How to start a Direct Primary Care practice.
A practical framework for entity formation, financial planning, operations, patient acquisition, and opening readiness.
Inside the guide
What Is Direct Primary Care?
Direct Primary Care (DPC) is a membership-based healthcare model where patients pay a recurring fee directly to their physician; AAFP reports $50 to $100 per month for individual adults, while pricing varies by scope and market for comprehensive primary care. The practice does not bill insurance for membership-covered primary care, and included services do not carry per-visit copays. Membership terms, excluded services, and separately priced items must be disclosed. Physicians commonly plan for smaller panels than insurance-based primary care, enabling longer visits and more direct access.
DPC removes insurance billing for membership-covered primary care and replaces visit-based collections with recurring membership revenue. That can simplify administration, but take-home income, workload, patient cost, and access still depend on the practice's pricing, staffing, scope, and enrollment.
How to Evaluate DPC Financial Viability
165+
Practices Launched
97%
Operating or Graduated
Model
Practice-Specific Break-Even
12–18mo
Planning Horizon
Beginning in 2026, qualifying DPC fees can be reimbursed tax-free from an HSA. Separate monthly fee limits apply when determining HSA contribution eligibility. This may reduce friction for some patients, but eligibility and tax treatment depend on the arrangement and the patient's circumstances.
Practices we've launched are operating across 39 states and Washington, DC. Use 12–18 months as a planning horizon for stable profitability and meaningful owner compensation, not a promised result. Enrollment pace, pricing, overhead, capital, and local demand all affect the outcome.
Six moves from decision to doors open.
Entity formation, financial planning, site selection, technology setup, and pre-launch marketing overlap. Freedom's structured operating build targets roughly 16 weeks after kickoff; the full path from first conversation commonly takes 6-8 months when financing, lease, licensure, or construction extends the calendar.
For the full week-by-week breakdown of what happens and when, see the Practice Launch Program.
DPC Startup Cost Breakdown
Freedom's three planning scenarios model $55,000-$180,000+ in physician-funded startup capital, depending on space, build-out, equipment, staffing, and runway. These are planning models, not an industry-average claim.
See the full cost breakdown with three transparent planning scenarios and month-by-month cash flow: DPC Startup Costs.
Model the Members Required for Your Income Target
Monthly gross membership revenue equals the monthly fee multiplied by active paying members. Owner income then depends on operating costs, collections, debt, taxes, benefits, and other assumptions. Do not treat a membership price or operating-cost percentage as a network average.
Use the DPC Patient Panel Calculator to test explicit fee, cost, capacity, and income assumptions.
How to Exit Insurance Contracts Safely
If you're transitioning from an insurance-based practice, exiting payer contracts requires careful planning. This is the physician's responsibility, our team does not manage insurance contract terminations, but here's a general framework to consider if it applies to your situation:
Review your contracts
Read the actual notice, renewal, non-solicitation, tail-coverage, record, and patient-notification terms. Confirm obligations with qualified counsel before setting dates.
Stage your exit
Map payer, employment, credentialing, cash-flow, and patient-care dependencies. Use a phased approach only when the agreements, legal advice, and operating plan support it.
Communicate with patients
Prepare patient communications only after the transition plan and required notices are approved. Explain timing, records, continuity options, membership terms, and how patients can make an informed choice.
Manage the revenue overlap
Model the income gap from your conservative enrollment scenario and household runway. A part-time clinical bridge may reduce pressure where employment terms and scheduling allow.
For the complete transition playbook, see our Insurance-to-DPC Transition Guide.
Opening-Stage Operating Priorities
Validate the workflow
- Test enrollment and billing
- Confirm scheduling and access
- Review clinical and escalation paths
Compare actuals with the plan
- Track active paying members
- Review collections and costs
- Separate known results from assumptions
Adjust deliberately
- Prioritize measured acquisition channels
- Change staffing only when workload supports it
- Update runway and capacity forecasts
Frequently Asked Questions
How much does it cost to start a DPC practice?
Freedom's three planning scenarios model $55,000-$180,000+ in physician-funded startup capital, depending on space, build-out, equipment, staffing, and runway. These are planning models, not an industry-average claim. See our full DPC startup costs breakdown for assumptions across three planning scenarios.
How long does it take to open a DPC practice?
The structured operating build is roughly 16 weeks after kickoff. The full path from first conversation to opening can take 6-8 months when site selection, lease negotiation, licensure, financing, or construction must happen before or alongside the build.
Do I need to quit my current job before starting?
Not necessarily. Planning may begin while you are employed, but outside-work restrictions, notice requirements, payer agreements, non-solicitation terms, tail coverage, licensing, and household runway should be reviewed before setting an exit date.
Can an NP or PA own a direct-care practice?
Ownership and scope rules vary by state and profession. Confirm current law with qualified counsel and verify that the proposed model fits the services and support Freedom Healthworks currently provides before relying on a launch plan.
How many members do I need to break even?
Break-even must be defined before a member count is quoted. For operating break-even before owner compensation, divide monthly operating expenses by collected monthly revenue per active member. For an owner-compensation target, add that target to expenses first. Freedom's displayed scenarios are planning models, not a network average or timing promise. Use our DPC income calculator to model your specific scenario.
What if enrollment is slower than planned?
Use conservative, expected, and downside scenarios for enrollment, collections, costs, and household runway. Compare actual results with the model regularly and adjust spending, staffing, and acquisition activity without assuming a fixed network-wide ramp.
Ready to Start Your DPC Practice?
Review your launch assumptions, dependencies, and support needs with the Freedom Healthworks team.
Request a Practice ConsultationEvidence standard
How to read this guidance.
The launch sequence combines current federal and professional guidance with Freedom Healthworks operating experience. Cost and timing ranges are planning assumptions, not industry guarantees; lease, licensure, staffing, market, and scope change the result.
Reviewed August 3, 2026. Educational and operational guidance only. Not legal, tax, financial, or medical advice.