U.S. Primary Care Physicians Shift to Direct Pay and Concierge Medicine Models
According to New York Magazine, an increasing number of primary care physicians are no longer accepting new patients, partly due to a shift towards direct pay and concierge medical practices, excluding patients reliant on insurance.
From 2018 to 2023, the number of fee-for-service clinics grew by 83.1%, with an estimated 10% to 20% of primary care physicians having joined such models; doctors report that this can reduce administrative burdens, increase income, and improve service quality. However, there is a nationwide shortage of about 13,000 primary care physicians, which is expected to expand to about 70,000 by 2038, leaving over 100 million Americans without stable access to primary care.
In the healthcare market, high-income patients receive priority services through membership fees, while accessibility for traditional insurance patients declines; funding and physician resources are concentrating towards direct pay models, putting pressure on insurance companies and large healthcare systems, benefiting concierge and direct primary care practices.
Source: Public Information
ABAB AI Insight
U.S. primary care has long faced low reimbursement rates, heavy administrative burdens, and burnout issues. The migration of physicians to concierge and direct pay models is not a new phenomenon but an acceleration of a trend that began post-pandemic. Previous studies have pointed out the pressure that traditional fee-for-service models exert on primary care.
In terms of capital pathways, physicians bypass insurance intermediaries by charging annual or membership fees, directly obtaining higher net income with fewer patients; resources are shifting from the insurance-covered mass market to a smaller group with greater payment capacity, motivated by the desire to avoid prior authorizations and paperwork while securing stable cash flow.
Similar stratified services can be seen in high out-of-pocket fields like dentistry and ophthalmology, as well as the diversion of private education from public systems. Currently, U.S. primary care is in a phase of accelerated differentiation from a "universal coverage orientation" to a "payment capacity stratification."
The structural judgment indicates a transfer of pricing power: when the costs of insurance intermediaries and administrative friction are too high, service providers choose to exit the insurance network, regaining direct control over patients and pricing, leading to accessibility stratified by income.
ABAB News · Law of Cognition
- When intermediary costs are too high, suppliers choose to bypass intermediaries.
- Service quality and patient numbers are often inversely related.
- Stratified services are a natural outlet for systemic pressure.