Adam Wheeler, MD is a pediatrician and founder of Big Tree Medical based in Columbia, Missouri. Bibb Beale is Founder and CEO of Frontier Direct Care, which has five locations in Texas. Adam Wheeler, MD and Bibb Beale speak from a medical and business perspective on how leveraging “mid-levels,” which include Physician Assistants and Nurse Practitioners, can scale DPCs and address the shortage of physicians in the U.S. 


The Association of American Medical Colleges (AAMC) predicts that by 2034 there will be a shortage of 48,000 primary care physicians and 77,100 non-primary care physicians. Currently, the U.S. has 500,000 primary care physicians. Dr. Wheeler brings up the fact that most direct primary care physicians serve a smaller patient panel than fee-for-service, roughly about half. Therefore, if 10% of all primary care physicians transition to direct care there would be 50,000 primary care physicians serving half of the patients that they used to, which would exacerbate the problem of the lack of physicians in the country. However, if these physicians structure their practice around mid-level clinicians providing a majority of the primary care then a shortage suddenly becomes a surplus.


Dr. Adam Wheeler leverages mid-level clinicians at his practice, Big Tree Medical, which makes it possible to care for over 5,000 patients. With 5 physician assistants, each provider including Dr. Wheeler has 800-1,200 patients and sees 15 patients per day with each patient averaging 4.5 visits per year. Dr. Wheeler has 6 registered nurses who in addition to care, handle communications, prescription refills, scheduling and other administrative tasks. Additionally, Big Tree Medical employs pharmacists, dieticians and counselors. 


The model that Dr. Wheeler and his team has works, offering nearly 6,000 patients with unlimited primary care, free or nominal cost medications, and access to care around the clock. With a 20% net margin on each provider’s full panel and a 20%-40% reduction in the total cost of care for self-funded health plans, it’s a win-win for providers and patients. Big Tree Medical has a net promoter score of 89, serving patients, who almost all (99%) come from Health Professional Shortage Areas (HPSAs) and about a third of patients (30%), who are uninsured.


Bibb Beale with Frontier Direct Care shares their fundamental strategy for growth, which is:

#1 Do hard things

#2 Experiences over comfort

Bibb highlights that “the DPC Trends Report showed that there is a substantial amount of demand coming from members [who] want to experience healthcare in this way.” Frontier Direct Care saw 600% year over year growth and grew to 3,000 patients in 5 locations over the past year and has plans to scale to 20,000 patients in 12 locations over the next year. In order to meet this increased demand, the corporate team behind Frontier Direct Care relieves the pressure of growth from clinicians by having an engine that operates behind the scenes following their DPC playbook.


There is no doubt that the direct primary care model works and Bibb illustrates an example of a patient who saw the same doctor but under different circumstances and as a result, better health outcomes. Dr. Suja Perakathu is a doctor at Frontier Direct Care who previously worked in fee-for-service for over 10 years. Dr. Perakathu had a patient named Emily who had diabetes stuck at an A1C level of 11 for years and when she began getting seen by Dr. Perakathu at Frontier Direct Care, Emily’s A1C level dropped to 8.3 within 3 months! 


Bibb and his team structure their direct primary care practice for sustainable growth around these 3 tenets:

  1. Know Your Goals
  2. Know Yourself
  3. Build a Team

Watch the video to learn more about how to develop and scale your direct primary care practice for success.