Direct primary care (DPC) is a flat membership fee paid straight to your doctor, covering all of your primary care with no copays and no insurance billing for visits. At Fishtown Medicine in Philadelphia, membership is $250 a month, 100% HSA and FSA eligible, and includes 60-90 minute visits, same-day text and video access to Dr. Ash, and home visits across greater Philadelphia.
If you have been searching for direct primary care in Philadelphia, you have probably already lived the reason people look. The 12-minute visit where the doctor typed the whole time. The portal message that came back 3 days later from someone you have never met. The 5 phone calls it took to refill one prescription. Somewhere along the way you heard there is a model where you pay your doctor directly, text them when something comes up, and get visits long enough to think in, and you wanted to know whether it is only for executives.
It is not. It was built for working people, and it lives here in Philly. This page covers what DPC is, what it costs, how fast you can be seen, how insurance fits, and how the model works at Fishtown Medicine.
What is direct primary care (DPC)?
Direct primary care is a membership model for primary care. Instead of your doctor billing insurance for each visit, you pay the practice a flat monthly fee, and that fee covers your primary care itself: visits, messaging, sick care, prevention, and chronic condition management, with no copays and no per-visit bills.
Removing insurance billing from the visit changes the medicine more than it changes the payment. A typical insurance-based practice carries 2,000 or more patients per doctor and slices the day into 15-minute slots to keep up. A DPC doctor carries a fraction of that panel, which is what makes 60-90 minute visits, same-day answers, and a doctor who knows your history possible.
Pennsylvania recognizes the model, and DPC practices have been growing across Philadelphia, from Fishtown and Northern Liberties to Center City and the Main Line, for the same reason everywhere: people want a doctor with time.
What does direct primary care cost in Philadelphia?
Across the city, DPC memberships generally run $50 to $300 a month depending on the practice, the doctor's panel size, and what the fee includes.
At Fishtown Medicine, membership is $250 a month, with $685 quarterly and $2,500 annual options that lower the effective rate. We also have a Colleague rate for healthcare workers and a Plus-One rate for a member's partner; current numbers for all of them live on the membership pricing page.
The fee covers the care itself, so it is one number rather than a stack of surprises:
- A 90-minute first visit that goes through your history, your records, and your goals in one sitting
- Unlimited visits after that, most of them 30-60 minutes
- Direct text access to Dr. Ash, with same-day answers for anything urgent
- Same-day or next-day sick care by message, video, or a home visit when an exam is needed
- Advanced prevention: ApoB and advanced lipid testing, metabolic and hormone panels, read together by one physician
- Care coordination, referrals, and prior authorizations handled for you
Labs run through your insurance or at wholesale rates we pass through at cost, often well below retail. If you would rather start with a defined project than a membership, we also offer annual care packages built around a deep review of your records and labs.
How fast can you be seen?
Same-day access is the everyday experience of DPC. At Fishtown Medicine, most acute issues, a UTI, a sinus infection, a rash, a blood pressure reading that scared you, get sorted the same day by text or video, and prescriptions reach your pharmacy within hours. When something needs hands-on care, Dr. Ash schedules a home visit instead of routing you to urgent care.
That speed comes from the panel math. Dr. Ash caps his panel at 200 patients, so there is room in every day for the people who need it. The same-day primary care page walks through what this looks like in practice.
How do insurance, HSA, and FSA fit with DPC?
The membership is 100% HSA and FSA eligible, so pre-tax dollars can pay for it. That is usually the first question, and the answer is a plain yes; our HSA and DPC guide covers the details.
You keep your insurance, and you keep using it for what it is good at: labs, imaging, prescriptions, specialist visits, and hospital care all still run through your plan. The membership replaces insurance only for your primary care, which is the part insurance handles worst. DPC pairs well with a high-deductible plan, since most people with one pay out of pocket for primary care visits anyway.
What DPC does not replace is coverage for big events. You still want insurance for surgeries, emergencies, and specialty care, and we say that plainly to everyone who joins.
Who is direct primary care for?
DPC fits you well if:
Fishtown Medicine
A 90-minute conversation with Dr. Ash. A written plan you can actually follow.
- You want a doctor who knows you, answers you directly, and has time to connect the dots
- You have a high-deductible plan and rarely meet the deductible
- You care about prevention and want deeper testing than an annual physical
- You are managing something chronic, blood pressure, thyroid, prediabetes, and you are tired of 12-minute check-ins
- You want care that happens around your schedule: text, video, and home visits rather than waiting rooms
It is a weaker fit if you need intensive specialist-level management for complex unstable disease, or if you are on Medicare or Medicaid, which most DPC practices cannot bill; our Medicare and Medicaid guides point to Philadelphia primary care built for those programs.
How is DPC different from concierge medicine?
The two get lumped together, and the difference matters to your wallet:
| Direct primary care | Traditional concierge | |
|---|---|---|
| The fee | $50-$300 a month, flat | $2,000-$10,000+ a year |
| Insurance billing | None; the fee covers your primary care | The practice still bills insurance per visit, plus copays and deductibles |
| What you are buying | The care itself | Access on top of care that is billed separately |
In DPC you pay one price and the care is included. In concierge medicine the fee buys you a shorter line, and every visit is still billed to insurance. Our concierge vs DPC comparison goes deeper, and the concierge medicine cost guide puts numbers on every tier in the Philadelphia market.
How does Fishtown Medicine practice direct primary care?
Fishtown Medicine is a physician-led DPC practice built around one idea: your doctor should be the easiest person in your life to reach. Dr. Ash is a board-certified internal medicine physician, the panel is capped at 200 patients, and members rate the practice 4.96 stars across 124+ verified reviews.
A few things are different here even among DPC practices:
- Care comes to you. The practice is mobile-first: secure messaging, video visits, and home visits across greater Philadelphia. Most care happens by text and video because that is faster for you, and when you need to be seen, Dr. Ash comes to your door.
- Your message reaches your doctor. Texts go to Dr. Ash, and urgent issues get same-day answers.
- Prevention runs deeper than a physical. Fasting insulin, ApoB, full thyroid panels, and inflammatory markers are read together by one physician who knows your whole story, so early signals get caught while they are still easy to act on.
- Sick care is fully covered. Prevention is where the biggest gains live, but when you are sick today, you are seen today.
You can get to know Dr. Ash first, or read how care works for your neighborhood on the areas we serve page.
What should you ask any DPC practice before joining?
Whether you talk to us or anyone else in the city, these questions separate the practices that deliver from the ones that only market well:
- How many patients does each doctor carry? Under 500 is the honest ceiling for the access DPC promises; ours is capped at 200.
- When I message, who answers? "The doctor, same day" and "the front desk, within 2 business days" are different products at the same price.
- What does the fee include, in writing? Visits, messaging, and sick care should all be inside the fee, with a clear list of what costs extra.
- What happens when I need a specialist? The answer you want involves a warm referral, a summary sent ahead of you, and a debrief after the visit. If the answer is a list of names, keep interviewing.
- Can I cancel? A practice confident in its care does not need a 12-month lock-in.
Key Takeaways
- Direct primary care is a flat membership fee that covers your primary care directly, with no copays and no insurance billing for visits.
- In Philadelphia, DPC runs $50 to $300 a month; Fishtown Medicine's membership is $250 a month and 100% HSA and FSA eligible.
- You keep insurance for labs, imaging, specialists, and hospital care; the membership replaces it only where it serves you worst.
- Same-day access, 60-90 minute visits, and home visits across greater Philadelphia are the everyday experience at Fishtown Medicine, not upgrades.
- Before joining any DPC practice, ask about panel size, who answers your messages, and what the fee includes in writing.
Scientific References
- Eskew PM, Klink K. Direct Primary Care: Practice Distribution and Cost Across the Nation. J Am Board Fam Med. 2015.
- Klemes A, et al. Personalized preventive care reduces hospitalization rates in a Medicare population. Am J Manag Care. 2012.
- Doherty R. Assessing the Patient Care Implications of "Concierge" and Other Direct Patient Contracting Practices. Ann Intern Med. 2015.
Related at Fishtown Medicine
- Primary Care Physician in Philadelphia - what primary care looks like when the doctor has time for you
- Concierge Medicine Cost - the numbers on concierge medicine in Philadelphia
- Concierge vs DPC - how the two membership models compare on cost and access
- Same-Day Primary Care - a doctor today rather than in 3 weeks
- Doctor Without Insurance - how care works if you are uninsured or between plans
- Virtual Primary Care Across Pennsylvania - how membership works if you live an hour or more from Philadelphia
- Membership Pricing - current rates, including Colleague and Plus-One
- How Long Is the Average Doctor's Visit? - the 18-minute data behind why the standard visit feels rushed
Frequently Asked Questions
Common Questions
Deep-Dive Questions
Ready when you are
Dr. Ash reads every intake himself, and answers questions personally - usually within a few hours.
