Current State of Pediatric Direct Primary Care: A National Cross-Sectional Survey of Pediatricians

TL;DR

This study surveys pediatricians in direct primary care (DPC) to understand their practice characteristics, motivations, and satisfaction levels with the DPC model.

Contribution

The study provides the first national assessment of pediatric DPC practices, highlighting physician satisfaction and challenges in this emerging healthcare model.

Findings

Most pediatric DPC practices are single-doctor models in suburban areas with small patient panels.

Physicians report high satisfaction in DPC due to reduced moral injury and improved work-life balance.

While initial income in DPC is lower, financial viability improves over time for established practices.

Abstract

Introduction

Direct primary care (DPC) is an emerging healthcare model emphasizing patient-centered care, reduced administrative burden, and enhanced physician satisfaction. While DPC has gained traction among pediatricians, limited data exist on the distribution, characteristics, and satisfaction of pediatric DPC practices. This study aims to provide a national overview of pediatric DPC practices, describe physician demographics and motivations, and evaluate satisfaction among DPC physicians.

Methods

We conducted a cross-sectional survey of US-based pediatricians practicing in the DPC model to assess physician demographics, practice characteristics, and satisfaction. A 19-section survey was developed in consultation with pediatric DPC leaders and piloted within the Zest Pediatric Network. It was distributed on July 11, 2023, via the “Pediatricians Who Do DPC” Facebook group, practice websites, and direct outreach. Physicians were eligible if ≥75% of their panel was pediatric and their practice was operational. Descriptive statistics were calculated, and satisfaction between current and prior roles was compared using a two-tailed t-test (p < 0.05). Analyses were performed using Microsoft Excel.

Results

The analysis included 73 pediatric DPC physicians across 26 states. Most practices were single-doctor models (85%), located in suburban settings (73%), and managed small patient panels (<200 patients: 79%). Physicians reported high satisfaction; 94% were happier in DPC than in prior roles, citing reduced moral injury (89%) and improved work-life balance. While 73% of physicians earned less in DPC initially, 65% with practices ≥3 years old reported incomes similar to or greater than prior positions. Physicians cited meaningful patient relationships, greater autonomy, and improved work-life balance as key benefits. Key challenges included financial uncertainty, marketing burdens, and isolation.

Conclusions

Pediatric DPC offers significant benefits, including high physician satisfaction and reduced administrative burden, despite initial financial challenges. As practices mature, financial viability improves, suggesting long-term sustainability. Future research should evaluate patient outcomes, financial accessibility, and strategies to support new practices.

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