There are four real primary care options in Philadelphia: traditional insurance-based primary care (cheap per visit, short appointments, hard to reach), urgent care (fast walk-in, no continuity), hybrid concierge (longer visits but still bills insurance with copays), and direct primary care (one flat fee covers all primary care visits, no copays). Fishtown Medicine is direct primary care. Each model is the right answer for a different person; we are honest about which one fits.
This is the conversation we have on most fit calls. Worth having in writing.
The four real options
| Traditional Primary Care | Urgent Care | Concierge (Hybrid) | Direct Primary Care (us) | |
|---|---|---|---|---|
| Visit length | 7 to 15 minutes | 10 to 20 minutes | 20 to 45 minutes | 30 to 120 minutes |
| Same-day access | Rare | Yes (walk-in) | Sometimes | Routine |
| See your actual doctor | Sometimes | No (whoever is on) | Usually | Always |
| Direct text or video | Rare | No | Sometimes | Yes |
| Annual physical depth | 12 to 20 minutes | None | 30 to 60 minutes | 90 minutes |
| Advanced labs (ApoB, Lp(a), fasting insulin) | Rare | No | Sometimes | Yes, standard |
| Wearable + CGM review | No | No | Rare | Yes |
| Same physician across years | Sometimes | No | Yes | Yes |
| Care coordination | Light | None | Some | Full |
| Home visits | No | No | Rare | Yes (for members in the city) |
| Bills your insurance for visits | Yes | Yes | Yes | No |
| Per-visit copays | Yes | Yes | Yes | No |
| Membership fee | None | None | Yes (mid to high) | Yes (low to mid) |
| Replaces your other insurance | No (it IS insurance care) | No | No | No |
| Typical cost per year | Insurance premium + copays | $200 to $500 per visit | $3,500 to $7,500 + insurance | $250 to $2,500 / yr + your insurance for hospital, surgery, specialists, imaging, prescriptions |
Who each one is for
Traditional primary care. Good for adults who are mostly well, see a doctor once a year, and use insurance for everything else. The visits are short and the doctor changes more often than you would like, but the cost per visit is low.
Urgent care. Good for acute, uncomplicated issues when you do not have a primary care relationship or your doctor cannot fit you in. Not a continuity model, by design.
Hybrid concierge. Good for adults who want longer visits and more access but want to keep using their insurance for everything, including primary care visits. You pay a membership fee AND copays on visits.
Direct primary care (us). Good for adults who:
- Want to actually reach their doctor (text, video, same-day).
- Want longer visits and a real annual physical, not 12 minutes.
- Want advanced labs (ApoB, Lp(a), fasting insulin, wearable review) read with them.
- Are willing to pay a flat membership fee for unlimited primary care visits instead of paying per visit through insurance.
- Are NOT trying to drop their insurance entirely (we run alongside it).
When a different model is the better fit for you
We truly want you in a setup that works for you, even if that setup isn't ours. You're probably a better fit somewhere else if:
- You only see a doctor once a year and feel well between visits. Traditional primary care is cheaper for you.
- You want one-time acute care without a relationship. Urgent care is faster.
- You want a doctor to bill your insurance for every visit so you pay nothing out of pocket on the visit itself. We do not do that.
- You are looking for a Medicaid-only primary care home. Our billing model is not compatible.
- You need OB / delivery, pediatric, or active oncology care as your primary. Those are different specialties.
If you fit one of those better, a short intake takes a couple of minutes and routes you to the right place.
How insurance fits with direct primary care
Worth being explicit because this surprises people every week:
- Your insurance still covers hospital, surgery, specialists, imaging, and prescriptions, exactly the way it does now.
- We do not bill your insurance for our care. The membership fee covers that.
- You can keep a high-deductible plan, a PPO, an employer plan, or marketplace coverage alongside.
- The membership is 100% HSA and FSA eligible, so pre-tax dollars pay it.
The mental model: insurance covers the expensive things you hope you never use. The membership covers the unhurried, continuous care insurance has stopped paying primary care to provide.
The next step
Twenty minutes on the phone with Dr. Ash. If we are the right fit, you will know. If a different model is the right fit, we will say so and point you to it.
Ready when you are
Dr. Ash reads every intake himself, and answers questions personally - usually within a few hours.
