The 2026 Medicare pay bump meets primary care reality

PCPs have been feeling the squeeze—for years now—around Medicare reimbursement failures, inflation, and the rising cost of delivering solid care to patients. 

In response to these issues, the Centers for Medicare and Medicaid Services (CMS) issued the 2026 Medicare Physician Fee Schedule (MPFS),^[] which may represent a meaningful step in the right direction.

“The rule’s higher conversion factors and more appropriate valuation of primary care’s real costs will meaningfully rebalance how Medicare compensates family physicians,” David Tully, the American Academy of Family Physicians vice president of Government Relations, explained.^[]

But while these changes may signal progress, the economic realities of being a PCP are still largely shaped by your practice model—ie, whether you’re employed, independent, or in direct primary care (DPC). 

How the 2026 MPFS lands across practice models

Each model presents a wholly unique experience, with sometimes wildly different risks and benefits. For this reason, the effects of the 2026 MPFS are felt unevenly, and are actively being debated in online physician communities and forums.^[] Because each model differs so greatly,^[] the risk-to-reward ratio should be carefully considered, especially with CMS changes that could affect provider income over time.

• Direct Primary Care (DPC): The DPC model offers providers a high degree of autonomy. You get more control over appointment times and scheduling, with fewer administrative hoops to jump through. For many providers, this means more meaningful time with your patients. However, the DPC model also carries considerable risk—especially early on—given the fact that it is membership-based and that patient panels may be lower. The CMS changes won’t directly financially impact DPC providers. 

• Independent private practice: Independent practice means great risk—but also great potential reward, with its high degree of autonomy and its operational demands. You’ll have to oversee everything from staffing to revenue management, and your income can greatly fluctuate, depending on patient panels and shifts in or problems with reimbursements. 

• Employed physician: Employed physicians enjoy the most income stability and workplace protection. You’ll also be more insulated against reimbursement issues. However, you’ll have the least autonomy over scheduling, workflow, and productivity demands. 

What your peers are saying

“I've spent years navigating the financial realities of traditional primary care, private practice, and the DPC model from both the clinical and business sides,” says Monica McKitterick, a family nurse practitioner and owner and CEO of Impact Family Wellness. 

“Every model carries risk, but the risks are different. Employed clinicians trade autonomy for a predictable paycheck. Insurance-based private practice owners face significant overhead, reimbursement uncertainty, prior authorizations, staffing challenges, and payer dependence,” she says. 

The highest salary may not be the best deal

Her best piece of advice for younger PCPs? Study the business side of medicine early on in your career. “Whether you choose employment, private practice, or DPC, understanding revenue, overhead, contracts, and practice operations will give you more career options and greater long-term satisfaction,” she stresses.

Ultimately, McKitterick landed on the DPC model herself, running a multi-location direct primary care practice in Texas. “DPC owners assume more business risk upfront, as it takes time to build a panel of patients, but they also gain greater control over revenue, scheduling, pricing, patient relationships, and the overall patient experience,” she says. 

Not dealing with billing codes, she says, has made the most sense for her. “That creates alignment between what is best for the patient and what is best for the practice,” she says. “While it requires entrepreneurial thinking and a tolerance for uncertainty, it also offers a level of professional autonomy that is increasingly difficult to find in traditional healthcare settings.”