Between 2018 and 2023, the number of concierge and direct primary care practices in the United States grew 83%, and the number of clinicians working in them grew 78.4%, from 3,935 to 7,021.[1] But one number inside that growth moved the other way. The share of those clinicians who are physicians fell from 67.3% to 59.7%.[1]
An important side note. At NextMD we only list practices that are run by a physician who is either an MD or a DO.
In plain terms: the category is getting bigger, but you must be cautious as a growing number of practices are not staffed by medical doctors. The word "concierge" on a practice's front door no longer tells you, by itself, that a physician is the one seeing you.
This guide explains what is happening, why it matters for the care you get, and the one question that cuts through the marketing.
What "concierge," "membership," and "direct care" actually mean
These labels describe how you pay, not who treats you.
Concierge medicine is a private model where you pay an annual or monthly membership for more access to your doctor: same-day or next-day visits, longer appointments, and direct phone or text contact. Annual fees run from $3,000 to over $40,000 depending on the practice.
Direct primary care (DPC) is a similar membership idea at a lower price, usually $50 to $200 per month ($600 to $2,400 per year), billed directly to you with no insurance in the middle.
"Membership medicine" and "direct care" are loose umbrella terms that get applied to both of the above, and increasingly to practices that look like them but are staffed differently.
None of these terms is regulated the way "physician" is. A practice can call itself concierge or membership-based regardless of whether the person you see holds a medical degree. For a fuller breakdown, see our guides on what concierge medicine is and how concierge and DPC compare side by side.
The numbers behind the shift
Here is what the 2018 to 2023 data shows.[1]
Metric (2018 → 2023) | Change |
|---|---|
Concierge/DPC practices | +83% |
Concierge/DPC clinicians | 3,935 → 7,021 (+78.4%) |
Physician share of those clinicians | 67.3% → 59.7% (down 7.6 points) |
The category nearly doubled in five years. As it grew, it added nurse practitioners (NPs) and physician assistants (PAs) faster than it added physicians. That is why the physician share dropped even as the raw number of doctors rose.
Why this is happening
Two forces are pushing in the same direction.
First, there are not enough primary care physicians to meet demand, and the gap is widening. Practices that want to grow often staff up with NPs and PAs because they are faster to hire and less expensive to employ.
Second, in roughly half of US states, nurse practitioners can practice independently, without a supervising physician, under what is called full practice authority.[2] That makes an NP-led membership practice legally straightforward to run in much of the country.
Neither of these is inherently bad. NPs and PAs are skilled, licensed clinicians who handle a large share of routine care well. The issue is not competence. The issue is that the membership label has stopped reliably signaling that a physician is leading your care, and most patients still assume it does.
MD, DO, NP, PA: what the letters actually mean
The credential after your clinician's name tells you their training.
MD (Doctor of Medicine) and DO (Doctor of Osteopathic Medicine) are the two physician degrees in the US. Both require four years of medical school plus three to seven years of residency, and both carry full authority to diagnose, prescribe, and lead complex care.
NP (Nurse Practitioner) is an advanced-practice nurse with a master's or doctoral nursing degree. NPs diagnose, prescribe, and manage chronic conditions, often independently depending on the state.
PA (Physician Assistant) is a clinician trained in a medical model, typically practicing alongside physicians.
The difference that matters most for a patient is depth of training before independent practice: a physician completes roughly 11 to 15 years of education and supervised residency, several years more than an NP or PA. For complex, multi-system, or undifferentiated problems, that depth is what you are paying a premium for. We break down every credential in our guide to what MD, DO, and NP degrees mean.
What this means for you
If you are paying a membership fee, you are paying for a relationship and for access. It is reasonable to know exactly who is on the other end of that relationship.
Ask three questions before you join any concierge or membership practice:
Is the practice physician-owned or physician-led? Who makes the final call on your care plan?
Will I see an MD or DO at my visits, or will I primarily see an NP or PA? Both answers can be fine. You just deserve to know which one you are buying.
If I see a non-physician clinician, what is the physician's role in my care? Is a doctor reviewing your case, or not involved at all?
There is no wrong answer here, only an uninformed one. Some patients are happy with NP-led primary care at a lower price. Others are paying specifically for a physician's training and want that guaranteed. The mistake is assuming the "concierge" label settles the question. It does not.
Why NextMD verifies a physician on every practice
Every practice listed on NextMD must have at least one MD or DO. That is a hard rule, not a preference. A practice that is NP-only or PA-only does not get listed, no matter how it markets itself. We believes this drawls clear lines and allows users to find practices who are only staffed by MD/DOs.
As more concierge medical practices pop up, we believe sourcing for high quality is essential.
As the membership label spreads across practices staffed in very different ways, a marketplace that verifies a physician-led practice becomes a filter you can trust rather than a limit. When you browse a practice or search for a concierge doctor near you on NextMD, the physician question is already answered before you ever pick up the phone. You can also browse by state, for example concierge and DPC practices in Florida, and see physician-led options first.
This is not a knock on nurse practitioners or physician assistants. It is a statement about what NextMD is for: helping patients who specifically want a physician find one, with the credential verified up front.
NextMD helps you find and compare concierge medicine and direct primary care practices across the United States. Every practice we list has at least one verified MD or DO. Browse by city, compare pricing, and find a physician who has time for you at nextmd.ai/search.
Sources
Zhu, J. M., et al. (2025). Growth Of Concierge And Direct Primary Care Practices, 2018–23. Health Affairs. Read the study abstract on Health Affairs. Coverage and clinician figures also summarized in MedPage Today.
American Association of Nurse Practitioners. State Practice Environment. Referenced for the number of states granting nurse practitioners full practice authority. AANP State Practice Environment.