Direct Specialty Care: What It Is and Why Specialists Are Leaving Insurance
I am here to tell you it is possible, and that I am not alone.
There are specialists across this country quietly running practices like mine. Hidden gems, really, doctors who removed the middlemen and reconnected with the people they trained to help.
We are not waiting for the system to fix itself.
We are building something next to it.
Quick answer: Direct specialty care is specialist medicine practiced outside the insurance billing system. The specialist contracts directly with the patient for transparent, upfront prices, while the patient keeps their insurance for hospitalizations, surgeries, labs, and imaging. It is not concierge care, and it is not direct primary care. It is emerging now because both physicians and patients are worn down by the insurance system, and it is emerging together, through a national community and directory, so patients can actually find these specialists.
Let me tell you why direct specialty care is emerging now, and why it is emerging together.
How does direct specialty care actually work for a patient?
A 64-year-old patient needed a specialist. Through the usual system, the answer was a long wait and a bill that ran into the thousands. Her primary physician took the time to research her options and called my practice in a genuine effort to help her. After a short peer-to-peer consultation, I called her and scheduled a visit for the next day.
The patient was surprised. We did not greet her by asking for her insurance card. We planned her labs and her medication together, and every cost, the consultation, the testing, the imaging, was made clear to her upfront. Her care went from an estimated several thousand dollars to a few clear hundred. No copays. No surprise bills weeks later.
That is direct specialty care. And the reason that story is possible is not that I am special. It is that more of us are choosing to practice this way, and more patients are looking for exactly this.
What is direct specialty care?
Direct specialty care is specialist medicine practiced outside the insurance billing system. You contract directly with the patient for your professional time, your consultations, your follow-up, your management. The patient typically keeps their insurance for the things it is good for, hospitalizations, surgeries, labs, and imaging, while your expertise is paid directly and transparently.
It is not direct primary care, which is for family medicine.
It is not concierge, which charges a fee on top of insurance.
Direct specialty care replaces the insurance billing relationship instead of adding to it. That distinction matters, and it is the whole reason specialists needed their own model.
Direct specialty care vs. concierge vs. direct primary care
| Model | Who it serves | How is it paid | Relationship to insurance |
|---|---|---|---|
| Direct specialty care | Specialists (rheumatology, cardiology, endocrinology, and more) | Transparent, upfront price paid directly to the specialist | Replaces insurance billing for the specialist’s time |
| Direct primary care | Family and primary care | Flat membership fee | Replaces insurance billing for primary care |
| Concierge medicine | Primary or specialty | Membership fee on top of insurance | Adds a fee, still bills insurance |
Why is direct specialty care emerging now?
The direct primary care movement began roughly a decade ago, and the patients who joined it quickly discovered what they had been missing: access, affordability, and price transparency. Specialists watched, and the same forces pushing primary care doctors out of the insurance grind were pushing us too. Less time with patients than with documentation.
Reimbursement cut.
Patients are paying higher deductibles and premiums while they wait longer to be seen.
Patients are not passive in this anymore. They are actively looking for access, transparent pricing, and affordable quality care. They are willing to shop for their health. When a physician and a patient are directly accountable to each other, both get something the insurance system kept taking away.
What fears do specialists have, and are they real?
I will not pretend it is effortless. When I first considered this, the questions were loud, and they are the same questions I hear from specialists now.
How am I supposed to survive without a referral system feeding patients to my door?
How do I teach patients that I am here for them?
How do I justify not billing their insurance?
How do I set a fair price?
Here is what I learned. None of those questions has a hard answer once you stop facing it alone. Referrals come from the growing network of direct primary care physicians who need specialist partners, and from patients who find you directly when your practice is built to be found. The pricing is learnable. Patient education is a set of words you can borrow from someone who has already written them.
The fear is real. It is also the only thing standing between most specialists and the practice they actually want.
Why build an alliance, not just a practice?
When my co-founder Lara and I made this transition, no one had built what we needed.
No specialist-specific directory.
No attorney-reviewed contracts written for direct specialty care.
No room full of peers who understood what it meant to be a rheumatologist or a hematologist practicing outside the system.
So we built it, and we built it so the next specialist would not have to figure it out alone.
That is the Direct Specialty Care Alliance.
A community, a set of real tools, and a national directory designed so patients searching for transparent, direct care actually find you, on Google and increasingly inside the AI assistants they now ask first.
Alone, each of us rebuilds the same wheel. Together, we make the contracts tighter, the pricing fairer, the standard of the whole field higher, and every one of us easier to find. Every specialist who succeeds in this model makes the next one more credible.
With a little imagination, we can create a space for ourselves and our patients. We already are. Together.
Medicine the way it was meant to be. Findable and shared.
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 Starter Guide, 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 on December 31.
Create your free founding account → dscalliance.org/membership
Key takeaways
- Direct specialty care is specialist medicine outside insurance billing, with the physician contracting directly with the patient for transparent, upfront prices.
- It is different from concierge care (a fee on top of insurance) and from direct primary care (family medicine). It replaces insurance billing rather than adding to it.
- Patients usually keep their insurance for hospitalizations, surgeries, labs, and imaging, and pay the specialist directly for expertise and time.
- It is emerging now because both physicians and patients are exhausted by rising costs, shrinking time, and longer waits.
- The DSC Alliance exists so specialists can make the transition together and so patients can actually find direct care from specialists.
Frequently asked questions
What is direct specialty care? Direct specialty care is a model in which a specialist physician works directly with the patient, outside of insurance billing. The price is transparent and known before care, and the patient keeps their insurance for hospitalizations, surgeries, labs, and imaging.
How is direct specialty care different from concierge medicine and direct primary care? Concierge medicine charges a membership fee in addition to insurance. Direct primary care applies the direct model to family medicine. Direct specialty care carries the direct model into the specialties and replaces insurance billing rather than adding a fee on top of it.
Do patients keep their insurance with direct specialty care? Yes. Patients typically keep their insurance for hospitalizations, surgeries, labs, and imaging. The specialist’s professional time and management are paid directly and transparently.
Is direct specialty care cheaper for patients? Often, yes, for the specialist’s time and services, because prices are transparent and set upfront with no billing markup, copays, or surprise bills. Patients still use insurance for hospital care, surgery, labs, and imaging. Individual costs vary by specialty and practice.
Why is direct specialty care growing now? Physicians spend more time on documentation and insurance work than with patients, reimbursement keeps falling, and patients wait longer while paying higher deductibles. Both sides are looking for access, affordability, and transparency, which the direct model provides.
Can a specialist really leave the insurance system? Yes. The common fears about referrals, pricing, and patient education all have answers, and they are far easier to solve alongside physicians who have already built direct practices.
Where do direct specialty care patients come from without insurance referrals? From the growing network of direct primary care physicians who need specialist partners, and from patients who search for transparent, direct care directly on Google and inside AI assistants, when your practice is built to be found.
What is the DSC Alliance? The DSC Alliance is a physician-only community and national directory for board-certified specialists practicing direct specialty care. It provides contracts, pricing information, a community, and a directory to help patients find these specialists.
How do I join the DSC Alliance? Verified physicians can create a free founding account at dscalliance.org/membership. Founding membership is free for the first 12 months with the founding price locked for life, and the founding round closes December 31.
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.
