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Michigan healthcare freedom community forum
Direct Primary Care (DPC) is expanding in Michigan, and is likely to grow faster under OBBBA provisions.
Central planners look on with a jaundiced eye, so this DPC doc gives them a double dose of reality via KevinMD.
I knew choosing DPC would exacerbate primary care physician shortages, and I chose it anyway. Here’s why.
Marina Capella, MD | August 2, 2025When I made the decision to leave the traditional, insurance-based system and start a direct primary care (DPC) practice, I didn’t do so under any illusions. I knew what the critics would say. In fact, I’d already heard it.
You’re making it harder for patients to find a primary care doctor.
You’re reducing access for the underserved.
You’re selling out.
I’ve read the blog posts, like the one recently published on the Harvard Medical School site titled “How buying primary care on the free market adds to doctor shortages.” And I get it. I really do. From a 10,000-foot policy-level view, a physician moving from a 2,000-patient panel in a traditional system to a 300- or 600-patient panel in a DPC model can look like a loss for access.But here’s the thing: It was never that simple. For me, as for the roughly 20 percent of physicians planning to leave the profession in the next two years, the choice wasn’t between 2,000 and 500 patients, it was between 500 and zero.
The unspoken assumption in these critiques is that the alternative to DPC is staying in the system. What if the actual alternative is severely cutting down on hours or leaving medicine entirely?
Because that was the choice I was staring down. And I’m not alone.
Burnout isn’t a buzzword — it’s a crisis.
I was burned out. Not just tired, not just stressed. I was the kind of burned out where you start imagining what it would be like to never drive to the clinic again. The kind where you fantasize about quitting medicine—even though it’s the thing you’ve poured your whole self into for years (or decades). The kind where you start wondering if your patients might be better off with someone else—someone who isn’t barely holding it together.
And I was doing this work in a community that I care deeply about. I had over ten years of experience working in a community hospital, a federally qualified health center, and community urgent care. I didn’t want to leave. But staying in that system—where every minute was tracked, where I was expected to squeeze complex care into 15-minute visits (or less), where I spent more time documenting and playing whack-a-mole with my inbox than connecting with families—was slowly destroying me.
I knew I needed a different way. Not because I was giving up on my patients, but because I was trying not to give up on myself.
DPC wasn’t a step away from medicine. It was a step back into it.
Let’s be honest: Many physicians are reducing clinical hours
One of the frustrations I have with the criticisms aimed at DPC physicians is how selectively they’re applied.
Yes, I reduced my panel size. Yes, I opted out of the insurance-based system. But I didn’t reduce my commitment to caring for patients. I didn’t check out. I still spend long days seeing families, managing chronic illness, addressing mental health concerns, and helping parents navigate complex social systems. (And, on top of that, I have to manage all of the finances and operations of a business!)
What gets less attention is that many academic physicians and administrators are already working limited clinical schedules. I know physicians in leadership roles who haven’t seen patients in years. I know colleagues who see patients one day a week and spend the rest of their time teaching, doing research, or consulting. And that’s fine. That’s necessary. But we don’t level the same kind of moral judgment at them that we do at DPC doctors.
When we talk about “access” and “shortages,” we have to look at the full picture. We have to be honest that doctors across the system are making adjustments—stepping back, shifting roles, cutting hours—in response to burnout and systemic dysfunction. DPC just happens to be more visible, because it’s a structural change.
But it’s not the only change happening, and we should be asking why so many of us are seeking refuge, not just scolding those who are.
DPC is not a perfect system—but neither is the one we left.
Listen, I’m not going to sit here and pretend DPC is the solution to every problem in American health care. It’s not. We still have deep inequities. We still have systemic racism, barriers to access, rural care deserts, and a fragmented public health infrastructure. DPC doesn’t solve all of that.
But the traditional insurance-based system isn’t solving it either. In fact, it often makes it worse.
It’s a system where physicians are asked to carry out complex, nuanced, emotional work in short, volume-driven visits, while managing a bloated administrative burden that grows by the day. It’s a system where patients fall through the cracks, not because their doctor doesn’t care, but because the system is designed to reward volume, not depth.
So many of us came to medicine with the intention to serve—and then found ourselves in a model that made true service nearly impossible.
DPC gave me the chance to build a practice where I could actually deliver the kind of care I was trained to provide. Thoughtful. Personalized. Relationship-based. It wasn’t about “going concierge” or opting out of hard work. It was about building a model where the work meant something again.
And let’s not turn a blind eye to the tragic reality of physician suicide.
One of the hardest truths we need to face as a profession is that physician suicide is real. It’s not rare. And it’s not just the result of individual vulnerability. It’s also the predictable outcome of a system that devalues our humanity.
Physicians die by suicide at significantly higher rates than the general population. According to the American Foundation for Suicide Prevention, an estimated 300 to 400 U.S. physicians die by suicide each year, the equivalent of losing an entire medical school class annually. Despite relatively high rates of education and financial stability, male doctors are 40 percent more likely to die by suicide than non-doctors; for women the rate is 200 to 400 percent higher.
We know these numbers, and yet we still resist real change. When a physician dies by suicide, we mourn. We talk about resilience. We launch wellness committees and schedule mindfulness workshops.
But when a physician tries to prevent that outcome—when they choose to step outside the system and find a way to keep practicing medicine without sacrificing their well-being—we criticize them.
That disconnect should alarm all of us.
Because the future of care depends on doctors being well. On doctors staying in the game. On doctors being able to show up for their patients without emptying themselves in the process.
We don’t get better care for society by breaking the people providing it.
This is a rebalancing, not an exodus.
I know it’s tempting to frame this moment as a rupture—DPC physicians “leaving” the system, taking their marbles and going home.
But what’s happening is more complex than that. This is a re-equilibration. A recalibration. It’s the natural response of human beings trying to adapt to an unsustainable situation.
Some of us are adapting by embracing new models like DPC. Others are doing it through advocacy, leadership, education, or research. Some are staying and fighting to change things from within. That’s all valid. That’s all part of the broader solution.
We don’t have to pit these approaches against each other. We can honor the multiplicity of responses without pretending there’s only one “right” way to serve.
I know many physicians who are thriving in traditional systems. I admire and celebrate them. That just wasn’t my reality, and it isn’t the reality for many others.
Let’s build a system that works for patients and doctors.
If we want to build a sustainable future for primary care—and I believe we all do—we need to make space for innovation, for reinvention, and for honest conversations about what’s working and what’s not.
We don’t have to agree on everything. But we do need to stop turning on each other.
Because the system isn’t going to fix itself. And physicians fighting each other isn’t going to fix it either.
What will? Supporting one another. Listening to lived experience. Respecting diverse paths. And staying focused on the shared goal: a health care system that serves patients well, and allows physicians to thrive in the process.
DPC isn’t the whole answer. But for me, it’s part of it. It’s how I found my way back to the kind of medicine I believe in.
And I don’t regret it for a second.
Learn more and find a DPC physician in your area.
Anyone interested in quality affordable care should hear Episode #61 of the Doctors Making a Difference podcast.
Besides the podcast audio, the show notes have many direct links for patients and physicians to learn more.
Dr. Josh Umbehr is a board-certified family physician who took an unconventional path—opening a Direct Primary Care (DPC) practice straight out of residency.
In this conversation with host Dr. Peter Crane, Dr. Umbehr breaks down why the insurance-based system is structurally broken, how DPC flips the incentives back toward patients, and why time—more than technology or paperwork—is the missing ingredient in modern medicine.
Drawing from over 15 years of real-world experience, Dr. Umbehr explains how monthly membership models allow physicians to spend more time with fewer patients, dramatically lower costs for labs and medications, and reclaim professional satisfaction without compromising care.
This episode is a grounded, practical look at how medicine can work again—by being simpler, leaner, and more human.
Episode Highlights
Why insurance was never designed to pay for routine primary care
How Direct Primary Care works (and how it differs from concierge medicine)
The real cost of labs, medications, and procedures—without insurance markups
How smaller patient panels lead to better outcomes and lower burnout
Why “do no harm” must include financial harm
How DPC improves physician work–life balance without sacrificing access
The role of HSA/FSA funds in Direct Primary Care
Why chronic burnout is an unwinnable game in insurance-based care
Top 3 TakeawaysHealthcare isn’t expensive—insurance makes it expensive.
Most primary care services are affordable when stripped of administrative overhead.
Time is the most powerful clinical tool.
Longer visits, fewer patients, and direct communication lead to better care and better outcomes.
Direct Primary Care restores agency—to physicians and patients.
By removing the middleman, care becomes simpler, cheaper, and more personal.About Dr. Josh Umbehr
Dr. Josh Umbehr is a family physician and founder of AtlasMD, a concierge-style direct primary care practice based in Wichita, Kansas. He’s passionate about reimagining how health care should feel—less bureaucracy, more humanity. Beyond patient care, Josh helps physicians transition to direct care models and is building the next-gen infrastructure (yes, software, insurance, etc.) to support them. On this podcast he’ll talk about innovation, challenges in medicine, and why he thinks health care can be better if we stop treating it like a broken machine.
Websites:
https://www.atlas.md
https://www.atlas.direct
About the Host:Dr. Peter Crane is a board-certified physician, educator, and storyteller with a heart for service and a calling to spotlight doctors who make a difference—in their communities, in medicine, and in the lives they touch.
Through Doctors Making a Difference, he brings you into intimate conversations with physicians who have overcome challenges, redefined success, and found purpose in and beyond the clinic. His goal is simple: to help more doctors stay in medicine by showing them what's possible.
About the Show:
Doctors Making a Difference is more than a podcast—it’s a movement to highlight the good, the gritty, and the deeply human side of medicine.
In every episode, Dr. Peter Crane interviews physicians whose stories defy the script. From burnout recovery to bold career pivots, health challenges to quiet leadership, this show honors the truth that healing begins with connection—and doctors, too, deserve to be whole.
Visit: doctorsmakingadifference.com
Ah, the simple life.
This Maine doc sets the record straight about AI utility.
https://dpcnews.com/technology-and-ai/can-ai-bring-back-the-small-town-doctor/
Can AI Bring Back the Small Town Doctor?
April 20, 2026
The question deserves a real answer. It was just discussed on this popular podcast. And the people asking it aren’t wrong about the problem.
The thesis goes like this: AI-powered back-office tools are getting cheaper fast. Billing automation. Scheduling. Intake. Care coordination. The administrative machinery that once required a hospital system’s infrastructure could soon run on a small group’s budget. If that’s true, the economics of independent practice change. The small town doctor — the one who knew your name, your kids, your history — becomes viable again.
That’s not a stupid argument. The operational burden that drove independent doctors into hospital employment wasn’t a failure of nerve. Most ran the numbers and made a rational decision. If AI genuinely shifts those numbers, it matters.
But here’s where it goes wrong.
The back-office burden in primary care doesn’t exist in a vacuum. It exists because of insurance. Prior authorizations. Denial management. Coding compliance. Payer contracts. The entire apparatus of third-party billing is the disease. What these startups are building is a better way to manage the symptoms. A more efficient way to be sick.
You don’t bring back the small town doctor by making it cheaper to fight with insurance companies. You bring them back by eliminating the fight entirely.
That’s what Direct Primary Care does. Not cheaper administration. Not smarter billing software. Elimination. No insurance contracts. No prior authorizations. No revenue cycle to manage. Patients pay a simple monthly fee and get direct access to their doctor. Doctors practice medicine without a middleman taking notes on everything they do. The math isn’t complicated — it’s just rare, because the system spent four decades making independent practice feel impossible, and most doctors eventually believed it.
Here’s the irony I’m sitting with this Sunday afternoon: I built my own AI scribe and in-house GPT stack. Yes, you read that correctly. A rural DPC doctor in Maine built their own. I use it every single day. I’m a bigger AI enthusiast than most of the people writing breathless think pieces about it — and if you’re a physician who wants to know how, reach out.
My AI bill this month is $3.51. I checked.
But my AI isn’t fighting insurance. It never has to.
I won that fight in 2014 when I stopped billing insurance altogether. My AI does what AI should actually do in a primary care practice — it helps me take better care of patients:
– Documentation — referral letters, letters of medical necessity, and more
– Clinical decision support
– Real-time research with the patient in front of me
– Differential diagnosis support
– Plain-language patient education, generated on the spot
– Medication dosing and interaction checks
– Procedure guidanceThe work that actually matters. It isn’t processing prior auth appeals or scrubbing claims for submission. Those problems don’t exist in my practice because I designed them out of existence before AI was even part of the conversation.
That’s the forest these startups keep missing. The small town doctor didn’t disappear because the field lacked billing software. Independent practice disappeared because the system made it financially irrational. Decades of declining reimbursement, administrative overhead, and payer complexity didn’t just raise costs — they changed what doctors believed was possible. AI that makes the irrational system slightly more tolerable is not the same thing as a solution. It’s a more comfortable form of the same trap.
I practice in rural Maine. My panel is over 1,200 patients, the majority of them uninsured — people who, under the old model, had no real access to a primary care doctor at all. I deliver babies. I do procedures. I dispense medications at wholesale cost directly from my office. None of this required a venture-backed startup, a sophisticated AI platform, or a health system’s administrative infrastructure.
It required getting out from under the model that was making all of it impossible in the first place.
AI can absolutely support independent primary care. In practices like mine, it already does. But not if you’re using it to prop up the billing apparatus that’s been strangling independent practice for decades. That’s not innovation. That’s rearranging the waiting room furniture while the building burns.
Direct Care brings back the small town doctor. AI, in that context, becomes a genuine force multiplier — because they finally have enough breathing room to actually use it.
I’m sitting at home on a Sunday afternoon — questioning why the Red Sox haven’t called me up yet — in a practice with 1,200 patients, no insurance contracts, and a homegrown AI stack. I didn’t need a venture-backed startup to get here.
Jack Forbush, DO. Practicing medicine since 2005. Free from insurance company supervision since 2014. Co-founder of the Direct Primary Care Alliance and the New England Direct Primary Care Alliance. Contributor to DPC News. 1,200+ patients, mostly uninsured. I write. I teach. I mentor. I deliver babies. The coffee maker has never complained.
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