5 Things I Noticed in the 2026 State of DPC Report
The largest physician survey direct primary care has ever had — 465 practices, real numbers on who's doing this and how.
I read the whole thing. Here's what stood out.
Back in early August I mentioned a strange fact: there are more than 3,600 direct primary care practices in the U.S. now, growing at almost 20% a year - and the entire body of peer-reviewed research on the model is 78 papers. Total.
That number came from the State of Direct Primary Care 2026 Report, published this summer by the DPC Alliance. It's the largest and most rigorous survey of DPC physicians ever conducted - 465 responses, representing roughly 13% of all physician - owned DPC practices nationally. I sat down and read the whole thing, cover to cover, the way I'd want a patient to read a lab report: not skimming for the headline, but actually looking at what the numbers say.
The evidence gap is still the biggest story in that report. But it's not the only one. Five other things caught my eye - some validating, one a little uncomfortable, all worth sitting with if you're a patient trying to understand this model, or a physician wondering whether it's for you.
1. This is a career now, not just an exit ramp
For years, the story people told about DPC was an escape-hatch story: burned-out doctors, usually mid-career, fleeing the RVU treadmill for something saner. The demographics in this report complicate that.
Mean age of respondents is 46, median 45 - so yes, the median DPC physician has practiced for a while first. But nearly 1 in 10 started their DPC practice straight out of residency. That's a meaningfully different signal than "escape hatch." It says a growing number of new physicians are looking at the traditional system on their way out of training and deciding not to get on the treadmill in the first place.
Two other numbers stood out. Women make up 67% of respondents - a clear majority in a field that, in traditional practice settings, still skews male in ownership roles. And family medicine dominates the specialty mix at 76%, with internal medicine and pediatrics trailing well behind. Internal Medicine–Pediatrics - my own training - is 3% of the sample. I'm used to being a minority in a room. Apparently that's true in DPC too.
2. The "600-patient panel" number is a survivor's number
If you've spent any time in DPC circles, you've heard the folk wisdom: a full panel is around 600 patients. This report is the first real data check on that claim, and the answer is more interesting than a simple confirm or deny.
Across all respondents, panels are much smaller than 600, and nearly 70% of physicians say their panel isn't full yet. That makes sense - most of these practices are young, and a young practice is, definitionally, still filling up. But when the researchers isolated only the physicians who said their panel was full, the picture snapped into focus: full panels cluster tightly in the 400–700 range, right where the folklore said they'd be.
The takeaway isn't that the 600 number is wrong. It's that it describes a mature practice, not the field as it currently exists. Most of DPC right now is still building toward that number. Which is a useful thing to know if you're a new-ish DpC doc looking at your own panel and wondering if something's broken. Probably not. You're just early.
3. Solo isn't the exception. It's the default.
I built B2 Direct Care as a solo micropractice on purpose - no MA, no front desk, just me. I'd assumed that made me somewhat unusual even within DPC. The data says otherwise.
82.4% of respondents are full owners of their practice. 89.3% operate a single location. The vast majority run as solo physicians with zero or one additional doctor, and roughly two-thirds of practices have either no support staff at all or exactly one person helping out. This isn't a field of small group practices that happen to bill differently - it's overwhelmingly a field of individual physicians choosing direct ownership and direct control over everything else.
That's worth naming plainly: DPC's appeal is entrepreneurial as much as clinical. Physicians aren't just opting out of insurance billing. They're opting into running their own small business, on their own terms, at a scale one person can actually hold in their head. I find that reassuring rather than lonely - it means the model I built isn't an outlier. It's the norm.
4. The map doesn't say what you'd expect
Nearly half of all DPC practices in this survey - 46.5% - are in the South. Three of the top five states by practice count (Texas, Florida, and Georgia) are states that have not expanded Medicaid under the ACA. That's a pattern worth sitting with: DPC appears to be growing fastest in places where the traditional safety net is thinnest.
Colorado, for what it's worth, made the top 10 - tied for 10th with Oklahoma. Not a hub, but not nowhere either.
The setting breakdown surprised me more than the region breakdown. Suburban practices make up 55% of the field. Urban is 24%. Rural - the setting where access problems are usually most acute, and where I'd have guessed DPC's low overhead would be the biggest advantage - is the smallest slice, at 21%. Rural practices do charge meaningfully less ($81.56 per member per month, versus $110 in urban markets), which suggests the access economics work the way you'd hope where DPC does exist rurally. It just hasn't gotten there at scale yet. Rural DPC is real. It's not yet where the growth is concentrated.
5. There's an awkward on-ramp problem with Medicare
80.7% of respondents have opted out of Medicare entirely — the cleanest way to practice DPC without a competing billing framework in the room. But the report flags a structural catch that I hadn't seen named this clearly before: a physician who's moonlighting elsewhere while building their DPC panel cannot opt out of Medicare. Opting out is an all-or-nothing election tied to your NPI, not your practice.
So a new DPC physician who needs moonlighting income to bridge the startup runway is stuck choosing between turning away Medicare-age patients entirely, or running a hybrid model that reintroduces some of the billing complexity DPC exists to escape. Neither option is great. It's not a flaw in the model so much as a gap in how the rules were written for a model that didn't exist when they were written. Worth knowing if you're a resident or early-career physician mapping out how you'd actually get from here to a full DpC panel.
Why I'm reading reports like this
None of these five things changes what I'm doing at B2 Direct Care. But all five sharpen it. Knowing that solo ownership is the norm, not the exception, tells me I'm not improvising - I'm following a well-worn path. Knowing the 600-patient number describes a mature panel, not a starting one, keeps me from measuring year one against year five. Knowing rural DPC is real but still rare tells me where the unmet need actually is, if I ever think about what's next.
That's the whole point of a report like this existing. Not to prove DPC is right - the physicians and patients choosing it every year have already answered that with their feet. But to help a young field grow up with its eyes open, instead of running on folklore and vibes. I'd rather build on 465 real data points than on the story I assumed was true.
Source: DPC Alliance Member Insights Committee. State of Direct Primary Care 2026 Report. Survey data collected October 2024; published July 2026. n=465. Available at dpcalliance.org
Brian Bost, MD, MPH, is a Med-Peds physician and Physician-Founder of B2 Health Solutions and its clinical practice, B2 Direct Care — a hospitalist-informed, solo DpC micropractice in Denver, Colorado.
