07/04/2026
Direct Physician Care: A New Declaration of Independence for American Healthcare
Posted on June 29, 2026 by Shane Purcell, MD
The Rise of Direct Care — Throwing Off the System of Abuse
As America celebrates its 250th anniversary in 2026, we are once again called to remember the courage of those who, in 1776, dissolved the bands of a distant and oppressive power. They did not do so lightly—many lost their homes, their fortunes, and their lives. They acted only after a long train of abuses made continued allegiance intolerable.
Today, a parallel revolution is unfolding in medicine, proclaiming we hold these truths to be self-evident, that the patient-physician relationship is the foundation of medical care and must be protected and pursued at all costs. Justifiably, physicians and patients are declaring their independence from a healthcare system that has inserted itself between healer and patient, turned doctors into billing clerks and data-entry servants, and prioritized volume, compliance, and corporate profit over the sacred relationship at the heart of good care.
The model rising to meet this moment is direct care (direct primary care and direct specialty care) — a simple, transparent arrangement in which patients pay their physician an affordable fee for medical services. In the Direct Primary Care (DPC) model, this would be a flat monthly fee for comprehensive primary care services. The results are clear. No insurance middleman. No prior authorizations for basic services. No rushed 7- to 15-minute visits. Just medicine as it was meant to be practiced: between one doctor and one patient who know and trust each other.
A Long Train of Abuses
The current third-party payer and regulatory regime has pursued, with remarkable consistency, the reduction of physicians to functionaries and patients to revenue streams. Its abuses are well known to anyone who has practiced or sought care in recent decades:
It has buried physicians under crushing administrative burdens — prior authorizations, varying insurer rules, complex billing codes, and documentation requirements designed more for reimbursement than for clinical truth. These tasks now consume more physician time than actual patient care.
It has incentivized high-volume, low-value medicine through fee-for-service reimbursement, forcing doctors to see 20–30 patients a day in 7- to 15-minute slots, eroding continuity, prevention, and the very possibility of a real relationship.
It has inserted distant corporations and algorithms between doctor and patient, dictating what tests may be ordered, what medications may be prescribed, and whether care will even be paid for.
It has mandated electronic health record systems whose primary purpose often appears to be billing compliance and data harvesting rather than clinical excellence.
It has driven physician burnout to epidemic levels, with administrative hassle repeatedly identified as the leading cause. Many excellent doctors have left practice early; some have been lost entirely.
It has left patients with fragmented care, surprise bills, high deductibles, and medical debt, even when “insured,” along with the constant sense that their doctor is working for someone else.
These are not isolated frustrations. They are the predictable result of a system that long ago ceased to serve the doctor-patient relationship and instead made that relationship serve the system.
The Right and Duty to Throw Off Such a System
The founders understood this principle clearly:
“But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.”
That right and duty now belongs to physicians and patients alike. When a system consistently destroys autonomy, destroys time, destroys relationships, and destroys joy in the practice of medicine, it has forfeited its claim to loyalty. The response is not reform from within the machine. The response is to build something better outside it.
The Declaration of Direct Care Independence
We, the physicians who have chosen the Direct Primary Care (DPC) and Direct Specialty Care (DSC) model and the patients who have joined them, do hereby declare our independence from the insurance-dominated, administratively bloated, relationship-destroying system that has dominated American primary care for decades.
We hold that the doctor-patient relationship is not a commodity to be managed by third parties. It demands the power of the patient’s freedom to choose and the liberation of physician autonomy.
In DPC practices across the country, physicians are exercising that independence every day:
Smaller panels (typically 400–600 patients instead of 1,800–2,500) allow 30- to 60-minute visits.
No insurance billing for primary care services removes the administrative tyranny.
Direct access — same-day or next-day appointments, phone, text, and video — restores true continuity.
Clinical decisions are made by the physician and patient together, not by distant utilization reviewers.
Transparent monthly fees replace surprise bills and opaque deductibles for routine care.
The results speak for themselves. According to the Hint Health DPC Trends 2026 report, DPC physicians report dramatically higher satisfaction (68% higher) and far lower burnout (48% lower). Nearly half report no burnout at all. Patients gain a happy and focused doctor who actually knows them.
We Pledge Our Lives, Our Fortunes, and Our Sacred Honor — to the Patient-Physician Relationship
For the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our lives, our fortunes, and our sacred honor.
In practical terms, this pledge means:
Physicians commit to putting the relationship first — even when it means forgoing higher earnings available in the old system.
Patients commit to valuing and supporting practices that restore time and trust.
Together, we commit to building a parallel system of care that proves, by its results, that medicine does not require the current bureaucratic apparatus to flourish.
The Fight Is Only Begun
This is not the end of the story, only the beginning.
Direct Primary Care remains a minority model, though its growth has been rapid — from roughly 100 practices in 2009 to well over 3,000 today, with continued expansion as more physicians and patients discover what has been lost. Direct Specialty Care is even more in its infancy, but growing.
Nevertheless, with every new DPC practice opened, every patient who leaves the old system for one that treats them as a person rather than a claim, every doctor who reclaims their vocation — these are acts of quiet revolution.
On the 250th anniversary of American independence, the same spirit that animated 1776 animates the rise of Direct Care: the belief that free people have both the right and the duty to throw off systems that have become destructive of the ends for which they were supposedly established.
The old system will not surrender its power willingly. But it does not need to. We simply need to build something better — and walk away.
The chains are not as strong as they appear once enough people decide they will no longer wear them.
The fight for the soul of American medicine has only just begun.
Physicians: Start a DPC or DSC practice. Join one. Leave the system that no longer serves your patients or your calling.
Patients: Seek out Direct Care models. Ask your doctor about it. Vote with your feet and your wallet. Ask for transparent cash pricing for medical care, even if you have insurance.
All of us: Remember that the doctor-patient relationship is worth fighting for — and that in 2026, as in 1776, throwing off tyranny begins with the courage to declare independence.
The new guards for our future security in healthcare are already being raised. They look like small practices, long visits, direct relationships, and physicians who once again feel free to practice medicine.
That is the revolution worth joining.
