr. Frank Filipetto, a distinguished professor at the Texas College of Osteopathic Medicine, added the age problem. He estimated that 40% to 45% of primary care physicians are over 55. “You got this almost iceberg-ahead kind of thing,” he told the paper.

That’s an estimate from one physician, not a measured share of Tarrant County’s workforce. It still names the real risk in a rising count: a large group of doctors could leave over the same decade that a large group of patients starts needing more care.

Where membership medicine enters

Lower primary care reimbursement means doctors have to see many patients a day, the paper noted. Filipetto put the squeeze in business terms: good care “takes time, that takes care, and the business model sometimes, often, contradicts that.”

The Fort Worth Report then turned to two alternatives. Some doctors choose direct primary care, the paper wrote, a model that skips insurance billing in favor of a regular patient fee and can give patients more time with their doctor. It described concierge medicine as a similar membership model.

Pickell said concierge medicine works for patients who can afford it but isn’t feasible for everyone.

“My concern is that they’ll end up having a two-tiered system, where you’ve got the people that don’t have the money to pay for the time that they need with their doctors, and then you’ve got the people who do have the money and they don’t mind paying $100 or $200 a month or whatever the fees are,” he said.

His dollar figures came right after the paper’s paragraph on concierge medicine, so read them as his rough sense of membership fees in general. For DPC specifically, the American Academy of Family Physicians says monthly fees generally range from $50 to $100. Prices vary by practice.

The top of Pickell’s range also crosses a federal line. Under the HSA rules for DPC described in IRS Notice 2026-5, the monthly limit is $150 for one person. A $200 individual fee would sit above it.

The counterargument

Pickell’s worry is the strongest case against the model, and it deserves its best version.

A DPC membership covers primary care, and AAFP notes that some services may require additional insurance coverage. A $50 to $100 monthly fee is $600 to $1,200 a year by our arithmetic, and for many patients it comes on top of whatever coverage they carry. The residents Pickell describes, the ones who can’t get across town to a clinic, are the least likely to have that money spare. DPC physicians also keep small panels on purpose. AAFP puts the average at about 413 patients. If a doctor who switches was carrying more patients than that, the ones who don’t follow go back into the queue. In a county already short on hours, that could make the wait longer for everyone else.

That argument survives in part. A fee is a barrier, and no amount of good intent removes it.

Where it weakens is in what it compares DPC against. Pickell’s own practice describes the other tier. A patient who waits three months for a first visit has already been sorted, by time instead of money. AAFP says about 99% of DPC practices offer same-day appointments. For a working patient with a sick child, that may matter more than a covered visit three months away.

DPC physicians quoted by AAFP push back on the stereotype too. “A lot of people have the misconception that DPC is only for the healthy and the wealthy,” Wisconsin DPC owner Dr. Wendy Molaska said. That’s her view, not a measurement.

Nothing in the Fort Worth Report’s reporting says how many of Tarrant County’s 1,967 primary care physicians run membership practices, or what their patients earn. So the honest version of the reply is narrow. If you run or plan a DPC practice, you might hear Pickell’s objection from a colleague. Answering it means pointing to the wait that already exists, and keeping a fee low enough that the patients he’s worried about can actually join.