Part 3b
Structural comparison
DPC vs. Fee-for-Service:
the structural
difference.
This isn't a values argument. It's a structural comparison — what each model actually produces in terms of visit volume, admin burden, revenue, and ownership access.
Source: AAFP Policy on Direct Primary Care (September 2024) · ABFM Family Medicine Factbook, 2024
Side-by-side
Eight structural dimensions
These aren't preferences or opinions — they're documented structural outcomes of each payment model. The numbers reflect the practice environments each model creates.
Dimension
Fee-for-Service
Direct Primary Care
Patients per day
20–30 patients
8–12 patients
Visit length
7–12 minutes average
30–60 minutes
Panel size
2,000+ patients
500–800 patients
Revenue driver
Per-visit billing volume
Stable monthly memberships
Admin burden
High — coding, billing, prior auth
Minimal — no insurance billing
After-hours EHR
1–2 hrs EHR per 1 hr care
Direct text / phone as needed
Ownership access
High barriers, especially early career
Realistic within 2–5 yrs post-residency
Clinical scope
Narrows under volume pressure
Supported by longer visits + smaller panels
"For family physicians, this revenue model can stabilize practice finances, allowing the physician and office staff to focus on the needs of the patient rather than coding and billing."
— AAFP Policy on Direct Primary Care, September 2024
Why it matters
What each structural difference actually produces
Visit volume
Seeing 8–12 patients per day instead of 25–30 is the structural prerequisite for the relationships that make primary care effective. 80.8% of early-career ABFM Diplomates provide continuity care. DPC is built around exactly that.
Revenue
Monthly memberships mean your income is not tied to visit volume. Revenue is steady whether you see 8 or 12 patients that day. No upcoding. No chasing billing. No volume pressure.
Admin
Over 50% of family physicians report EHR time at home as moderately high or excessive. DPC eliminates the source: no insurance billing, no prior authorizations, no coding staff. Many DPC practices run with just one support staff member.
Ownership
Only 14% of early-career FPs are in independent practice in FFS. In DPC, low overhead makes practice launch realistic within 2–5 years post-residency. The model structurally lowers the barrier — not the ambition required.
Scope
Scope narrows in FFS because volume leaves no time for complex procedures and longitudinal management. DPC's smaller panel + longer visits structurally support maintaining the broad scope FM residency trains for. The skills don't atrophy the same way.
What this is — and isn't
A structural comparison, not a verdict.
DPC is not the right model for every physician. Running a DPC practice requires small-business ownership skills, comfort with marketing your practice, and engagement with the business dimensions of medicine that many physicians prefer to delegate.
Fee-for-service employment offers stability, institutional support, and a clear onboarding path. For physicians who want to focus entirely on clinical care without building a practice, that's a legitimate and defensible choice.
The point is that the structural differences are significant enough to understand early — before a job offer or inertia makes the decision for you.
Not sure where you land? The self-assessment applies the AAMC reflect framework to exactly these tradeoffs — 6 questions, 2 minutes, personalized next steps by training stage.