08/31/2026
"Do you know how health insurance actually works?"
I asked a resident this week. Nobody had ever walked him through it.
So we followed the money, and it explains something most physicians feel years before they can name it.
In a hospital system, primary care isn't the foundation. It's the front door.
Primary care is supposed to lose money. That's not bad management, that's the design. Primary care is customer acquisition. The margin lives downstream: imaging, specialists....
Which means you're measured by what you send out, not by what you solve.
The 10-minute visit guarantees it. You can't work up a complex complaint in 10 minutes. You can only recognize it and route it. The referral quietly stops being clinical judgment and becomes time management.
Do that for a decade, and you start to forget you were trained to handle it yourself.
Here's what makes that such a waste. The evidence has been consistent for decades: 75–85% of people need nothing beyond primary care in a given year. A well-run practice can resolve the overwhelming majority of what walks through the door.
That isn't a lesser tier of medicine. That IS medicine.
Direct Primary Care is the only model I've seen where a primary care physician actually gets to practice at that level. Small panel. Thirty, forty-five, sixty minutes if that's what it takes. Nobody upstairs tracking your referral capture rate.
You see a problem, you fix it. You refer when the patient genuinely needs a specialist, not when the clock does.
Everywhere else, the primary care physician is a necessary loss leader. Top of someone else's funnel. In DPC, they're the entire practice of medicine.
Dr. Gage Hallbauer from Lone Star Family Health Center was rotating at Meridian Springs Primary Care with Bhavana Rao, MD and spoke to me today to understand the business and insurance side of healthcare. He asked me sharper questions in an hour than most people ask in a career.
