According to projections from the Association of American Medical Colleges, cited by the American Medical Association, by 2034, the U.S. faces a projected shortage of somewhere between 37,000 to 124,000 physicians.
Specifically, primary care faces a shortfall of between 17,000 and 48,000 doctors. Surgeons are projected to come up short between 15,000 and 30,000. Specialists, 3,000 to 13,000.
Health care insurance premiums are rising. Some practices are refusing to accept new patients. Doctors in traditional care offices rush in to see you and are out the door just a few minutes later. And getting a next-day appointment with your doctor is about as easy as snapping a photo of Darth Vader in a kilt while riding a unicycle. Neither the photo of the leader of The Empire (who is comfortable with his manhood), or the next-day appointment is an easy get.
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That kind of scarcity highlights a deeper issue: the U.S. primary care system isn’t just stretched thin – it’s starting to fracture.
A 2025 survey conducted by AMN Healthcare found that in 15 of the largest metropolitan areas in the country, the average wait time to schedule an appointment with a physician (across a variety of specialties) is 31 days. In 2022, the average wait was 26 days; in 2004 it was 21 days.
The highest wait times were in obstetrics/gynecology (an average of 42 days). The best wait times were for orthopedic Surgery (an average of 12 days).
For family medicine, the wait time average was right about in the middle: 23.5 days, with Boston being the worst (69 days) and Miami and New York tied for the best (4 days).
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Some completely bonkers numbers from the survey: in Detroit, you could end up waiting as long as 208 days for a gastroenterology appointment. In Boston, the survey revealed a wait of 231 days for an appointment with an obstetrician. And in Portland, Oregon, it took one patient an incredible 281 days to see a dermatologist.
Wait times to get an appointment are one part of an overstressed system – how much time the doctor spends with you is another.
In 2023, Dr. Troy Burns, founder and medical director of ProPartners Healthcare, told Forbes, “Doctors are paid for how many people turn the turnstile.” When Bruce Scott was the president of the American Medical Association in 2024, he said the medical field was “almost at crisis level.”
A 2020 paper in the Journal of General Internal Medicine from researchers at the University of Chicago, Johns Hopkins University, and Imperial College London noted that a typical primary care physician averages a panel of 2,500 patients (a panel is a medical term for a roster of patients).
If that physician were to provide the recommended time to address acute care (2.2 hours), chronic patient care (7.2 hours), preventive care (14.2 hours), and documentation/“inbox management” (3.2 hours), he or she would spend almost 27 hours per day trying to complete all tasks.
News flash: 27 hours don’t fit into 24 hours.
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Reality is much different, but not by much: a January 2021 paper published by the National Library of Medicine pegged the average primary care visit at just 18 minutes. So what happens – wait times for appointments get stretched out to make the math do what math does.
Where does this leave the average me and you when it comes to seeing a doctor?
Running down to the local CVS MinuteClinic® and seeing a nurse practitioner or physician’s assistant is an effective stopgap for the emergency flu prescription, antibiotic, or EpiPen refill. Telehealth apps help tremendously as well, with having a doctor run through basic questions and calling in a quick prescription or recognizing that you need to get to an urgent care or emergency room ASAP.
Those workarounds help – until they don’t. Quick visits and virtual consultations can’t replace long-term relationships, complex care, or coordination among caregivers when something goes wrong.
As traditional primary care faces the monumental challenge of volume-driven medicine, patients with the means – and doctors with the option – are increasingly looking for better answers.
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Two alternative models for family medicine have emerged, moving from the fringes into the mainstream: direct primary care and concierge medicine.
Concierge practices typically layer an annual retainer on top of traditional insurance billing, while direct primary care cuts insurance out of the primary care relationship entirely, relying instead on a flat monthly membership paid directly to the doctor.
Both promise fewer patients, longer visits, and faster access, but at a price. And both are examples of the haves and have-nots: you want quicker access and better service, be prepared to pay.
Welcome to fast pass health care.
What is concierge medicine?
Let’s start with the one you might have already heard of: concierge medicine (also known as boutique medicine). Like many concierge services that cater to the rich and famous, concierge medicine hits close to that mark as well.
Concierge practices shrink panels down to about 400 to 600 patients and the typical physician often sees only about 6 to 10 patients per day.
Same or next-day appointments are the norm rather than the exception, with practices carving out specific times for acute (emergency) cases. Visits might go 30 minutes or more, and don’t be surprised if your yearly checkup consists of half-a-day of testing and consultation. Doctors are usually available 24/7.
But you’re going to pay for that exclusivity: memberships or retainers could run $2,000 to $10,000 yearly. One practice, Private Medical (with offices in California, Florida, and New York) charges up to $40,000 per year (Private Medical doesn’t advertise and typically get their patients through referrals).
Regardless of a $2,000 or $40,000 practice, each is unique and offers different services. Typically, a yearly fee doesn’t mean you can see your doc every day – some concierge practices place limits on visits (more are available, for a fee). Also, that half-a-day yearly check-up may include tests not covered by insurance (so patients have to pay out-of-pocket).
Some concierge practices may have health and wellness coaches tied to their offices (some as an add-on). The good news – concierge practices usually take insurance as well as HSA or FSA (flexible or health spending accounts). They are also very good at bringing in specialists.
And one last thing, that yearly fee is like a gym membership: you might be able to cancel and get back a pro-rated amount, or you might be on the hook for the whole year regardless of whether you use it or not. If you’re thinking about joining a concierge practice, check on their cancellation policy.
One research firm believes the concierge medicine market in the U.S. was valued in 2025 at $8.09 billion with a projected growth to $13.23 billion by 2030.
A separate survey had the concierge practice market globally to be worth some $20.33 billion in 2025 with a projected growth to $35.79 billion by 2030.
What is direct primary care?
The second option, and the one that slots in between traditional care and concierge medicine, is direct primary care.
It’s worth repeating: direct primary care (DPC) cuts out the insurance middleman and puts the burden of paying directly on the customer.
Patients pay anywhere from $50 to $150 each month for direct access to their physician (think of it kind of like a membership club like BJ’s, Costco or Sam’s), but DPC doesn’t replace health insurance for hospital or specialist care.
But what does that fee of anywhere between $600 to $1,800 a year get you?
Well, how about unlimited access, capped panels of 600 to 900 patients, appointments that last 30 to 60 minutes, and a much cheaper cost than most concierge practices?
Clinical and lab tests could be covered under your fee (depending on the provider) as well as telemedicine consultations. The big advantage: no copays, no billing hassles, just direct payment for direct care with same or next-day slots. Some families like the idea of DPC, paying one fee for everybody and having one direct point of contact.
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Drawbacks: if you’ve already got health insurance, you’re paying twice for primary healthcare. Many DPC patients will enroll in an HDHP (high deductible health plan) to avoid the double hit – the HDHP will help in emergency coverage. Prescriptions are usually offered at wholesale prices but aren’t included in your monthly fee.
In addition to not accepting insurance, DPCs don’t bill Medicare and Medicaid, but those patients can enroll privately and pay out-of-pocket.
Finally, some specialized procedures or imaging typically require referrals outside the DPC model, meaning those costs still fall to traditional insurance.
Direct primary care is a smaller segment of America’s healthcare system than concierge medicine, but it’s growing fast, especially over the last decade. A policy analysis using the DPC Frontiers mapper estimates that the number of DPC practices has jumped from around 100 in 2009 to more than 2,500 by early 2025, operating in 48 states and U.S. territories and serving over a quarter-million patients.
For physicians, direct primary care frees them up from the mountains of paperwork (coding and billing) that come with payments from insurance companies. Strange as it may sound, a DPC model for the physician and staff works better as they spend more time on patients and less time on paperwork.
For doctors, both the concierge and the DPC model offer a way to escape the churn of fee-for-service billing, but DPC in particular removes insurance paperwork entirely.
Critics warn that these free‑market models, while relieving patient pressure for some, can reduce the number of physicians serving patients who rely on traditional insurance – deepening inequities in access.
As the demand for care rises and the system strains, the future of medicine may hinge less on one single approach and more on a mosaic of options that put patients at the center. For some patients, speed and personalized attention justify paying a premium, while for others, predictable costs, broad access, or a traditional insurance-supported family practice are a better fit.
The real question isn’t which model is best, but which one aligns with your health needs, your wallet, and your willingness to partner with a clinician who can see you through both routine checks and complex challenges.
One last thing, I just found that photo of Darth Vader. He’s also playing flame-throwing bagpipes.