Nearly Half of DPC Doctors in AAFP's Survey Say They Earn Less
In the AAFP's 2026 survey, 47% of family physicians practicing DPC reported lower earnings and 30% higher, while 99% said care improved. The brief gives no dollar size, and its response rate was 9.3%.
Research Desk 4 min read Analysis
Nearly every family physician practicing direct primary care in the American Academy of Family Physicians’ newest survey says the model improved care. Ask about money and the answer turns.
In the 2026 DPC data brief, 99% of respondents in a DPC setting reported improved care quality and patient relationships. Work-life balance came in at 89% and paperwork burden at 86%. Earnings were the one exception: 47% reported lower earnings in DPC practice, and 30% reported higher. The brief doesn’t describe the other 23%.
The AAFP’s own summary is plain about it. Respondents “viewed DPC as a clear quality-of-practice gain, even when it involved a financial trade-off.” Only 17% named income as a reason for choosing the model. Improved care quality was a reason for 96%.
You might be doing this math right now, with a contract on the table or a practice you’ve been sketching for years. Here’s how far the number carries.
Who answered
The survey went to family physicians who had engaged with DPC content in the previous three years: DPC Summit attendees, visitors to the AAFP’s DPC pages, members of its DPC interest group and buyers of DPC products or CME. It got 313 usable responses, a 9.3% response rate. Of those, 167 were practicing in a DPC setting.
So this is a list of people already interested in the model, and the earnings answers come from doctors still in it. A physician who tried DPC, lost money and went back to employment can’t be among the 167.
That makes 47% an unusual kind of finding. The sample leans friendly, and lower earnings still outnumber higher ones.
The frame also moved. The 2024 study went partly to a random sample of AAFP members. The 2026 description lists no random sample, which is a reason for caution with any year-to-year comparison.
Panel size shows why. The new brief reports an average panel of 504, up from 402, and it reports that for all survey respondents. That group includes the 146 who weren’t practicing DPC. The 2024 figure sat under DPC practice characteristics. The AAFP’s own DPC page now shows 504 in its stats section and about 413 in its FAQ. Quote 504 as a DPC panel at your own risk.
A number with no size attached
The brief gives direction and nothing else on pay. It has no dollar figure, no percentage change and no split by years in practice.
The AAFP does publish a dollar figure elsewhere. Its DPC page cites a Career Benchmark Dashboard showing family physicians in DPC settings earned an average full-time income of $288,779 in 2024. That’s a separate source, and the page gives no sample size. It also measures something different. The dashboard reports a level. The survey reports a direction. A doctor can report lower earnings and still make a solid income.
Practice age is the likely missing variable, though that’s our inference and not an AAFP finding. In the DPC Alliance’s State of DPC report, based on 465 responses collected in late 2024, the physician group says 68.4% of respondents reported panels that weren’t yet full. The AAFP’s respondents point the same way: 40% called panel growth a major challenge and 29% named revenue stability. And 89% hold an ownership stake, while 63% opened an independent practice after leaving a health system or group. An owner with a panel still filling carries the overhead that an employer used to carry.
The model is changing shape too
Pure DPC accounted for 71% of respondents’ practices. The AAFP says that share “declined steadily” from 90% in 2022 and 84% in 2024.
That framing starts at a high point. The 2024 brief put the 2018 share at 80% and the 2019 share at 84%, so 2022 looks like the peak. Even so, 71% is the lowest of the five surveys.
The AAFP attributes the shift to diversification, “including increased use of hybrid and concierge models,” and prints no split between them. One detail doesn’t fit neatly. The share still doing some fee-for-service billing is 9%, the same as in 2024. Pure DPC fell 13 points and that line didn’t move, and the brief prints no hybrid or concierge share to account for the difference.
Employer work slipped as well. Fifty-five percent had employer contracts, down from 63% in 2024 and 65% in 2022. Those contracts skew small: 69% of contract holders worked with employers under 10 employees, and 22% with employers above 250. Respondents could pick more than one size.
On software, Atlas.md was the most-used EHR at 26%. Elation Health held the top spot in earlier surveys, at 26% in 2024 and 53% in 2022. The brief doesn’t give Elation’s 2026 share.
The Open Question
If you’re thinking about leaving a salaried job, the thing you most need to know is whether lower earnings last. This brief can’t say.
The brief gives no earnings figures by years open. So 47% could be a startup phase, a permanent trade or some mix of both. And the doctors who’d settle it fastest, the ones who left DPC over money, aren’t in the group reporting.
You might get closer with a few phone calls. Ask physicians past their fifth year what they take home compared with their last job, and ask what year it stopped hurting.
The survey has run every two years since 2022. One added table, earnings by practice age, would tell a resident more than another round of topline percentages.
