“That Wouldn’t Work Here”. That’s usually the first response I hear when direct care comes up as a possible way out of the current healthcare mess. It’s said confidently, often reflexively, and almost always without much evidence. Just a statement of assumed fact. Case closed.
Physicians are not known for being particularly good at running a business, most of us, anyway. We are trained to diagnose, treat, and manage disease, not to evaluate markets, pricing models, or consumer behavior. Yet somehow, many doctors feel completely comfortable declaring that a direct care model could never work in their city, their specialty, or their patient population.
What they really mean is this: I don’t see how I would make it work, therefore it must not work.
That’s a very different claim.
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If you had asked a group of physicians what they thought of my direct mobile orthopedic practice when I started it back in 2019, I’m confident the consensus would have been that it was a terrible idea. No insurance. No hospital affiliation. No physical clinic. Driving to patients instead of the other way around. Cash pay musculoskeletal care? In orthopedics? In a world dominated by hospital systems and insurance contracts?
Bad idea. Naive. Risky. “That wouldn’t work here.”
They would have been wrong.
Not because I’m some business savant or visionary entrepreneur. I’m not. I didn’t reinvent healthcare. I just stripped out a massive amount of administrative nonsense, aligned incentives in a way that made sense, and treated patients like patients instead of billing units. Turns out that’s not a radical concept. It’s just unfamiliar to many physicians who have spent their entire careers inside large systems.
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One of the biggest mistakes doctors make when evaluating direct care is asking the wrong people for advice. They ask their partners, their colleagues in hospital-employed positions, or their friends who are deeply embedded in insurance-based practices. These are not neutral observers. These are people who are financially, psychologically, and professionally invested in the status quo.
And humans are very good at defending the systems they are trapped in.
This is the classic “crabs in a bucket” problem. Put a single crab in a bucket and it can climb out. Put several in together, and any crab that tries to escape gets pulled back down by the others. Not out of malice, just reflex. That same dynamic plays out constantly among physicians.
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When you start talking about leaving insurance, reducing overhead, setting your own prices, or practicing medicine on your own terms, it makes people uncomfortable. It forces them to confront the possibility that their own misery might not be inevitable. That maybe the burnout, the prior authorizations, the productivity quotas, and the endless documentation are not immutable laws of nature.
So instead of engaging with the idea honestly, they dismiss it.
“That wouldn’t work here.”
If you actually want to know whether a direct care practice will work in your area, there’s a very simple solution: ask a doctor who is already doing direct care. Preferably someone in a similar specialty, but even that’s not strictly necessary. Ask them how they started, what mistakes they made, what surprised them, and what they would do differently.
You’ll get real answers instead of reflexive pessimism.
What you’ll often find is that the barriers physicians imagine, patients won’t pay cash, the market is too poor, competition is too strong, malpractice risk is too high, are either exaggerated or flat-out wrong. Patients already pay enormous amounts of money out of pocket. They just pay it to insurance companies, hospital systems, and opaque billing departments instead of directly to the physician actually providing care.
Direct care doesn’t require that every patient be wealthy. It requires that the value proposition be clear. When patients know what they’re paying, why they’re paying it, and what they’re getting in return, many are more than willing to opt out of the traditional system, especially when that system routinely fails them.
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None of this is to say that direct care is easy. It’s not. It requires stepping outside the familiar, accepting uncertainty, and taking responsibility not just for clinical decisions but for the viability of your practice. That’s uncomfortable for many physicians, especially after years of being insulated by large organizations.
But discomfort is not the same thing as impossibility.
The doctors who insist that direct care “wouldn’t work here” are often the same ones who complain the loudest about insurance companies, hospital administrators, and the loss of autonomy in medicine. They correctly diagnose the problem but refuse to consider a treatment that requires personal risk.
If you’re genuinely curious about direct care, stop listening to the crabs in the bucket. Find someone who climbed out. Learn from their experience. Then decide for yourself whether it could work where you are.
You might discover that the thing that “wouldn’t work here” is already working, just not for the people telling you it can’t.
When you start talking about leaving insurance, reducing overhead, setting your own prices, or practicing medicine on your own terms, it makes people uncomfortable. It forces them to confront the possibility that their own misery might not be inevitable.
