The 83% figure is real. It reflects something genuine about where physicians are choosing to practice and where patients are choosing to seek care. It is not, by itself, a mission.

By Concierge Medicine Today | Editorial Analysis Category: Field Intelligence, Practice Design

In December 2025, researchers from Johns Hopkins University, Oregon Health & Science University, and Harvard Medical School published findings in Health Affairs that the healthcare industry has been citing ever since. Between 2018 and 2023, the number of concierge and direct primary care practice sites in the United States grew by 83.1% — from 1,658 practices to 3,036. The number of clinicians working inside those practices grew by 78.4%, from 3,935 to 7,021.

By the time you read this, that 83% figure has already appeared in investor decks, association newsletters, conference promotional copy, and no small number of vendor marketing emails. Everyone wants to attach themselves to a growth story.

That is precisely why it is worth slowing down.

Concierge Medicine Today has been covering this field since 2007. We have watched numbers get cited selectively, growth get conflated with legitimacy, and momentum get mistaken for mission. This analysis is not a celebration of a statistic. It is an attempt to say, honestly, what this data shows, what it does not show, and what physicians should actually do with it.

What the Data Actually Shows

The Zhu et al. study is methodologically serious. The researchers used a linked national dataset — combining public and proprietary sources — to identify concierge and direct primary care practices and track them over a six-year window. The sample covered more than 6,000 practices. The growth trend is not an artifact of better counting. It is real.

Three findings within the study deserve more attention than they have received in coverage of this data:

The clinician mix is shifting. In 2018, physicians made up 67.3% of clinicians in these practices. By 2023, that figure had dropped to 59.7%. Advanced practice clinicians — nurse practitioners and physician assistants — grew from 32.7% to 40.3% of the workforce. That is a structural shift, not a rounding error. What it means for patient experience, practice culture, and long-term physician leadership within this model is a question the field has not yet seriously answered.

The absolute numbers remain modest. 3,036 practice sites in a nation of more than 330 million people. 7,021 clinicians in a primary care workforce estimated at over 200,000. The growth rate is striking. The market penetration is not. Both things are true simultaneously and both matter for how physicians interpret this signal.

The study does not measure patient outcomes. It measures practice and clinician counts. Growth in the number of practices tells us something meaningful about physician behavior and market demand. It tells us nothing directly about whether patients in these practices are healthier, whether access has improved at a population level, or whether the model’s promises are being delivered consistently across those 3,036 sites.

What the Data Does Not Show

This is where most coverage of the Zhu study stops asking questions.

83% growth does not mean 83% satisfaction. There is no longitudinal outcome data embedded in this study. We do not know how many of those 3,036 practices are thriving, how many are struggling, or how many are structured in ways that actually deliver the physician-patient relationship their marketing describes. Growth in practice count captures none of that variance.

Growth does not validate every version of the model. Concierge medicine and direct primary care are not interchangeable terms, and the umbrella has widened considerably in recent years to include hybrid structures, employer-sponsored models, and large-scale platforms that bear limited resemblance to an independent physician who simply wants a sustainable practice with 400 patients. The study counts all of them together. Physicians evaluating this field of membership medicine (an umbrella term) should not.

The workforce shift toward advanced practice clinicians warrants honest conversation. The data shows physicians declining as a share of this workforce. That may reflect rational economic choices by nurse practitioners and physician assistants who want sustainable practice environments. It may also reflect cost-structure decisions by practice operators that have implications for clinical scope and patient care. The field should discuss this openly.

The access question is legitimate and will not go away. The Johns Hopkins press summary stated directly: the widespread adoption of membership-based models, which frequently target higher-income patients, creates concerns about a growing general primary care shortage. That concern is not anti-concierge medicine advocacy. It is an honest policy question about what happens to patients who cannot pay a membership fee when their primary care physician exits the traditional system. Physicians who believe in this model are in the best position to engage that question — and should.

What Physicians Should Do With This Information

The growth trend confirms demand. It does not confirm that every path into this model is equal. The evidence that patients and physicians are actively seeking alternatives to volume-based primary care is substantial and growing. That is signal worth taking seriously. What it does not tell you is which operational model, which fee structure, which patient panel size, or which ownership structure will produce a practice worth leading in ten years.

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Ask harder questions of anyone citing this data evangelically. Organizations and vendors who present 83% growth as straightforward validation are giving you marketing, not analysis. The physicians who build the most sustainable practices in this model are the ones who evaluate critically rather than adopt enthusiastically.

The workforce shift is a leadership question. If physicians continue to decline as a share of this clinical workforce, the profession’s ability to define the standards, culture, and ethics of these models will also decline. That matters not just for individual practices, but for whether membership medicine retains its physician-led identity over the next decade.

The access conversation is yours to lead. Physicians in concierge and membership practices are in the best position to articulate honestly what these models do and do not do for access and community health. Ceding that conversation to critics or to cheerleaders leaves a vacuum that others will fill.

What CMT Is Watching

The 83% figure is real. It reflects something genuine about where physicians are choosing to practice and where patients are choosing to seek care.

It is not, by itself, a mission.

The mission — building sustainable, relationship-driven practices that serve patients and communities well — is what physicians in this field are working on every day, independent of what any study says.

That work deserves honest analysis. CMT will keep providing it.

Source: Zhu JM, Marsh T, Polsky D, Huntington A, Song Z. “Growth in Number of Practices and Clinicians Participating in Concierge and Direct Primary Care, 2018–23.” Health Affairs. 2025;44(12):1473–1481. doi:10.1377/hlthaff.2025.00656

Concierge Medicine Today has covered the concierge and membership medicine field since 2007. This editorial analysis reflects the publication’s independent assessment of publicly available research. CMT is not affiliated with MDVIP or any other network, vendor, or membership association. Content is for educational and informational purposes only and does not constitute medical, legal, or financial advice. © 2007–2026 Concierge Medicine Today, LLC. All rights reserved.