I left a practice with over 3,000 patients.
That’s not a typo. I had a panel that large, and like a lot of physicians in that situation, I was doing everything I could — back-to-back appointments, phone messages stacking up between them, documentation until late in the evening. I cared about my patients. I just didn’t have the time to show it the way I wanted to.
When I decided to leave and build something different, I kept being asked the same question: What exactly is direct primary care?
It’s a fair question. The term gets used loosely, and there’s a lot of confusion about what it actually means in practice — and more importantly, what it means for you as a patient.
Here’s my honest answer.
In a traditional insurance-based practice, the relationship between a doctor and a patient runs through a third party — your insurance company. That third party determines what visits are covered, how long they can be, what treatments are approved, and what gets reimbursed. The physician’s job becomes partly clinical and partly administrative: documenting for billing, coding for reimbursement, justifying decisions to insurers.
Direct primary care removes that layer entirely.
At Retro Health & Aesthetics, you pay a monthly membership fee — not a copay, not a claim. We don’t bill your insurance for primary care visits. We don’t submit codes. We don’t need prior authorizations before we can spend time with you.
What that means in practice: we see fewer patients, which means we can give each one more time, more attention, and more access.
I want to be honest about something that took me years to fully reckon with.
The standard primary care model isn’t broken because physicians don’t care. It’s broken because the incentives are misaligned. When your revenue depends on volume — on the number of visits billed — the system pushes you toward shorter appointments, faster decisions, and less time per patient. Fifteen minutes for a follow-up is generous by some standards.
That’s not medicine. That’s triage.
I found myself spending more time managing the administrative requirements of insurance than I was spending thinking carefully about the people in front of me. Lab work would come back and I’d have to carve out time to call. A patient with a complex question would leave a message and wait. Chronic conditions that needed ongoing management got squeezed into appointment slots that weren’t long enough to do them justice.
When you’re inside that model, you adapt. You learn to work within the constraints. But the longer I worked within them, the more I understood that the constraints themselves were the problem.
When I co-founded Retro Health with Gregory LaFontaine, PA-C, we made a deliberate decision about how we wanted to practice medicine.
Our members have same-day and next-day appointment availability. Not a scheduling center. Us. When something comes up — a fever that isn’t breaking, a medication question, a lab result you want to understand — you reach us directly through Spruce, our secure messaging platform. You don’t wait for a callback from someone who needs to pull up your chart before they know who you are.
We have a panel cap. We see fewer patients than a conventional practice, and that’s intentional. It means the time we have goes further for everyone.
We also think about primary care more broadly than the acute visit. If you’re on a wellness optimization plan, managing your hormones, working on weight loss, or monitoring a chronic condition, that context follows you across every interaction — because we actually know your history. We’re not reading notes for the first time when you walk in.
I get this question a lot, so it’s worth clarifying.
Direct primary care (DPC) and concierge medicine are similar in structure — both use a membership model, both remove the friction of insurance billing for primary care — but they’re not identical.
Traditional concierge medicine typically charges higher membership fees, often bills insurance in addition to the membership, and is usually positioned at the very top of the market. Direct primary care tends to be more accessible in pricing and is insurance-free by design.
At Retro Health, we think of what we do as concierge-caliber care at a price point that’s sustainable for real families. We’re not a luxury add-on to your existing healthcare. We’re designed to be your primary care relationship — the foundation.
This is the practical question I hear most often, and the honest answer has two parts.
First: you should still carry insurance. Direct primary care does not replace coverage for hospitalizations, specialist referrals, imaging, surgical procedures, or emergency care. What it replaces is the primary care relationship — the day-to-day medical home where you handle most of your healthcare needs.
Second: many of our members find that their actual use of insurance drops significantly once they have direct access to a provider who can address things early, order labs efficiently, manage medications, and keep them out of urgent care for things that don’t need to be urgent.
We’re not anti-insurance. We’re pro-relationship. The two can coexist.
I didn’t leave a large practice to start something small. I left a large practice to start something better.
The Worthington community is exactly the kind of place where this model works — patients who want to be known, who value access, who take their health seriously and want a provider who does too. I’ve met people here who had never had a physician who called them back the same day. That shouldn’t be remarkable. We’re trying to make it unremarkable.
Gregory and I built Retro Health because we believed that medicine could feel different — not just for patients, but for the people practicing it. When I’m not managing prior authorizations and billing reviews, I can do what I trained to do: think carefully about your health and give you my full attention when it matters.
That’s what direct primary care actually means. Not a product. Not a model. A relationship.
If you’ve been curious about what concierge primary care would look like for you or your family, I’d love to talk.
Dr. Bethany Recker, MD is the Medical Director and co-founder of Retro Health & Aesthetics in Worthington, Ohio. She practices concierge primary care, functional medicine, and hormone optimization.
