P4.005: Current State of Pediatric Direct Primary Care: A National Physician Survey

Background: Direct primary care (DPC) introduces a revitalized framework, shifting from traditional fee-for-service toward a subscription model that eliminates insurance-related expenses and regulations. Physicians are liberated to practice medicine as they see best for their patients.
Recently, there has been growth in pediatricians drawn to DPC’s patient-centered approach, fulfilling practice environment, and promise of less moral injury. Data on the distribution, structure, and value propositions of pediatric DPC practices (PDPCP) is limited. This study aims to fill these gaps by characterizing the current landscape and operational attributes of PDPCP, examining their demographic and professional profiles, and evaluating physician satisfaction levels, thereby, providing a current comprehensive, national perspective on PDPCP.

Methods: The Google Forms survey had 19 sections gathering information on physician/practice demographics and physician satisfaction. The survey ran for three weeks in July 2024 and was promoted in social media groups and directly to PDPCP practices. Responses from non-physician practitioners, non-operational practices, and those with more than 25% adult patients were excluded. Statistical analysis was performed using a two-tailed t-test.

Results: Of 78 responses, 72 met inclusion criteria, representing 26 states and having the characteristics detailed in Table 1.
Solo physicians represented 85% of practices and 47% of practices had no non-physician staff. Doctors reported patient panel goals of < 150 patients (26%), 151 to 250 patients (40%), 251 to 350 patients (22%), and > 350 patients (12%). Practices mean patient panels were 76, 139, 169 for practices open < 1 year, 1-3 years, > 3 years respectively.
Monthly patient membership fees were <$100 (11%), $101-$125 (29%), $126-$150 (29%), $151-$175 (21%), and >$175 (10%). Medicaid insured children received care in 70% of practices.
Pediatricians in 92% of practices reported providing home-based care, with 10% providing exclusively in-home care.
Compared to their prior job, 94%, of physicians reported being happier. Pediatricians had a statistically significantly higher current level of job satisfaction across various metrics including ability to practice their ideal type of medicine, overall job satisfaction, and work-life balance (Figure 1). Additionally, 89% reported experiencing less moral injury. For those physicians open 3 or more years, 65% reported similar or greater total income. Only 3% of physicians indicated they would ever consider returning to a fee-for-service position.

Conclusion: The DPC model presents a compelling and sustainable alternative to traditional pediatric care offering improved pediatrician satisfaction, better work-life balance, and reduced moral injury. Panel size grows over time and many physicians achieve comparable or higher incomes. The model’s flexibility, including Medicaid coverage and home-based care, broadens its reach.
We expect the number of PDPCP to grow as pediatricians seek practice autonomy and meaningful patient relationships. Future research should focus on PDPCP long-term patient health outcomes, accessibility to diverse patient populations, and workforce impact.