KevinMD January 2, 2026
A recent Johns Hopkins study has reignited that debate. The research documents rapid growth in concierge and direct primary care practices and warns that these models may worsen access to care.
That framing feels intuitive. It is also incomplete.
It assumes that traditional primary care access was functioning before physicians began moving into fee-based models. It was not.
Long before concierge and direct primary care gained traction, primary care access had already eroded. Patients waited weeks or months for appointments. Visits were compressed into minutes. Physician panels routinely exceeded 1,800 to 2,500 patients per clinician, far beyond what safe, longitudinal care can realistically support. Burnout was framed as an individual failure rather than the predictable outcome of system design.
When...
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