Direct primary care has been gaining steam in the physician practice space for several years now, as physicians seek out ways to cut out financial and operational inefficiencies associated with traditional fee-for-service models and insurance companies.
But DPC is still relatively new in the pediatric space, Rhett McLaren, MD, pediatrician and founder of Premier Pediatric Consultants in San Antonio, told Becker’s. He started his own pediatric DPC practice in August 2025 after decades of experience in employed and traditional physician practice settings. His practice is subscription-based, meaning that patients pay a monthly fee for access to scheduled appointments and other services.
While his model is similar to DPC models in adult primary care, there are key differences to navigate in the space.
“In pediatrics, we’re kind of the tip of the spear, because pediatricians have always been the lowest paid specialty — not just in primary care, but the lowest paid specialty,” Dr. McLaren said. “And the other thing that is distinctly different is there has historically been an over abundance of pediatricians, especially in urban areas.”
Dr. McLaren added that pediatricians often have “less assertive” personalities than adult physicians, making them less likely to advocate for themselves within systems or in independent practice. This, combined with a historic surplus of pediatricians, has created a “perfect storm” within the specialty, which led Dr. McLaren to start his own pediatric DPC practice.
“It’s not a transition I would recommend for the weak of heart. We are behind adult care in that transition, and fewer young parents know about that kind of model,” he said. “So you’re starting from scratch in terms of describing the benefits.”
He added that adult physicians have been managing a shortage for many years, which created the impetus for DPC to begin with.
“We don’t have that in pediatrics. And so the whole concept of paying outside of insurance is really kind of shocking to parents,” he said, noting that there are also sometimes financial barriers in pediatric care that differ from adult DPC.
“As I like to say, people with young children are not necessarily in their peak earning years,” he said. “Even people who have stable jobs that will provide good security long term are stretched with student loans, saving for college and just providing for their children. Whereas people who need more care as they get older are often past their child-rearing years and maybe have more discretionary income.”
However, he has found that patients who do utilize pediatric DPC are “very happy with the type of access and the type of care it provides,” especially when it comes to appointment times.
“Since I have transitioned to direct primary care it provides more time for patients. It also provides more time for me,” he said.
He added that amid the compounding pressures facing healthcare today, time is perhaps a practitioner’s most valuable resource — and something that should be taken seriously.
“When patients actually come into the office, their problems are more involved. There’s a big increased demand in primary care, adults and children, for mental health care, which takes more time, but then the time that we’re allotted per patient is getting lower and lower,” he said.
Furthermore, he hopes that his leadership and vision can spark new conversations around medical economics and systems for payment in the future.
“We keep calling it health insurance — and insurance is actually you pay a small amount to insure against the unlikely occurrence of a catastrophic event, right?” he said. “Health insurance is not health insurance. It’s a health plan. I think [DPC] is another way to get back to health insurance. … We should have people paying for the day-to-day care straightforwardly and negotiate that directly with their providers, and reserve insurance for those unexpected, more severe, costly problems. I think that is a big part of what would go a long way toward regaining autonomy.”
