Direct Care Beyond Primary Care: Any Specialty Can Use This Model

When physicians hear “direct care,” many still picture a family doctor with a monthly membership. That is direct primary care, and it is wonderful, but it is not the whole story. The same model works for specialists, and increasingly, for nearly every specialty.

Quick answer: Direct care is not only for family medicine. The same model, contracting directly with the patient outside insurance billing, works across nearly every specialty, from rheumatology and cardiology to psychiatry and podiatry. Even heavily procedural specialties can run direct care for their consultative work. The specialty matters far less than most physicians assume.

If you have told yourself, “direct care sounds nice, but it would never work for my field,” this is for you.

Does the direct care model work for specialists, not just primary care?

Direct specialty care simply means you contract directly with the patient for your professional time, outside of insurance billing. The patient keeps their insurance for the things it is good for, hospitalizations, surgeries, labs, imaging, and pays you directly for your expertise. That structure does not care whether you are a rheumatologist, a cardiologist, or a podiatrist. If you are new to the model, start with what direct specialty care is and why it is emerging now.

Even procedural specialties fit. A direct care podiatrist set her own rates, got paid in full on the day of service, and streamlined elective procedures down to the patient, herself, and one support staff member, saving the patient money while preserving hospital capacity for urgent cases. The principle- fewer middlemen, transparent prices, paid directly- scales across fields.

Which specialties are the best fit for direct specialty care?

The specialties with frequent consultations, chronic disease management, or patients motivated to pay for ongoing access tend to thrive:

• Rheumatology, endocrinology, cardiology, neurology
• Hematology and oncology (complex case management, second opinions, survivorship)
• Psychiatry, palliative care, vascular medicine, podiatry

Which specialties work with the right structure?

Others fit well with a combination of consultative and procedural work, or strong telemedicine:

• Dermatology, gastroenterology, pulmonology, ENT
• Infectious disease, allergy and immunology, nephrology, ophthalmology

Even heavily procedural specialties can run direct care for their consultative work, pre-op and post-op management, second opinions, while keeping procedures within the hospital or surgery center. The anesthesiologist who left insurance to build Renovo Health is a good example.

The point is not that every dollar moves out of insurance.

The point is that your judgment and your time finally get paid directly, transparently, on your terms.

Specialty fit at a glance

What does direct specialty care unlock for patients?

Across every one of these specialties, the same thing happens when you remove the insurer. The appointment is as long as it needs to be. Your documentation serves medicine instead of billing. And patients show up differently, more engaged, because they chose you and they know what they are paying for.

Do you have to be the first in your specialty to figure it out?

The most common reason specialists stall is the belief that their field is the exception. It rarely is. And the fastest way to find out is to stand next to physicians in your specialty who have already built it, who can hand you the contract, the pricing, and the answer to “but how does it work for us.”

That is what the Alliance is, organized by specialty so you are not inventing your model alone.

Medicine the way it was meant to be. For every specialty, built together.

We built this, and now it has a home.

For years there was no specialist-specific home for direct care. So we built one. Explore the new platform at dscalliance.org: the full webinar library, the DSC Starter Course, the monthly newsletter, a private community of specialists, and a national directory built so patients can actually find you.

This is the opportunity, and the door is open. Founding membership is free for your first 12 months, for verified physicians, with your founding price locked for life. Come be part of our family before the founding round closes December 31.

Create your free founding account → dscalliance.org/membership

Key takeaways

• Direct care is not limited to primary care. Direct specialty care applies the same model across nearly every specialty.
• The best-fit fields have frequent consultations, chronic disease management, or motivated patients: rheumatology, endocrinology, cardiology, neurology, hematology, oncology, psychiatry, and more.
• Procedural specialties can run direct care for consultative work, pre-op and post-op, and second opinions, while keeping procedures in the hospital or surgery center.
• The specialty matters far less than the belief that yours is the exception, which it rarely is.
• The DSC Alliance is organized by specialty so no physician has to invent their model alone.

Frequently asked questions

Can any specialty use the direct care model? Nearly every specialty can. Direct specialty care means contracting directly with the patient for your time and expertise outside insurance billing, and that structure works whether you are a rheumatologist, cardiologist, psychiatrist, or podiatrist.

Which specialties are the best fit for direct specialty care? Specialties with frequent consultations, chronic disease management, or motivated patients tend to thrive, including rheumatology, endocrinology, cardiology, neurology, hematology, oncology, psychiatry, palliative care, vascular medicine, and podiatry.

Can procedural specialties like surgery or dermatology do direct care? Yes, often with the right structure. Procedural specialties can run direct care for consultative work, pre-op and post-op management, and second opinions, while keeping the procedures themselves in the hospital or surgery center.

Is direct specialty care the same as direct primary care? No. Direct primary care applies the direct model to family medicine. Direct specialty care carries the same model into the specialties. Both remove insurance billing from the direct patient relationship.

Do patients keep their insurance under direct specialty care? Yes. Patients keep their insurance for hospitalizations, surgeries, labs, and imaging, and pay the specialist directly for professional time and expertise.

Is direct care only realistic for cash-heavy or wealthy patient populations? No. Transparent, upfront pricing often costs patients less than high deductibles, copays, and surprise bills, especially for the ongoing consultations and chronic disease management that many specialties provide. Patients keep insurance for hospital care, surgery, labs, and imaging.

How does the DSC Alliance help specialists in my field? The Alliance is organized by specialty, so you can stand next to physicians who have already built a direct practice in your field and borrow the contract, the pricing, and the answers to how it works for you.

Related from the DSC Alliance blog

• Direct Specialty Care: What It Is and Why Specialists Are Leaving Insurance
• Dr. Steven Borene: Anesthesiologist Who Left Insurance for Direct Specialty Care
• DSC vs DPC vs Concierge Medicine

More on direct specialty care

• The emergence of direct specialty care (KevinMD)
• Direct Specialty Care or DSC: The Patient-Centric Personalized Medicine (SigmaMD)
• Starting a Direct Specialty Care Practice From Scratch, Because It Is Best for Patients (Finance For Physicians)
• Specialists in Direct Care (FreedomDoc Series)

About the author

Dr. Diana Girnita, MD, PhD, is a rheumatologist, the founder of Rheumatologist OnCall, and co-founder of the Direct Specialty Care Alliance. She completed a PhD in immunology and transplant immunology, trained at Harvard University and the University of Cincinnati, and is the author of two books on autoimmune disease and nutrition. She built the DSC Alliance so no specialist has to leave the insurance system alone.

Ready to practice medicine the way it was meant to be? Join the DSC movement at dscalliance.org.