Concierge and direct primary care practice sites grew 83.1% nationwide between 2018 and 2023, rising from 1,658 to 3,036, according to a study published in Health Affairs. The clinicians working inside those practices grew 78.4% over the same five years, climbing from 3,935 to 7,021, and who owns those practices changed almost as fast as the count did.
The study was led by Jane M. Zhu with co-authors from Johns Hopkins, Harvard Medical School, and Oregon Health & Science University, using national practice-level data through 2023. For an independent practice executive, the growth rate is the easy part to notice. The shift in who owns these practices and who staffs them is the part that changes how a practice manager should read the trend.
The scale of the move away from fee-for-service
A jump from 1,658 to 3,036 practice sites in five years works out to roughly 276 new concierge or direct primary care (DPC) sites opening each year on average. The clinician count moved on a similar curve, from 3,935 to 7,021, a 78.4% increase that slightly trails the site growth rate. That gap matters operationally. The average practice size grew only a little, from about 2.4 clinicians per site in 2018 to about 2.3 in 2023, so this expansion has been driven mostly by new, small sites rather than existing practices adding staff.
Family medicine associations are seeing the same curve from a different angle. The American Academy of Family Physicians' 2023 Practice Profile Survey, drawing 558 responses from a random sample of 20,000 members, found 9% of family physicians reported operating a DPC practice in 2023, up from 3% in 2022. A tripling in one year among a single specialty tracks closely with the five-year national trend Zhu's team documented.
Independent ownership is fading inside a model built to escape it
DPC and concierge medicine grew as an alternative to corporate and insurer control. Corporate ownership followed the money into the model anyway. Independent ownership of these practices fell from roughly 84% in 2018 to roughly 60% in 2023. Corporate-affiliated practices grew from 152 sites, or 9.2% of the total, to 1,027 sites, or 33.8% of the total, a 576% increase in five years. Health-system or integrated-delivery-network affiliation stayed roughly flat, at 5% to 6% of sites across both years, so the ownership shift is a corporate story, not a hospital-system story.
For a billing company or practice management firm watching this space, that 33.8% corporate share is the number to track. A model once defined by solo and small-group ownership now has one in three sites tied to a larger corporate entity, and that changes who a practice negotiates against for referrals and vendor contracts.
Who treats the patients is changing too
Physicians made up 67.3% of clinicians in concierge and DPC practices in 2018. By 2023 that share had fallen to 59.7%, while the advanced practice clinician share, nurse practitioners and physician assistants, rose from 32.7% to 40.3%. The clinician pool also became more female, from 39.5% female physicians in 2018 to 44.6% in 2023.
Billing profile shifted as well. Roughly 60% of clinicians in the study sample billed Medicare, while about 40% did not. That tells practice executives that direct primary care in practice is more often a hybrid arrangement layered on top of Medicare billing than a pure cash-only model. The distinction matters for revenue modeling, since a hybrid approach keeps a Medicare billing infrastructure running alongside membership fees.
| Metric | 2018 | 2023 | Change |
|---|---|---|---|
| Practice sites | 1,658 | 3,036 | +83.1% |
| Clinicians | 3,935 | 7,021 | +78.4% |
| Independent ownership | ~84% | ~60% | -24 pts |
| Corporate-affiliated sites | 152 (9.2%) | 1,027 (33.8%) | +576% |
| Physician share of clinicians | 67.3% | 59.7% | -7.6 pts |
| Advanced practice clinician share | 32.7% | 40.3% | +7.6 pts |
Source: Zhu et al., "Growth In Number Of Practices And Clinicians Participating In Concierge And Direct Primary Care, 2018-23," Health Affairs, December 2025.
Why practices that switch say they did it
A separate, targeted AAFP survey of 374 physicians, 177 of them already practicing DPC, found 94% of DPC physicians reported satisfaction with their practice model, against 57% of non-DPC respondents. Burnout ran at 12% among DPC physicians compared with 46% among non-DPC physicians in the same survey. Those two gaps, 37 points on satisfaction and 34 points on burnout, are the figures DPC advocates point to most often when making the case for conversion.
The same survey found the barriers holding other physicians back are financial. 54% of respondents cited capital or cash flow concerns as a top barrier to starting a DPC practice, and 50% cited patient recruitment. Both point to the same operational gap: a practice needs a revenue runway to cover the months where membership panels are still building, plus a marketing and scheduling process built for a smaller panel paying a recurring fee instead of a larger one billed per visit.
What the trend means for practices not converting
Independent practices staying in traditional fee-for-service are not competing against a shrinking category. The 83.1% growth rate in sites and the AAFP's move from 3% to 9% of family physicians in a single year both point the same direction: DPC and concierge care are pulling patients and clinicians out of the traditional pool at an accelerating rate, and one in three of the practices doing the pulling now carries corporate backing rather than a single owner-operator's name on the door.
That leaves two things worth tracking in a traditional practice's own numbers. Patient panel attrition to DPC competitors is a measurable line item by referral source, not an anecdote. And the same capital and cash-flow barrier that stops 54% of physicians from opening a DPC practice is a lever a traditional practice can use on its own side: a well-run revenue cycle and predictable collections are what let a practice consider a hybrid membership tier without the cash crunch DPC converts describe.
Sources
- PubMed Central, "Growth In Number Of Practices And Clinicians Participating In Concierge And Direct Primary Care, 2018-23," Health Affairs, December 2025
- MGMA, "Snapshot: Reactions and responses to the growth in concierge and direct primary care," December 30, 2025
- AAFP, "Surveys show more family physicians practicing direct primary care, and enjoying it," April 26, 2024
- Medical Economics, "11 practice models physicians are using to take back control of the business," 2026
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