Direct Primary Care: Good for What Ails ME!

Updated: Aug 18, 2020

What this model is trying to do, and the amazing doctors who are doing it, are inspirational. They give me hope that health care can be improved for all Americans. They show the way to challenge conventional wisdom.



I first became aware of Direct Primary Care sometime before 2010. I had been working in an actuarial role at an insurance company since 1997, and once I got through the exams I started thinking about how I wanted to contribute more broadly. I quickly honed in on health care. You can read more about how I felt when the Affordable Care Act passed here, but suffice it to say that I was disappointed and frustrated that this hugely impactful law was passed, seemingly without much input from actuaries or economists or any national dialogue. It was then that I decided I wanted to get more involved in health care policy and research as an actuary.


At first, I thought I could scratch this itch by participating in work groups and committees of the national actuarial organizations. This was a good experience in many ways, but ultimately it was not what I was looking for. Enter Direct Primary Care. When I first learned about this new model of primary care delivery that seemed to sidestep many of the problems of the health care system, I was intrigued. When I realized that DPC honors actuarial principles by not using insurance to pay for primary care, I was hooked. I had to learn more. I started reading everything I could find on DPC. I started talking to DPC doctors and their patients. At first, it seemed too good to be true; there had to be a dark side somewhere or something problematic about it that I didn’t yet understand. I’ve been studying DPC for well over ten years now and I’ve not found a dark side or hidden secret that negates all of the positives.


Finding DPC has been life-changing for me. What this model is trying to do, and the amazing doctors who are doing it, are inspirational. They give me hope that health care can be improved for all Americans. They show the way to challenge conventional wisdom. I saw that there are ways for me to use my actuarial skills as a foundation and make a difference in health policy and research. I was inspired to go back to grad school for my doctorate in health policy & management. I am now embarking on a new career centered around health care policy, research, dialogue, and reform. DPC was the catalyst for this, and so I say DPC has been good for what ails me!


My first article about DPC, “Direct Primary Care: Good for What Ails Us?” was published in a health actuarial newsletter in 2016. When I read the article today, I’m not satisfied with it because I did not adequately deal with the issue of patient selection. Some of the articles I cited lacked enough details to confirm that their results are due to the DPC model and not due to the characteristics of patients who selected it. Despite this flaw, I’m glad that I wrote the article. It was the beginning of my venture into studying DPC.


Even today, rigorous research on DPC is scarce. I aim to continue studying and talking about DPC, and I hope that you will join me in dialogue. Perhaps together we will find that DPC is good for what ails the US health care system.

Brekke Health Watch article May 2016
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