What Texas Roadhouse Can Teach Us About Direct Primary Care

Most people don’t expect a national steakhouse chain to offer lessons about healthcare.

But Texas Roadhouse might be one of the clearest examples we have of what happens when the people closest to the work are treated like owners — not interchangeable labor.

And the results are strikingly relevant to primary care.

A Founder Who Trusted the People Doing the Work

Texas Roadhouse was founded by Kent Taylor, a restaurant operator who believed something simple and radical:

If you want great service, you have to trust the people delivering it.

Instead of tightly controlling every decision from corporate headquarters, Taylor built a system where local managing partners:

• Had real autonomy
• Were rewarded based on long-term performance
• Were encouraged to think like owners, not rule-followers

Managers weren’t just enforcing policies.
They were building relationships, investing in staff, and protecting the guest experience as if it were their own business.

And customers could feel the difference.

Why Owner-Operators Outperform Employees

This wasn’t about “working harder.”
It was about incentives and alignment.

When someone:

• Controls their environment
• Benefits directly from quality and consistency
• Isn’t punished for doing the right thing

They make better decisions.

They solve problems instead of escalating them.
They focus on long-term trust, not short-term metrics.
They care — because it’s theirs.

Healthcare Chose the Opposite Path

Modern healthcare did the reverse.

Physicians were:

• Stripped of ownership
• Buried under protocols designed far from the exam room
• Evaluated by productivity metrics instead of patient outcomes

Most doctors today function less like professionals and more like shift workers — with limited autonomy, limited continuity, and limited ability to fix what’s broken.

Patients feel that too:

• Rushed visits
• Fragmented care
• Endless referrals
• “That’s just policy” answers

Direct Primary Care Flips the Model Back

Direct Primary Care (DPC) restores something healthcare lost: physician ownership.

In DPC:

• The doctor owns the practice
• The doctor sets visit length and access
• The doctor is accountable directly to patients, not payers

That changes behavior immediately.

Doctors can:

• Spend time instead of rushing
• Solve problems instead of deferring them
• Prioritize relationships over billing codes

Just like the best Texas Roadhouse managers, DPC physicians act like owners — because they are owners.

Why Patients Win

This isn’t about physician comfort.
It’s about patient outcomes.

Ownership leads to:

• Better access
• Continuity of care
• Lower total costs
• Fewer unnecessary referrals
• Faster problem-solving

Patients don’t need a “network.”
They need someone who owns the responsibility for their care.

This Isn’t Radical — It’s Common Sense

We’ve seen this movie before.

In restaurants.
In small businesses.
In education.
In trades.

When professionals are trusted, empowered, and accountable, quality improves.

Direct Primary Care isn’t an experiment.
It’s a return to a model that works — because it aligns incentives with humanity.

Legendary service.
Legendary care.

Direct Care - If We Are Lucky Enough (Poem)

Zach Bryan’s Lucky Enough is a quiet inventory of a life well lived — not measured by fame or perfection, but by presence, truth, and the courage to choose what matters. It’s a song about growing older honestly, learning the hard way, loving deeply, and ending up exactly where your heart was pointing all along.

That spirit feels deeply familiar to those of us who believe medicine can be practiced the same way. What follows is a reflection on Direct Primary Care, written in that same cadence — not as a rewrite, but as an interpretation of what it means to build a life, and a profession, rooted in care.

The Work Worth Doing

If we’re lucky enough, we’ll know our patients by first names and tired eyes.
We’ll see fevers break and anxiety loosen in rooms where no one is watching the clock.
We’ll trade waiting rooms for conversations and never waste a day pretending medicine is supposed to be rushed.

This kind of care doesn’t scale well on spreadsheets—but it scales beautifully in real life.

The Long View

If we’re lucky enough, we’ll care for people long enough to see life change shape.
Wrinkles where worry used to live.
Confidence where confusion once sat.

We’ll remember stories without opening charts.
We’ll stop fighting battles that don’t matter.
And we’ll only die on hills closest to our hearts.

Simplicity Is a Moral Choice

If we’re lucky enough, we’ll tell the truth every chance we get.

Because care made complicated is just honesty delayed.
A clear answer now beats ten regrets later.
Simple pricing beats surprise bills.
Access beats authorization.

This isn’t radical. It’s respectful.

Continuity Counts

We’ll walk with people through ordinary days—
Coughs and check-ins, grief and quiet wins.
Sufferin’, smilin’, all of it counting.

If we’re lucky enough, we won’t just treat moments.
We’ll know the whole arc.

And that changes everything.

The Courage to Leave What’s Broken

Enough people will tell us,
“That’s not how healthcare works,”
that we’ll know we’re doing something right.

If we’re lucky enough, we’ll have the courage to leave systems that forgot why they exist.
To build something smaller, simpler, and more honest.
To trust that relationships still matter.

Gentle Medicine

If we’re lucky enough, the hard things will make us gentler.
With time.
With questions.
With the space people need to heal out loud.

This is medicine that listens first.

What Success Really Looks Like

If we’re lucky enough, we’ll make it exactly to where we’re standing now.

A place where care is human.
Payment is honest.
Access is expected.
And medicine feels like keeping a promise.

Direct Primary Care doesn’t promise perfection. It promises presence. And if we’re lucky enough— that will be more than enough.

Expanding the Circles of Care

Almost two thousand years ago, the Stoic philosopher Hierocles described life as a series of circles. At the center is the self. Then comes family, then community, then fellow citizens, and finally all of humanity. His challenge to us was simple: draw those outer circles closer. Treat the people on the edges as if they were in our innermost circle.

Healthcare in America has done the opposite. Instead of pulling patients in, it has pushed them out—into phone trees, billing departments, insurance claims, and network restrictions. The result is that the most important circle, the relationship between doctor and patient, has been smothered by layers of red tape.

Direct Primary Care (DPC) is about redrawing those circles. It starts with the most human of connections: a patient and a physician who know each other, trust each other, and can communicate directly. For a simple monthly membership, patients get unlimited visits, 24/7 messaging, wholesale prices on medications and labs, and most importantly—time. No rushed 7-minute visits. No fighting through bureaucracy. Just care that feels close again.

But DPC is not only about convenience. It’s about reclaiming healthcare as a circle of compassion rather than a maze of transactions. When we strip away the unnecessary layers, we discover that most of medicine is actually affordable—too affordable to insure. Ninety-five percent savings on labs, medications at pennies on the dollar, procedures included at no cost. Insurance should protect against the serious and catastrophic, not the routine. Direct care fixes healthcare by making most care simple and direct, and it fixes insurance by making it honest and limited to what it was meant for.

This is how Hierocles’ wisdom applies today. By choosing direct care, we bring patients back into the innermost circle where they belong. We expand compassion outward by lowering costs, restoring trust, and making healthcare accessible again. And as more communities adopt this model, the circles ripple outward—helping employers, families, and eventually the entire system.

Direct care is not just a business model. It’s a movement. It’s about remembering that healthcare is not paperwork—it’s people. By putting patients first, we can fix healthcare one circle at a time.

Is Direct Care a Flop? Yes and in the Best Way

In the 1960s, the sport of high jumping had stalled out. Athletes had tried every variation—straddle, scissors, western roll—but the records stopped inching higher. Then came Dick Fosbury.

At the 1968 Olympics, Fosbury showed up with a strange new technique: instead of going face-down or sideways over the bar, he threw himself over backwards, head first. It looked bizarre. Commentators laughed. But it worked. He cleared 2.24 meters, won gold, and shattered the plateau. Within a few years, every high jumper in the world was doing the “Fosbury Flop.”

The same thing happened in running. For decades, the four-minute mile was considered physiologically impossible. Then Roger Bannister broke it in 1954. The next year, dozens more did too. The barrier was never about biology—it was about belief and method.

Healthcare today looks a lot like those sports before their breakthroughs. Policymakers, insurers, and employers have tried every tiny tweak: higher deductibles, bigger networks, smaller networks, new acronyms, shiny apps. None of it has broken the plateau of skyrocketing costs and declining satisfaction.

Direct primary care is the Fosbury Flop. Instead of trying to run insurance through every routine doctor’s visit, we step back and say: what if most care is too cheap to insure in the first place? What if we rebuild the model so patients pay directly for a membership that offers unlimited visits, free procedures, and medications and labs at up to 95% savings? Suddenly, the impossible becomes obvious.

When the model changes, the records fall. Direct care has already delivered a 10x improvement in affordability for patients and employers who try it. The only thing standing in the way of mass adoption is old habits—just like track and field before 1968.

The bar isn’t too high. We just need to flip over it.

Abundance in Healthcare: A Direct Care Vision

When Tesla shared its “Master Plan” for sustainable abundance, the message was simple: technology should make essential things—like energy and transportation—so reliable and affordable that everyone can access them without worry. It’s a bold vision, but it resonates far beyond cars and batteries.

Healthcare needs its own master plan for abundance.

Today, too many patients experience scarcity in the system: not enough time with their doctor, not enough clarity about costs, not enough control over decisions. The system often leaves people feeling like healthcare is a luxury, instead of a necessity we all depend on.

Direct Care flips that script. By removing insurance middlemen, cutting through red tape, and restoring the doctor–patient relationship, we make most healthcare too simple and too affordable to insure. Medicines that used to cost hundreds are available at wholesale prices. Labs that used to feel out of reach are now cheaper than a trip to the grocery store. And the most important resource—time with a physician—is restored.

This isn’t just about saving money. It’s about creating abundance. When patients don’t have to ration care, delay visits, or fear surprise bills, they can finally get the care they need, when they need it. When doctors aren’t crushed by paperwork and bureaucracy, they can spend their energy where it matters most: with patients.

Tesla’s vision is to power the world without compromise. Ours is to care for patients without compromise. Abundance in healthcare doesn’t mean more complexity, more programs, or more layers of coverage. It means making the basics—access, time, and trust—so reliable and affordable that no one has to think twice about them.

That’s what Direct Care is building. And it’s why we believe the future of healthcare can be not just sustainable, but abundant.