Direct Primary Care Has a Data Problem. Not the One You Think.
At My DPC Story, where I run marketing, we just closed this year's voting on the Battle of the Support Stack, our annual community vote.
Every year, the community ranks the tools they actually use. EHRs one year, the wider support stack this one. Then we carry that feedback back to the companies so they hear, with some weight behind it, what DPC physicians want changed.
It is one of the few moments where a scattered community gets to speak as one and have a vendor listen. It is built for the doctors, start to finish. And every year, getting people to take part is a climb.
That has had me thinking all week about something bigger than one vote.
Direct Primary Care is, at its heart, about the part of medicine that is hardest to put a number on: the relationship. The time. The feeling of being known by your own doctor. That is the whole point of it, and it is a good point.
But it does mean the movement keeps bumping into a strange problem. The thing it is best at is the thing that is hardest to measure, and measurement is how the rest of the world decides what to pay attention to.
Employers, policymakers, the people who write the rules all tend to move on numbers. So there is real value in counting DPC well, even though counting is tangled up with the very system many of these doctors left.
The Numbers We Have Are Real. They Are Also Partial.
A couple of the most-cited data sources in DPC are genuinely good, and I lean on them. They also have a specific scope, which is worth being clear about if we want to use them well.
The American Academy of Family Physicians runs the numbers you see quoted most. They are encouraging. In the AAFP's 2023 survey, about 9% of responding members were in a DPC practice, up from 5% in 2021. Their data brief reports 94% of DPC physicians satisfied with their practice, compared with 57% of those not in DPC, with much lower burnout.
Real findings, worth celebrating.
The important context is simply who the survey was designed to reflect. The AAFP surveyed a sample of its own members, and of 20,000 invited, 558 completed it. So the picture comes from family physicians who are AAFP members and chose to respond. That makes it useful. It also means it is not trying to represent every kind of direct-care physician now practicing outside the insurance-based model, including non-members, DOs, or the specialists moving into direct specialty care.
A good window, onto one room.
Hint Health's 2026 patient experience report is the other one, and I read it closely this week. In a lot of ways, it is the best evidence for DPC I have seen put to data. Using a federally recognized measure of person-centered care, it draws on 1,534 patients across 12 clinics in eight states, and the results are strong: an overall score of 89%, a 97% on access, and a Net Promoter Score of 85, where anything over 70 counts as world-class.
Best of all, the scores rise the longer a patient has been with their doctor. Trust, building over time, showing up as a number.
And here too, the context matters.
Hint recruited clinics from its own customer base. Those clinics chose to take part, and their patients chose to respond. That kind of voluntary participation is common in patient-experience work, and it gives us a meaningful look at the practices and patients who participated.
The geography is useful context as well. "Eight states" sounds wide, and it is. At the same time, Colorado supplied three of the twelve clinics and nearly a third of the responses, while Texas and Washington each had one smaller participating clinic.
None of that weakens the findings. It tells us what the findings are showing: patient experience at a specific group of DPC clinics willing to participate in a structured measurement effort, as told by the patients willing to answer.
That is valuable.
It is also not the whole movement.
And that is not because the reports fall short. It is because DPC is a decentralized movement by design. Some physicians belong to associations. Some do not. Some use modern platforms. Some run lean operations on paper charts, spreadsheets, Word documents, or a patchwork of tools. Some practice in places where they are the only DPC doctor for miles.
No single survey or report can capture all of that.
That is just the shape of the data we have, and it is worth saying out loud before we ask any one source to tell the whole story.
Why Participation Is Not a Small Ask
Some of why the fuller picture does not exist is obvious.
These are busy people, often running a whole practice alone, and a survey is one more unpaid thing on a long day. The benefit is shared and far off. The cost is yours and right now. That accounts for a lot on its own.
But I wonder if there is more to it.
These are doctors who left a system that turned them into numbers. RVUs, productivity targets, dashboards, panel sizes, a whole apparatus that measured everything except what they cared about. A lot of them walked away at real financial risk specifically to stop being a data point.
So I can understand if being handed a survey, even a thoughtful one, even one built by people on their side, sits a little strangely. It might carry an echo of the thing they left.
I am not sure that is right, and I would not want to put it on anyone as a motive. It is just something I find myself wondering when I watch how hard it is to gather even a friendly count.
If there is anything to it, there is a tension in it I cannot quite resolve.
The data would help the movement. And the instinct that makes the movement what it is, the refusal to be flattened into a metric, may be part of what keeps the data thin.
I do not say that as a problem to be fixed in the doctors. If anything, it is one of the things I respect about them. It just makes the practical task genuinely tricky.
The Hint survey actually seems aware of this. Tucked inside it is a question asking patients whether the form was hard to fill out, and whether they would even want their doctor to see their answers.
The instrument checking in on the burden of being measured.
That small thing feels like the whole knot in miniature.
Reach Is Not the Same as Measurement
What I think is small and, I hope, honest.
The data we have is good and worth using. It is also partial, because the easiest people to count are the ones already gathered close, and the heart of this movement may sit somewhere past them.
If DPC is going to be seen at the scale it deserves, the work ahead is to reach past the circles we have already drawn.
And this is the part where I will tell you, plainly, that I am proud of where I get to do that work.
My DPC Story is the largest and most established podcast platform dedicated to Direct Primary Care. The show has been downloaded around 245,000 times across more than 300 episodes, in over 6,300 cities and 153 countries. And the number I care about most: all fifty states and the District of Columbia.
Not just the metro pockets a benchmark sample tends to catch.
Wyoming. Alaska. Rural Maine. The Dakotas. The places where a doctor might be the only one for a hundred miles practicing this way, quietly certain she is alone.
The surveys cannot always see her. The show can reach her.
That gap, between who gets counted and who gets reached, is the whole reason a thing like My DPC Story matters.
The Work Is to Keep Showing Up
So I have come to think about our work a little differently.
DPC physicians spend their days making the case for a kind of care the system taught patients not to expect. They do it slowly, visit by visit, relationship by relationship. They give people time. They earn trust. They show patients that primary care can feel different than what they were taught to accept.
Maybe the work of counting this movement has to happen the same way.
Not by demanding participation from doctors who have every reason to be wary of being measured, but by coming back with better questions, clearer purpose, and enough trust built over time that the count starts to mean something.
That is why we keep asking. Not to wear anyone down. Not to turn the movement into a dashboard. But because we believe in these physicians and the work they do, and we want the rest of the world to be able to see them as clearly as we do.
The counting is hard.
It should be.
We will keep showing up to do it anyway.