When I chose to depart from the conventional, insurance-driven model and establish a direct primary care (DPC) clinic, I wasn’t under any misconceptions. I was fully aware of the criticisms that would arise. In truth, I had already encountered them.

– You’re complicating the process for patients to secure a primary care physician.
– You’re limiting access for those in need.
– You’re abandoning your principles.

I’ve perused articles, such as the recent one on the Harvard Medical School website entitled “How purchasing primary care in the free market exacerbates doctor shortages.” And I comprehend the viewpoint. I truly do. From a high-level policy perspective, a doctor transitioning from a 2,000-patient roster in a traditional setup to a 300- or 600-patient roster in a DPC framework may appear as a setback for accessibility.

However, here’s the reality: It was never merely that straightforward. For me, similar to the approximately 20 percent of doctors intending to exit the profession in the coming two years, the decision wasn’t between 2,000 and 500 patients, but rather 500 and none.

The implicit belief in these critiques is that the alternative to DPC is remaining in the system. What if the true alternative involves drastically reducing work hours or abandoning the profession altogether?

Because that was the dilemma I faced. And I’m not the only one.

**Burnout is not just a term — it’s a crisis.**

I was experiencing burnout. Not merely fatigue, not just pressure. I was the kind of burned out that led me to envision a life free from trips to the clinic. The sort where I fantasized about leaving medicine—even though it’s what I’ve devoted myself to for years (or even decades). The kind that made me question whether my patients might fare better with another provider—someone who wasn’t on the brink.

And I was working in a community I am passionate about. I had more than a decade of experience at a community hospital, a federally qualified health center, and urgent care. I didn’t want to walk away. But remaining in that environment—where every moment was scrutinized, where I was expected to condense intricate care into 15-minute appointments (or shorter), and where I spent more time on paperwork and managing my inbox than connecting with families—was gradually wearing me down.

I realized I needed an alternative approach. Not because I was giving up on my patients, but because I was striving to avoid giving up on myself.

DPC wasn’t a departure from medicine. It was a return to it.

**Let’s be real: Many physicians are cutting back clinical hours**

One of my grievances with the critiques directed at DPC practitioners is how selectively they are enforced.

Yes, I have reduced my patient panel. Yes, I have chosen to leave the insurance-dependent model. However, I did not lessen my dedication to patient care. I didn’t disengage. I continue to dedicate long hours to treating families, managing chronic conditions, addressing mental health issues, and helping parents navigate complex social systems. (And, on top of that, I must oversee all the finances and operations of a business!)

What receives less focus is that numerous academic physicians and administrators are already working reduced clinical hours. I know medical professionals in leadership positions who haven’t treated patients in years. I know peers who see patients once a week and devote the remainder of their time to teaching, researching, or consulting. And that’s acceptable. That’s necessary. Yet, we don’t impose the same kind of moral scrutiny on them that we do on DPC practitioners.

When we discuss “access” and “shortages,” we need to examine the bigger picture. We must acknowledge that doctors throughout the system are making changes—stepping back, altering roles, reducing hours—in response to burnout and systemic challenges. DPC merely happens to be more apparent, as it represents a structural shift.

But it isn’t the only transformation occurring, and we should inquire why so many of us are seeking sanctuary, rather than merely reprimanding those who are.

**DPC is not a flawless system—but neither is the one we departed from.**

Look, I’m not going to claim that DPC is the answer to every issue in American healthcare. It’s not. We still confront significant disparities. We still face systemic racism, obstacles to access, rural healthcare gaps, and a disjointed public health system. DPC doesn’t rectify all of that.

But the traditional insurance-based model isn’t addressing it either. In fact, it frequently exacerbates the situation.

It’s a system where doctors are expected to conduct complex, nuanced, emotional work during brief, volume-centered visits, while also managing an ever-increasing administrative load. It’s a system where patients slip through the cracks, not because their physician lacks concern.