The Direct Primary Care Market in 2025–2026

Direct primary care has moved from fringe experiment to a structurally important slice of US healthcare delivery. The global DPC market was valued at $70.17 billion in 2025, growing to an estimated $75.11 billion in 2026 at a 7.3% CAGR, according to The Business Research Company. That growth rate sits well above general healthcare inflation, driven by three converging forces: physician burnout in fee-for-service settings, patient frustration with 8-minute appointments, and employer demand for affordable benefits packages.

In the United States specifically, more than 2,800 DPC practices now operate across 48 states, serving upwards of 1.4 million patients — up from roughly 500 practices a decade ago. The American Academy of Family Physicians (AAFP) formally supports the model, and 34 states have enacted specific legislation exempting DPC membership agreements from insurance regulation.

The single biggest demand catalyst of 2026 is the Primary Care Enhancement Act, signed into law on July 4, 2025 as part of the One Big Beautiful Bill Act. From January 1, 2026, patients enrolled in high-deductible health plans can use tax-free Health Savings Account (HSA) funds to pay DPC membership fees — up to $150/month per individual and $300/month per family. This removes the most common objection from prospective patients ("I already pay insurance premiums") and is expected to significantly accelerate membership conversion rates for new DPC practices opening in 2026.

Why DPC Economics Work

The core financial logic of DPC is simple: drop insurance billing entirely, charge patients a flat monthly fee, and use the overhead savings to run a smaller, more profitable practice. A traditional insurance-based primary care practice spends 30–40% of gross revenue on billing administration — coding, claims, prior authorisations, denials, and collections. A DPC practice eliminates all of that. The resulting overhead reduction is what allows a DPC physician to serve 400–600 patients at a high level of care rather than grinding through 2,500 patients per year at 8 minutes per visit.

Notably, more than 58% of DPC memberships are now employer-sponsored, according to Elation Health's 2026 DPC Trends report. This means the most sustainable patient acquisition channel for a new DPC practice is often a handful of local small-business contracts rather than trying to recruit hundreds of individual self-pay patients one at a time. A single employer group of 50 employees, each paying $85/month, adds $51,000 in annualised recurring revenue from one partnership.

Questions Physicians Ask Before Launching a DPC Practice

These are the questions that come up most often from family physicians and general practitioners considering the DPC transition:

Startup Costs for a Direct Primary Care Practice

A lean DPC practice — operating from a shared medical suite or a small leased space — can open for as little as $15,000 to $50,000. A standard solo DPC office with 1,200–1,800 sq ft and two dedicated exam rooms typically costs $70,000 to $150,000 to set up. The wide range reflects the difference between a home-visit-only model with minimal infrastructure and a full clinic build-out with new equipment and signage. In the UK, the equivalent private GP subscription setup runs approximately £55,000 to £120,000 once CQC registration and professional indemnity insurance are included.

Detailed Cost Breakdown

• Leasehold improvements and office fit-out: $20,000–$60,000 (£15,000–£48,000). Exam room fit-out, plumbing, electrical, waiting area.
• Exam room equipment (2 rooms): $8,000–$20,000 (£6,000–£16,000). Exam tables, vital signs monitors, otoscopes, ophthalmoscopes, sphygmomanometers.
• Basic lab and CLIA-waived point-of-care equipment: $3,000–$8,000 (£2,500–£6,500). Rapid strep, flu, urinalysis, CBC analyser, glucose meter, ECG.
• EHR and membership platform (first year): $2,000–$6,000 (£1,500–£5,000). Hint Health ($150–$500/month), Atlas.md, or Elation Health ($300–$500/month).
• Medical malpractice insurance (year 1): $8,000–$25,000 (£5,000–£18,000). DPC-specific policies are available from Coverys, ProAssurance, and The Doctors Company.
• Legal and entity formation (LLC/PC + DPC agreement drafting): $2,000–$8,000 (£2,000–£7,000). State-specific DPC membership agreement is a non-negotiable line item.
• Furniture, reception desk, waiting area: $5,000–$15,000 (£4,000–£12,000).
• Marketing launch (website, local SEO, referral programme setup): $2,000–$8,000 (£1,500–£6,500).
• Working capital reserve (6-month ramp period): $20,000–$60,000 (£16,000–£48,000). This covers fixed costs while the panel builds from 0 to break-even patient count.

The working capital reserve is the item most first-time DPC founders underestimate. The average practice takes 8–14 months to reach cash-flow positive, and most months below 300 patients will produce a net operating shortfall. Building 6 months of reserves into your opening capital requirement is the single most important financial planning decision in a DPC business plan.

Funding Routes for DPC Practices

Most DPC practices fund their launch through a combination of personal savings (typically $20,000–$50,000) and an SBA 7(a) loan or equipment financing. Physician-specific lenders including Live Oak Bank, Bank of America Practice Solutions, and TD Bank Healthcare Practice Finance have established medical practice loan programmes covering DPC build-outs under NAICS 621111. Personal savings alone rarely cover both fit-out and the full 6-month working capital reserve, which is why most plans include a formal lending component.

In the UK, the Start Up Loans scheme offers up to £25,000 at 6% fixed interest with free business mentoring — useful for partial launch funding. Private bank lending from HSBC and Barclays also covers CQC-registered private GP practices, particularly where a credible 3-year financial projection is provided.

SBA 7(a) Loans for Direct Primary Care Practices

Direct primary care practices qualify for SBA 7(a) loans under NAICS code 621111 (Offices of Physicians, except Mental Health Specialists). This is the same code that covers general practice, internal medicine, and family medicine — SBA considers DPC a standard physician office business, not a novel or ineligible structure.

Key SBA 7(a) Parameters for DPC Practices

• Maximum loan amount: $5 million per borrower under the standard 7(a) programme
• Typical DPC practice loan size: $75,000–$350,000 for initial fit-out, equipment, and working capital
• Maximum term: 10 years for working capital; 25 years for real property
• Interest rate: Prime + 2.25–4.75% (variable) or fixed options via some lenders
• SBA guarantee fee: 0% on loans under $150,000; 1.85–3.75% on loans above $150,000
• Collateral: Business assets first; personal guarantee typically required from founders with 20%+ ownership

What SBA Lenders Require for a DPC Practice Application

Physician practices under NAICS 621111 have among the highest SBA 7(a) approval rates of any healthcare subcategory, largely because the revenue model is predictable (recurring membership fees) and the borrower (a licensed physician) carries a professionally regulated credential. However, lenders will scrutinise the membership ramp model closely. A credible application must include:

• A 3–5 year income statement projection with monthly detail for years 1–2
• A month-by-month patient acquisition schedule showing when the practice covers fixed overhead
• Demonstrated medical licence and malpractice insurance coverage
• Evidence of a signed commercial lease or lease-ready space
• Personal financial statement from each owner with 20%+ equity
• 2 years of personal tax returns (for existing practitioners transitioning from employed roles)

Our Research + Content package ($300/£250) and Bespoke Business Plan ($1,000/£800) both include SBA-compliant 5-year Excel financial models with the monthly membership ramp schedule that lenders specifically request for DPC applications.

Revenue Model, Profit Margins & Unit Economics

The DPC revenue model has three variables: number of patients, monthly membership fee, and overhead. Everything else follows from those three numbers. Most guides stop at listing fee ranges; this section works through the actual economics at three practice sizes.

Membership Fee Benchmarks

Monthly DPC membership fees vary by geography, patient age, and what the fee covers. Standard adult rates run $50–$100/month for individuals, with a median of $70/month across US practices. Children's memberships are typically $20–$50/month. Family plans range from $100–$200/month for a household of 2–4. Employer-sponsored plans frequently carry higher per-member rates of $100–$180/month because the employer values the cost savings from reduced ER visits and specialist referrals.

Geographic variation is significant. A DPC practice in a rural Kansas market may charge $49–$65/month and remain fully competitive. A practice in Austin, Denver, or Raleigh can support $90–$130/month without price resistance, particularly for employer-sponsored members. The business plan must include a local market analysis that justifies the chosen fee structure.

Worked Example: Three Practice Sizes

Additional Revenue Streams Beyond Membership Fees

Most established DPC practices generate 85–95% of revenue from monthly memberships. A small but growing number supplement this with:

• Employer group contracts: Typically priced at $100–$180/per-employee-per-month, often with a 12-month minimum commitment. These provide predictable, contractual ARR growth.
• Ancillary in-office procedures: Minor surgical procedures (laceration repair, skin biopsies, joint injections) billed outside the membership at cost-plus pricing. Many DPC practices charge $50–$150 per procedure — well below specialist rates.
• Wholesale lab testing: DPC practices typically negotiate wholesale lab pricing through Quest Diagnostics or LabCorp at 80–95% below retail. Some pass cost directly to patients (included in membership); others charge a modest markup on specialty panels.
• Telemedicine visits: For established members who prefer asynchronous or video consultations — particularly useful for extending reach in a large rural catchment area without adding office space.

Typical Operating Cost Structure

A solo DPC practice's cost structure looks materially different from traditional primary care because billing administration drops to near-zero. Key overhead categories for a 1,500 sq ft practice in a mid-size US city:

• Staff (1 medical assistant, part-time receptionist): $55,000–$75,000/year including payroll taxes
• Occupancy (rent + utilities): $24,000–$48,000/year depending on market
• Medical malpractice insurance: $8,000–$20,000/year
• EHR, membership platform, and technology: $5,000–$9,000/year (Hint Health + clinical EHR)
• Medical supplies and lab reagents: $8,000–$18,000/year
• Marketing and patient acquisition: $3,000–$8,000/year
• Professional fees (accounting, legal, DEA registration): $4,000–$8,000/year

Total overhead for a lean solo practice typically falls between $180,000 and $280,000 per year. This means break-even occurs at roughly 200–333 patients (at $75/month average), well below the typical full panel of 600.

Licensing, Registration & Regulatory Requirements

The compliance picture for a DPC practice is more complex than a standard medical office because DPC agreements sit at the intersection of healthcare law, contract law, and — in states without a DPC safe harbour statute — insurance regulation. Get the regulatory structure wrong and a state insurance commissioner can classify your membership fees as an unlicensed insurance product.

United States

• State medical licence (MD or DO): Required. Agency: State Medical Board. Cost: $300–$900 initial. Timeline: 2–4 months. If you are relocating to practice DPC, build licensure time into your launch timeline.
• State DPC statutory compliance: In the 34 states with DPC legislation, your membership agreement must comply with specific disclosure and termination requirements. In the 16 states without a safe harbour statute, work with a healthcare attorney before launching. Consult: Patient Options DPC Laws by State (2026).
• DEA registration (controlled substances): Required if prescribing. Agency: Drug Enforcement Administration. Cost: $888 for a 3-year registration. Timeline: 4–6 weeks.
• CLIA waiver (in-office lab tests): Required for point-of-care testing. Agency: CMS. Cost: $150 biennial fee. Timeline: 4–8 weeks. Without this, you cannot legally run rapid tests in the practice.
• NPI registration: Free. Agency: NPPES/CMS. Timeline: 1–2 business days. Required even if you opt out of Medicare/Medicaid entirely.
• Business entity formation (LLC or Professional Corporation): Agency: State Secretary of State. Cost: $50–$500. Timeline: 1–4 weeks. Most DPC physicians operate as a single-member LLC or a professional corporation depending on state rules for physician-owned entities.

United Kingdom

A UK private GP subscription practice operates under a different regulatory structure from the US DPC model, but the economic logic is essentially identical. CQC registration replaces state medical board compliance as the primary gate.

• CQC registration (Independent Medical Agency): Agency: Care Quality Commission. Fee: £1,434–£2,552/year depending on income band. Timeline: 8–24 weeks. You cannot see patients for a fee before CQC registration is confirmed. Start the application 6 months before your planned opening date.
• GMC registration with licence to practise: Agency: General Medical Council. Cost: £425/year. Must be current before accepting any patients.
• Medical indemnity insurance: Providers: MDU, MPS, MDDUS. Cost: £3,000–£15,000/year depending on scope of practice. Private GP work without NHS indemnity requires standalone private indemnity.
• ICO registration (UK GDPR data controller): Agency: Information Commissioner's Office. Cost: £40–£60/year. Required as soon as you hold patient data.
• Enhanced DBS check: Required for any work involving children or vulnerable adults. Cost: £38 per person. Timeline: 2–6 weeks.

Canada & Australia

In Canada, provincial College of Physicians registration is required in each province where you practice. DPC-style "direct family practice" models operate either under provincial health authority frameworks or as fully private practices. Fee caps and billing rules vary by province — British Columbia and Ontario have historically been the most restrictive for private billing; Alberta and New Brunswick have more flexible frameworks. No federal DPC-specific legislation exists.

In Australia, AHPRA medical registration is the baseline requirement. Some Australian GP practices operate subscription concierge-style models under Medicare's bulk-billing framework, while others run fully private practices. The RACGP Fellowship (FRACGP) is strongly desirable but not legally required for private practice. The Private Health Insurance Act 2007 governs certain membership arrangements and should be reviewed by a healthcare solicitor before launching a subscription model.

Six Costly Mistakes DPC Practices Make in Year One

Most DPC failures trace back to a small set of predictable errors. These are the ones we see most often in practice plans — and the ones that SBA lenders and investors flag first.

• Underpricing below $60/month then running out of cash during the ramp period. At $50/month, you need 400 patients just to hit $240,000 ARR — which may barely cover overhead. At $75/month with 400 patients, you're at $360,000 and well past break-even. Price reflects value, not just competitiveness with the cheapest practice in your area. Model the fee sensitivity before settling on a number.
• Building a panel over 700 patients before hiring a second staff member. Physician burnout is the leading reason DPC practices fail after initial success. Iora Health's team-based model — physician + nurse + health coach — is designed precisely to prevent this. A solo physician carrying 700+ patients without support staff quickly loses the same-day access that makes DPC worth the membership fee.
• Operating in one of the 16 states without a DPC safe harbour statute without a compliance review. Without explicit state legislation, a membership agreement can be characterised as an insurance product by a state insurance commissioner. This has happened to practices in states including New York, where the regulatory environment for DPC agreements is more ambiguous than in states like Colorado, Virginia, or Texas with clear DPC laws.
• Choosing a generic EHR not built for subscription billing. Standard Epic or eClinicalWorks implementations are designed around fee-for-service billing workflows. Trying to run a DPC membership in a generic EHR creates data management headaches and typically still requires a separate membership billing tool. DPC-native platforms — Atlas.md, Hint Health, PracticeQ — combine clinical documentation and recurring membership billing in a single system designed for this model.
• Targeting only uninsured patients as the primary growth channel. Uninsured patients are price-sensitive and less likely to maintain memberships through financial stress. The more resilient patient mix combines some individual self-pay members with employer-sponsored groups (predictable, contractual, higher per-member rates) and a small number of patients who keep a low-cost wraparound insurance plan alongside their DPC membership. Practices like Paladina Health and Nextera Healthcare have scaled by focusing almost exclusively on employer groups rather than individual recruitment.
• Not drafting a clear termination and transition-of-care clause in the membership agreement. State DPC laws typically require a minimum 30-day notice period before terminating a patient's membership. But the agreement also needs to address medical records transfer, referral to a replacement provider, and refund of any pre-paid fees. Missing these clauses creates patient complaints and — in some states — regulatory action. This is money well spent on a healthcare attorney before signing patient #1.

Sample Direct Primary Care Business Plan — Executive Summary Extract

Here is a representative extract from a DPC business plan written by our team, showing the kind of specific, data-backed narrative that lenders and investors expect:

What's in the Direct Primary Care Business Plan Template

Every Avvale business plan template includes these sections, pre-structured for the DPC model. The free template covers the narrative structure; the paid tiers add financial modelling, market research, and full written content.

• Executive Summary: Practice overview, founding physician credentials, capital requirement, and key financial projections formatted for SBA lenders and private investors
• Practice Overview: Legal structure (LLC/PC), location, catchment area, founding team, and service scope (what services are inside and outside the membership)
• DPC Market Analysis: Local primary care supply/demand, competitor analysis (nearest DPC practices, concierge practices, and traditional family medicine groups), and your differentiation strategy
• Target Patient Segments: Individual self-pay members, employer group contracts, and any specialist patient populations (Medicare opt-out, paediatric-only, etc.)
• Membership Pricing Model: Monthly fee tiers by age and plan type, employer group contract structure, and fee rationale anchored to local market comparables
• Operations Plan: Appointment model, daily patient capacity, staffing structure (MA, front desk, coverage arrangements), telemedicine integration, and EHR/membership platform choice
• Patient Acquisition Strategy: Direct employer outreach, referral partnerships, digital marketing, and founding member launch campaign
• Regulatory & Compliance Section: State DPC statute compliance, CLIA waiver status, Medicare opt-out status, and DPC agreement structure
• Management Team: Founding physician biography, advisory relationships, and planned future hires as the panel grows

The optional Financial Forecast add-on — included in our $300/£250 and $1,000/£800 packages — includes a 5-year Excel model with income statement, cash flow statement, balance sheet, break-even analysis, SBA loan amortisation schedule, and a month-by-month membership ramp projection for years 1 and 2. This is specifically what SBA lenders under NAICS 621111 require.

Looking for related templates? See also our concierge medicine business plan template and our medical clinic business plan template for adjacent care models.

Frequently Asked Questions About Direct Primary Care Business Plans