Are Direct Primary Care Practices Located in Health Professional Shortage Areas?

PLAIN-LANGUAGE ARTICLE SUMMARY

Research Brief

Direct Primary Care Practices Less Likely Found in High-Need Shortage Areas but More Common in Rural Regions 

Background and Goal: Direct primary care (DPC) is a model where patients pay a membership fee to a physician who provides your primary care, bypassing insurance. While this model has grown in popularity, there are concerns it might worsen the shortage of primary care doctors by focusing on areas that are already well-served. This study explored how often health professional shortage areas overlap with DPC practices across the U.S. DPC practices were also compared with a random group of primary care physicians in the U.S. to determine if there were significant differences between the two groups.

Study Approach:The researchers collected data on DPC practices from public sources and compared their locations to health professional shortage areas in the U.S. They also compared DPC practices to insurance based primary care physicians to see if there were differences in where they were located. Analyses were stratified by degree of rurality and health professional shortage area priority need scores.  

Main Results: As of the date of download, there were 3,935 population-based health professional shortage areas in the US. 2,125 DPC practices were identified.

• 44% of Direct Primary Care (DPC) practices were located in health professional shortage areas, slightly lower than the 47% of insurance based primary care physicians in health professional shortage areas.

• DPC practices were more often found in low- and medium-priority need areas within health professional shortage areas (45% in low-need, 47% in medium-need). In contrast, 20% of insurance based primary care physicians were in high priority need areas, compared to 14% of DPCs, showing that insurance based primary care physicians were slightly more concentrated in higher-need areas.

• 25% of DPCs in Health Professional Shortage Areas were located in rural areas, and 22% were in partially rural areas, while insurance based primary care physicians were more concentrated in non-rural areas (63% of insurance based primary care physicians versus 53% of DPCs).

Why It Matters: DPC practices are generally less likely to be located in health professional shortage areas compared to insurance-based primary care practices. However, they are more likely to be found in rural or partially rural health professional shortage areas. These findings suggest that, while DPCs do not currently serve the most underserved populations overall, their success in rural areas—traditionally a challenging environment for primary care—indicates that this model could be scalable in other underserved regions.

Are Direct Primary Care Practices Located in Health Professional Shortage Areas?

Neal D. Goldstein, PhD, MBI, et al

Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania