What Is Pediatric Direct Primary Care?
Pediatric direct primary care is a membership practice where a pediatrician cares for children for a recurring fee paid by the family, instead of billing insurance for each primary care visit. A practice built this way generally delivers well-child visits, sick visits, and direct access by text or phone, while the family keeps insurance for hospital, emergency and specialist care. The evidence base is small, and the best peer-reviewed picture of how these practices run comes from one national survey of 73 pediatricians, collected in July 2023 and published in May 2025.
This guide is for physicians and owners deciding how to serve children. It is about running the practice and is not clinical advice, and every schedule below links to the body that sets it, as current on the day we checked, November 5, 2026. If you are earlier in the decision, start with the 2027 guide to starting a DPC practice and leaving employed medicine for DPC.
What Do We Actually Know About Pediatric DPC Practices?
The national survey by Belt and colleagues went to about 130 physicians and kept 73 who ran operating practices with panels at least 75% pediatric, in 26 states. The paper dates it to July 2023, though one of its authors has since called it 2024 survey data. It is self-reported and was spread through DPC communities, two of its authors co-own a pediatric DPC network, and the authors estimate slightly over 100 pediatric DPC practices existed at the time, while saying the true number isn't known. A 2025 follow-up survey by the same group, presented in April 2026, estimates about 140 practices. It isn't peer reviewed, and its authors run pediatric DPC practices.
| What the survey asked | What 73 pediatricians reported in 2023 |
|---|---|
| Doctors in the practice | 85% had one doctor, 12% two, 3% three |
| Other staff | 47% had none, and 53% had at least one staff member |
| Age of the practice | 40% open under a year, 14% open four years or more |
| Current patients per physician | 45% under 100, 34% from 100 to 200, 15% from 200 to 300, 5% over 300 |
| Where care happens | 82% office and home, 10% home only, 8% office only |
| Medicaid | 70% reported caring for Medicaid-insured children |
The Medicaid row comes with a limit. The authors say it suggests some access for families with lower incomes, and also that they didn't fully analyze patients' finances, so it doesn't show how those children are served or paid for. If you are considering it, start with 42 CFR 447.15, which limits Medicaid participation to providers who accept the Medicaid payment plus any allowed cost sharing as payment in full, and talk to a health care attorney before you enroll a child with Medicaid coverage.
How is pediatric DPC different from family medicine DPC?
The survey's authors argue the difference deserves its own name, Direct Pediatric Care. Their comparison table, a summary and not a separate measurement, puts adult-focused DPC at 18% of patients under 18 and a panel of 300 to 600, against 100% and a panel of 100 to 300 for pediatric practices, with home visits a maybe for one and a yes for the other.
Their child price comparison runs from $100 to $175 a month in pediatric practices and from $20 to $75 in adult-focused ones.
The median first child's price at about 570 practices of all kinds in the DPC Finder's records is about $49 a month, using the method and dates in our guide to family and child pricing. Pricing a child is a different problem in a pediatric-only practice, where children are the entire business.
How Do Well-Child Visits Work on the Bright Futures Schedule?
The Bright Futures/AAP periodicity schedule is AAP's map of preventive visits, and the version posted when we checked is the one updated in February 2025. It lists a newborn visit, then visits at 3 to 5 days, by 1 month, and at 2, 4, 6, 9, 12, 15, 18, 24 and 30 months, then one a year from age 3 through 21. By our count that is 12 visits through 30 months and 31 in all, plus a prenatal visit recommended for first-time parents, parents at high risk and those who request one.
The schedule says it does not "serve as a standard of medical care", that variations may be appropriate, and that it is updated annually, so check the file each year before you change your visit templates.
Three details in its footnotes affect how you run the practice:
- A new member can join at any age. The first footnote says a child coming under care partway through should be brought up to date at the earliest possible time.
- The early visits come fast. The evaluation at 3 to 5 days is meant to fall within 48 to 72 hours of hospital discharge and to include feeding and jaundice, and a newborn discharged less than 48 hours after delivery must be examined within 48 hours of discharge, so a solo practice needs a way to open a slot on short notice.
- Immunization appears at every visit from the newborn visit on. The footnote calls every visit a chance to update a child's immunizations, so your vaccine plan and visit templates have to be built together.
Which screenings can a small practice do in-house?
This table pairs a few schedule items, from the file linked above, with what practices said they included. The survey's items don't always match the schedule's wording exactly.
| Schedule item | When the schedule lists it | What the 2023 survey reported |
|---|---|---|
| Hearing | Newborn with results verified soon after, then at 4, 5, 6, 8 and 10 years, then audiometry once each at 11 to 14, 15 to 17 and 18 to 21 years, with risk assessment at other ages from 4 months through 9 years | Hearing screening included by 73%, not offered by 27% |
| Vision | Screening at 3, 4, 5, 6, 8, 10, 12 and 15 years, with acuity at 4 and 5 years and in cooperative 3-year-olds, instrument-based screening optional at 12 and 24 months and 3 to 5 years, and risk assessment at other ages | Electronic vision screening included by 30%, not offered by 70% |
| Lead | Risk assessment or screening by age, tied to universal requirements for Medicaid patients or high prevalence areas | Included by 23%, extra charge at 12%, not offered by 64% |
| Newborn bilirubin | Confirm the initial screen, verify results and follow up | Transcutaneous bilirubin included by 10%, extra charge at 7%, not offered by 84% |
| Developmental and autism screening | Developmental at 9, 18 and 30 months, autism at 18 and 24 months | Not asked as screening; 27% offered autism spectrum disorder testing |
The survey doesn't say what practices do for items they don't offer, so it can't tell you whether a child gets the test elsewhere. For each item you won't do in-house, decide where it goes, who orders it and who checks that the result came back, much like a referral tracking routine.
Practices also reported offering a fourth trimester package (33%), one-time consults (55%) and behavioral health only plans (30%), and our guide to mental health care in DPC goes further on that last one.
How Do Pediatric DPC Practices Handle Vaccines and VFC?
Our guide to offering vaccines in a DPC covers buying, storage and billing in detail. At a high level, the survey shows practices using several sources, since respondents could pick more than one. A third-party vaccine vendor was the most common answer at 64%, followed by the Vaccines for Children program at 25%, buying from a local pharmacy and giving the dose themselves at 23%, and the health department and buying vaccines at the practice's own cost at 11% each. Overall 96% provide vaccines in some way.
For the Vaccines for Children program, the CDC says any provider authorized by state law to give vaccines can enroll, and that you don't need to be a Medicaid provider. You apply through your state, local or territorial immunization program, then have a site visit and complete annual training. You must also stock all ACIP-recommended vaccines for VFC-eligible patients, apart from exempt ones such as COVID-19, which you still need a way to make available, and CDC's guide says pediatricians aren't specialty providers.
A VFC provider cannot charge for any vaccine given to an eligible child, and may charge an administration fee up to the regional cap, and an office visit fee if other services were provided, but a per-vaccine fee must be removed if the parent cannot afford it, and a child can't be turned away for that reason. For a child enrolled in Medicaid, CDC's Operations Guide says the administration fee is billed to Medicaid and not to the family. We found no CDC guidance on how a monthly membership fee fits these rules, so ask your immunization program in writing before you enroll.
Eligibility covers children 18 or younger who are uninsured, Medicaid-eligible or enrolled, American Indian or Alaska Native, or underinsured. Underinsured children can get VFC vaccine only at a federally qualified health center, a rural health clinic or an approved deputized location, and children in a separate CHIP program count as insured. Track that status alongside your vaccine inventory.
Which immunization schedule should the practice follow?
The CDC approved a revised childhood schedule on January 5, 2026, and a federal court stayed it on March 16, 2026, along with the appointments of 13 ACIP members and their votes, according to the Congressional Research Service. The government appealed only the appointments, not the schedule stay, and the First Circuit heard argument on October 6. We found no ruling on that appeal as of November 5, 2026. Sources don't fully agree on which earlier version is in effect, since CRS says the schedule reverted to the version as of May 2025, Georgetown's Center for Children and Families wrote in March that the June 2024 schedule was back in effect, and CDC's schedules page shows addenda updated July 2, 2025.
The Bright Futures footnote points to the schedules from the AAP Committee on Infectious Diseases, and AAP published its own 2026 schedule. CRS also reported in June 2026 that the revised schedule came with no change to VFC's coverage resolutions, and it judged vaccine coverage unlikely to be affected in 2026, while noting there may be questions about private coverage of certain vaccines if that schedule goes into effect. Because this keeps moving, name and date the schedule you follow in your policy, and recheck CDC and AAP before you print anything for parents. Back-to-school paperwork has its own guide, school and camp immunization form requests.
How Do Pediatric DPC Practices Handle After-Hours Calls?
A small survey shows how parents use direct access. In a survey of one multi-physician pediatric DPC network, sent in April 2023 and published in June 2025, all 59 responding parents out of 155 reported texting questions to their doctor, 93% sent pictures, 88% phoned the doctor directly and 22% used video. The only volume figures we found are self-reported: a 2025 follow-up survey, written by one of the national survey's authors, says 65% of 99 respondents answer 5 or fewer evening texts a week and 86% get less than one call after 10 PM a month. More than half of those respondents (55%) had fewer than 100 patients. It isn't peer reviewed, and its authors run pediatric DPC practices. We found no published data on how fast messages are answered, so you will need to measure your own.
The harder question is what happens when the doctor is away, since 85% of the surveyed practices had one doctor. For in-person needs during a vacation, where respondents could give more than one answer, another pediatric DPC doctor was the most common at 44%, followed by telling families to use urgent care or the emergency department when clinically indicated at 32%. Among practices open over a year, 41% called their vacation time too little.
A written policy can cover:
- Who answers after hours, and how long a parent should expect to wait for a reply.
- What goes straight to 911 or the emergency room, in plain words on the page parents see first.
- How a photo or a late-night text gets into the chart.
- Who covers when you travel.
- How messages from teenagers work, since the schedule says to make every effort to preserve an adolescent's confidentiality during depression and suicide risk screening, and your state's minor-consent rules will shape the rest.
Our guides to after-hours message triage and urgent care in a membership go deeper, and it is worth asking your malpractice carrier about home visits and phone advice when you set up insurance for a new practice.
What Insurance Do Parents Still Need With Pediatric DPC?
Parents still need coverage for what a primary care practice can't provide, including hospital stays, emergency care, surgery and specialists, and our guide to what insurance to pair with DPC is a useful page to hand them.
Well-child care is where the overlap needs explaining. Under 45 CFR 147.130, non-grandfathered plans must cover ACIP-recommended immunizations and HRSA-supported preventive care for children, and HealthCare.gov lists well-baby and well-child visits among those services. The same rule doesn't require a plan with a network to pay for those services out of network, unless the plan has no in-network provider who can deliver them. So a parent may be able to get a well-child visit at no cost from an in-network pediatrician, and your membership is a choice to pay for the time and access around it. It helps to say so before they join.
Expecting parents should also know a new baby has to be added to a plan. Employer plans must allow at least 30 days after a birth to request enrollment, and HealthCare.gov gives a 60-day window on the Marketplace, with coverage that can start on the day of birth.
Since January 1, 2026, a qualifying DPC arrangement no longer blocks HSA contributions when fees stay within a monthly limit, and IRS Notice 2026-5 lists pediatric medicine as a primary care specialty and vaccines as permitted primary care services. The full rules are in our 2027 DPC and HSA guide.
For 2027, Rev. Proc. 2026-24 sets the limit at $150 a month for one person and $300 for an arrangement covering more than one person.
Pediatric prices can sit close to that line. In the survey's 2023 price bands, 22 of 73 practices were in the average monthly membership bands above $150, and the 2025 follow-up survey, which isn't peer reviewed and whose authors run pediatric DPC practices, puts 43% of respondents in the bands above that. Our family and child pricing guide walks through infant tiers, family caps and the open question of how a child-only tier is measured, one to take to a CPA.
What Does a Pediatric DPC Panel Earn, and How Long Does It Take?
The survey's panel figures rise with practice age. Practices open under a year averaged 76 patients per physician, those open one to three years averaged 139, and those open more than three years averaged 169. Family enrollment fees were the most common kind, at 60%, and our guide to enrollment fees covers how to set one.
Here is a rough gross figure from the survey's most common price bands and its mature-practice average. It ignores family caps and sibling discounts, and it is revenue only, before rent, staff, vaccines and supplies.
At $101 to $150 a month, 169 patients would bring in about $17,069 to $25,350 a month.
In the survey, 73% of physicians said they earned less than in their prior job, 15% about the same and 12% more. The authors say the share earning less is likely skewed by how many young practices responded, and they report that 65% of physicians in practices open three or more years earned the same or more. The paper prints the count as 47, but its own table shows only 23 respondents in practices open three or more years. Its Figure 4 gives the same 65%, about 15 of 23, so treat it as a small group. Run your own numbers with the break-even panel guide.
Satisfaction was high, with the limits of self-report from people who chose this path. In the same survey, 94% said they were happier than in their prior job and 89% reported less or far less moral injury, while 21% said maybe and 3% said yes to returning to fee-for-service pediatrics. They named financial uncertainty, marketing and isolation among the challenges.
Does Pediatric DPC Improve Children's Health or Save Families Money?
We can't say yet. A PubMed search on the day we wrote this returned 10 papers, and none was a controlled study of children's outcomes in pediatric DPC. The national survey's authors call for research on patient outcomes and financial accessibility.
The closest thing to a savings figure comes from the parent survey above. It priced the visits parents said they avoided using the discounted cash prices in a nearby children's hospital's chargemaster, a stand-in and not what these families paid, and the survey question gave no time period. Its authors note they didn't specify total avoided visits or children per family, and several of them co-own a pediatric DPC network. With 59 responses from one network, it is a signal worth studying and not a number we would put in marketing.
Its estimate was at least $1,171.13 a year in avoided spending per family.
With parents, you can stand behind what you control, such as how long your visits are, how you can be reached and what is included.
Running a Pediatric Practice Without Losing the Small Things
A pediatric practice runs on small handoffs. A visit is due at 15 months and nobody books it, a lab went out and hasn't come back, a birthday moves a child into a new price tier, and a parent's text about one sibling lands in another sibling's thread. In the 47% of surveyed practices with no other staff, that work falls to the doctor, and if you are ready to add help, hiring your first medical assistant is a good next read.
That work sits between the EHR, the billing system and the messaging app, which were never built to talk to each other. Tabflows is a dedicated tech team that connects those tools so follow-ups, tasks and family context end up in one place and get done. Whichever tools you use, it is worth tracking how many children are current on their well visits.
The DPC Finder lists practices across the country, and our guide to DPC for families shows how this looks from a parent's side.
FAQs
What is pediatric direct primary care?
Pediatric direct primary care is a membership practice where a pediatrician cares for children for a recurring fee paid by the family, instead of billing insurance for each primary care visit. It generally covers well-child visits, sick visits and direct access by text or phone, while the family keeps insurance for hospital, emergency and specialist care. The authors of a national survey of these practices suggest calling them Direct Pediatric Care, because they differ from adult-focused DPC in panel size, price and home visits.
How much does pediatric DPC cost?
The one peer-reviewed national survey we found collected prices in July 2023 and published them in May 2025. Prices have likely moved since, and the survey asked about the average monthly membership per patient, so a practice's infant tier can sit above its average. The range ran from $25 to $400 a month, and 42 of the 73 practices charged between $101 and $150. A 2025 follow-up survey by the same group, presented in April 2026, shows 41% of 99 respondents between $101 and $150 and 43% in the bands above that. It isn't peer reviewed, and its authors run pediatric DPC practices.
How many patients does a pediatric DPC doctor have?
Usually fewer than an adult-focused DPC doctor, going by the comparison table in a 2023 survey of 73 pediatric DPC physicians published in 2025. That table is a summary and not a measurement of adult practices. At the time, 79% had 200 patients or fewer. Practices open under a year averaged 76 patients per physician, practices open one to three years averaged 139, and practices open more than three years averaged 169. The most common panel goal was 151 to 250 patients.
How many well-child visits does the Bright Futures schedule call for?
The Bright Futures/AAP periodicity schedule, in the version updated February 2025 that AAP still posted on November 5, 2026, lists 12 visits from the newborn visit through 30 months, seven of them before the 12-month visit, and then one a year from age 3 through 21. That is 31 visits by our count, plus a prenatal visit recommended for some parents. AAP says the recommendations are updated annually, so check the current file before you build a template around it.
Can a pediatric DPC practice enroll in the Vaccines for Children program?
Yes. The CDC says any health care provider authorized by state law to give vaccines can enroll, and the provider does not need to be a Medicaid provider. Enrollment runs through the state, local or territorial immunization program and includes a site visit and annual training. VFC providers cannot charge for the vaccine itself. For a child enrolled in Medicaid, the administration fee is billed to Medicaid and not to the family. For other eligible children, a per-vaccine administration fee must be removed if the parent cannot afford it. We found no CDC guidance on how a membership fee fits those rules, so ask your immunization program before you enroll.
Do families in a pediatric DPC still need health insurance?
Yes. A membership pays for the practice's primary care, and it doesn't pay for hospital stays, emergency care, surgery or specialists. Federal rules require non-grandfathered plans to cover recommended preventive care for children without cost sharing in network, and they don't require a plan to pay an out-of-network provider when an in-network one is available, so a family's plan may not reimburse a well-child visit at a DPC practice outside its network.
Is there evidence that pediatric DPC improves children's health?
We found no controlled study comparing children's health outcomes in pediatric DPC with conventional pediatric care. What exists is survey research, with physicians reporting high satisfaction and parents at one network reporting heavy use of texting and fewer in-person visits. The authors of the national physician survey say future research should evaluate patient outcomes, financial accessibility and support for new practices.