47% of DPC Doctors Earn Less. 99% Say Care Got Better.
The American Academy of Family Physicians just published its 2026 Direct Primary Care data brief. The care numbers look like a win. The money number is the one residents will underline twice.
Among family physicians practicing in a DPC setting, 99% said care quality and patient relationships improved. Work-life balance improved for 89%. Paperwork got better for 86%. Then the survey asked about earnings. Forty-seven percent reported lower earnings in DPC. Thirty percent reported higher. The brief does not describe the other 23%, and it attaches no dollar size to the drop or the gain.
That is not a failure of the model. It is the trade most of us already knew was on the table. Only 17% of those DPC respondents named income as a reason for choosing it. Ninety-six percent named improved care quality. Ninety-four percent named autonomy. Ninety-one percent named less administrative burden. People left employed medicine for the practice, not for a raise.
The sample is friendly to the model. The AAFP emailed physicians who had engaged with DPC content over three years: Summit attendees, interest-group members, people who bought DPC CME. Three hundred thirteen usable responses came back, a 9.3% response rate, and 167 of them were currently in a DPC setting. A doctor who tried DPC, lost money, and went back to a health system is not in that 167. So 47% is not a random draw of American family medicine. It is still a hard number from doctors who stayed.
Panel growth is the other tell. Forty percent of DPC respondents called it a major challenge. Twenty-nine percent named revenue stability. Eighty-nine percent have an ownership stake, and 63% opened an independent practice after leaving a system or group. An owner still filling a panel is carrying rent, staff, and malpractice that a salary used to hide. The AAFP's Career Benchmark Dashboard, a separate source, puts average full-time DPC income at $288,779 in 2024. Direction and level are different questions. You can earn less than your last job and still make a living.
Pure DPC is also less pure than it was. Seventy-one percent of respondents' practices were pure DPC, down from 90% in 2022 and 84% in 2024. Employer contracts slipped to 55% from 63% in 2024. Atlas.md was the most-used EHR at 26%. Average panel size across all survey respondents was 504, up from 402, though that figure mixes DPC and non-DPC answers, so treat it carefully.
If you are sketching a practice on a napkin, do not pretend the money line is settled. Ask physicians past year five what they take home compared with their last job, and ask what year it stopped hurting. The brief cannot answer that. It can tell you this: nearly half of the doctors still in the model report lower earnings, and nearly all of them say the care got better. That is the deal. Patients feel the care side. Doctors feel both.
47% is a price. So is a panel that finally fills. Neither one is a reason to keep billing the oil change through the collision policy.