By Janis MVK
April 3, 2026

The Primary Care Divide

How direct and concierge care are reshaping American primary care

Millions of Americans struggle to afford, let alone access, healthcare. In Illinois, individual plans through Get Covered Illinois were 28.8% more expensive than last year, with unpredictable out-of-pocket costs that can run into the thousands — an average of $1,514 per person in 2023, according to the health policy research foundation KFF.

Hospital networks are also stretched thin, with growing patient rosters, lower reimbursement rates, and long waits. This leaves primary care physicians feeling overwhelmed and burned out. It pushes many out of traditional practices and leaves patients with fewer options. In fact, the Association of American Medical Colleges projects a shortage of up to 40,400 primary care physicians by 2036.

With people sometimes waiting months for routine visits, they end up in urgent care or the emergency room for issues that could have been treated earlier or prevented.

One possible solution? Direct primary care (sometimes called DPC) and concierge medicine. These approaches have attracted more patients over the past decade, and are available to patients who can afford them.

Direct primary care

In direct primary care, people pay a monthly subscription fee for primary care outside traditional health insurance.

For Amy Schroeder, MD, of Duet Family Health, the monthly fee ranges from $60 to $150 per individual, depending on age, and covers preventive, acute, and ongoing care, as well as common procedures and women’s health.

Chicago resident Kerri-Sue Adams, 57, does not have traditional health insurance, but rather relies on a medical health-sharing plan that only covers catastrophic events. This type of plan involves members pooling their monthly payments to help cover each other’s eligible medical expenses. “The two major factors for choosing DPC were the skyrocketing marketplace costs and decreasing availability of my primary care physician,” she says.

Where traditional appointments are scarce, direct primary care offers timely access that is longer and less rushed, Schroeder says. “Visits with me are half an hour to an hour, which gives me time to really talk to patients about what’s going on,” she says. “It builds relationships and enables me to provide much better care.”

Patients can address multiple concerns in a single visit, and the provider can order prescriptions directly, eliminating the need for insurance go-betweens. “I’m able to order medications through a wholesale pharmacy, and the costs are lower because there is no insurance or middlemen involved,” she says.

Schroeder says direct primary care works best for people who need periodic care. It may not suit those with complex, specialist-driven conditions.

For Adams, the biggest benefit is financial predictability. “DPC tells you the costs immediately so you can make informed decisions.”

Drawbacks include limited network integration (meaning physicians typically operate outside insurance networks and may not coordinate closely with hospitals or specialists), no backup provider, monthly fees even if services aren’t used, and no coverage for emergencies.

Concierge care

Concierge medicine requires an annual retainer in addition to an insurance plan, offering direct access to a physician, a higher level of personalized care, and coordinated entry into a trusted network of specialists. For Chicago resident Marina Terzich, 42, who has rare, chronic conditions, paying an additional $4,000 a year is worth it.

Sean Cahill, MD, who runs his own concierge medicine practice, says, “We take a yearly retainer fee and also bill insurance, augmenting coverage so patients have greater access and greater advocacy within a system to see specialists.”

We take a yearly retainer fee and also bill insurance, augmenting coverage so patients have greater access and greater advocacy within a system to see specialists.”

Concierge physicians, like direct primary care physicians, maintain far smaller patient rosters. “It’s logistically challenging for employed PCPs to provide individualized care because they have much larger caseloads and time demands, often seeing more than 25 patients daily,” Cahill says. Many employed primary care physicians have 3,000 patients on their roster. In contrast, a typical concierge doctor has a patient panel of “probably 250-300 patients,” Cahill says. Fewer patients leave more time per visit for comprehensive care.

For Terzich, this accessibility and availability have been critical during medical crises. “My concierge doctor can usually see me as soon as the next day, sometimes the same day, and is great about communicating in their messaging system,” she says. “I typically get responses within a few hours.”

But the cost of the concierge model is high. Annual fees for this white-glove service can range from $1,500 to $25,000, and patients must still carry traditional insurance to cover labs, hospitalizations, specialist visits, and major procedures. While the retainer covers more personalized care, it does not replace insurance for major medical costs.

Terzich recognizes that the price tag isn’t accessible to everyone. “But for someone who does see the doctor often, it can be a feasible investment in their health if they prioritize it,” she says.

Critics warn that these models are creating a two-tier system that accelerates inequality, giving faster, more comprehensive care to those who can pay while others remain stuck in overloaded networks. Some view them as market-driven fixes to a broken system. Yet, Cahill and Schroeder predict growth.

“It’s only going to grow in market share as patients get more dissatisfied with primary care and physicians become scarcer,” Cahill says.

Schroeder expects employers to incorporate direct primary care into more health plans over the next decade. “It can cost less and benefit employees,” she says.

Whether these models represent innovation or a shortcut for those who can pay, they could define the future of American healthcare.