Part 6 of 6
Primary care is under structural pressure from multiple directions. DPC is one response — not a cure-all, but a model with formal AAFP backing and a growing evidence base.
Sources: NASEM 2021 · ABFM Factbook 2024 · AAFP FM Champions Curriculum · AAFP DPC Policy September 2024
Primary care is in crisis
These aren't opinions. They're documented, persistent structural problems — the kind that shape workforce pipelines, burnout rates, and the decisions students make when they reach the match.
of family physicians report EHR time at home as moderately high or excessive
burnout rates — primary care consistently among the highest in all of medicine
Fewer medical graduates choosing family medicine each year — the pipeline is narrowing
dimensions of primary care underinvestment identified by NASEM: financing, workforce, access, training, research
The National Academies identified five interlocking dimensions of underinvestment in primary care. Each one compounds the others. DPC addresses several directly — particularly financing and workforce sustainability.
The evidence for primary care
Regions with more family physicians per capita have lower mortality and better chronic disease outcomes — consistent across multiple decades of research.
1 in 5 ABFM Diplomates report that over half their patients are from historically marginalized groups. Family medicine is where health equity is delivered — or isn't.
Family physicians are the most widely distributed physician specialty in the U.S. — rural access at rates no other specialty matches.
DPC addresses the structural mismatch between what fee-for-service pays for and what primary care actually does — longitudinal relationships, chronic disease management, care coordination — none of which bill well under CPT codes.
"The DPC model is structured to emphasize and prioritize the intrinsic power of the relationship between a patient and his or her family physician to improve health outcomes and lower overall health care costs."
— AAFP Policy on Direct Primary Care, September 2024AAFP FM Champions curriculum
The AAFP Family Medicine Champions Program is a 12-module mentorship curriculum equipping faculty to recruit and retain students in family medicine. Module 4 — "The Future of Family Medicine" and "The Business of Medicine" — is exactly where DPC belongs.
Module 4 covers how healthcare systems work, why family medicine is integral to the future of healthcare, and how to address myths. DPC has everything it needs to belong in that conversation:
What this means for you
DPC is not presented here as the only good answer, or even the best answer for most physicians. The goal of this guide is not to recruit you into a model — it's to make sure you understand the options before the pressures of clinical training, loan repayment, and inertia narrow the choice set.
Thousands of physicians have built DPC practices they describe as the most sustainable careers they've had. Thousands more have found that employed medicine suits them well. Both are legitimate.
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