The Impact of Specialty Clinics on Family Medicine and Internal Medicine Practices
Functional medicine doctor meeting with a patient at her cash pay clinic to discuss in depth hormone treatment.
Retail Clinics, Cash-Pay Specialists and the Rise of Patient-Directed Care
Direct-pay practices were never designed to replace primary care. Their intention was to remove friction — walk in, get treated, move on.
But retail access points are only part of a broader shift in how patients engage with healthcare. Alongside urgent care centers and pharmacy clinics, patients are increasingly turning to cash-pay specialty practices that offer deeper, more personalized care than traditional primary care visits can accommodate.
Functional medicine physicians, pelvic floor therapists, lifestyle-focused clinicians and other niche specialists are filling a gap many patients perceive in the system: time. These practices often provide longer appointments, comprehensive assessments and individualized care plans at a premium price point that reflects that intensity.
The question for primary care isn’t whether these models exist. It’s what they mean for continuity, coordination and long-term care.
Cash-Pay Specialists Are Expanding Access — Not Simply Shifting Volume
The data does not support a clean substitution story in which retail or specialty clinic visits neatly replace physician office visits.
In an analysis of claims data across low-acuity conditions, 58% of retail clinic visits represented new utilization, while 39% replaced physician visits and 3% replaced ED visits. Retail clinic use was associated with a modest increase in spending of $14 per person per year.
Translation: convenience can expand demand. It doesn’t just redirect it.
For primary care physicians (PCPs), this carries strategic implications. Even when specialty clinics draw away some low-acuity visits, they often increase overall touchpoints across the system. In fee-for-service environments, that creates competitive pressure. In value-based models, it introduces coordination risk.
Why Patients Are Willing to Pay More for Specific Care
Cash-pay specialty practices appeal to patients for several reasons:
Longer visit times that allow for in-depth history taking and education
Focused expertise for conditions perceived as underserved
A sense of partnership and shared decision-making
Continuity within a specific clinical niche
Pelvic floor therapy is a clear example. Patients managing postpartum recovery, chronic pelvic pain or incontinence often find that a 10–15 minute primary care visit cannot adequately address these needs. A cash-pay pelvic floor therapist offers time, specialization and hands-on treatment — elements that are difficult to replicate in traditional PCP workflows.
Patients Are Behaving More Like Consumers
Retail clinics and direct-pay practices reflect a broader consumer health shift: patients increasingly prioritize convenience, autonomy and a semblance of control.
This is evident not only in quick-access settings for minor conditions, but also in the rise of do-it-yourself health behaviors like direct-to-consumer testing, app-based coaching, lifestyle protocols and influencer-driven care plans. The common denominator is agency.
From a primary care perspective, this shifts the engagement model:
Patients may arrive with treatment decisions already made
Patients may prioritize speed over longitudinal plans
Patients may split care across multiple venues without a sole source of coordination
Primary care is no longer competing only on clinical expertise. It is competing on experience design: access, clarity, navigation and trust.
The Downstream Impact on Primary Care
While patient-funded care models can offer value, they also increase care fragmentation.
A patient may see a PCP, a retail clinic, a functional medicine provider and a specialty therapist — each addressing a piece of the puzzle. The responsibility for integration, risk management and longitudinal oversight still falls largely on primary care.
This creates new demands on family medicine and internal medicine practices:
Interpreting external test results and treatment plans
Reconciling medications and supplements
Monitoring for interactions or duplicative care
Anchoring decisions in the patient’s full medical history
Primary care may no longer be the first stop for every concern. But in general, it remains the only setting responsible for the whole story.
Primary Care’s Evolving Role: From Gatekeeper to Integrator
The rise of cash-pay specialty care does not signal the erosion of primary care’s value. Conversely, it helps clarify it.
The strategic role of primary care is shifting toward:
Contextualizing care delivered elsewhere
Coordinating across episodic and specialty services
Protecting patients from duplication and missed diagnoses
Maintaining continuity across life stages and chronic conditions
For patients with complex histories or chronic disease, this integrative role is indispensable.
What This Looks Like Operationally
To function effectively as integrator, primary care practices must evolve operationally:
Structured post-episode workflows to capture records and reconcile care
Defined navigation pathways that guide patients clearly and consistently
Team-based lifestyle support that does not rely solely on physician time
Measurement focused on closed loops, duplication reduction and outcome improvement
What This Means for Healthcare Leaders
For healthcare executives, this shift extends beyond clinical philosophy. It affects staffing models, workflows and leadership capability.
Organizations need leaders who can:
Design systems that absorb external care without sacrificing continuity
Build teams focused on coordination rather than visit volume alone
Align primary care, specialty care and consumer-driven services into a coherent experience
Establish accountability for integration rather than isolated encounters
Retail clinics and cash-pay specialists are not primary care’s competitors. They are indicators of unmet needs — and of rising expectations.
What Healthcare Organizations Should Watch Next
As consumer access points expand, primary care leaders should monitor three trends that will shape workforce and operating strategy:
1. Increased Demand for Integration Capacity
Someone has to stitch episodes into a coherent plan. Expect growing need for care coordinators, RN navigators, panel managers and clinical informatics support in primary care settings.
2. A Widening Gap Between Episodic Access and Longitudinal Value
Convenience-based models solve immediate access problems. But without integration, they can undermine long-term outcomes.
3. Pressure to Demonstrate Preventative Impact
Lifestyle-focused care resonates with patients, but prevention cannot remain an “extra” added to overloaded visits. Leaders must redesign workflows to support it structurally.
Leadership Implications: Why This Is a Staffing and Capability Issue
The rise of cash-pay specialists and patient-directed care is not simply changing where care happens — it is changing how healthcare organizations must operate.
Primary care practices are absorbing greater complexity without corresponding increases in time, infrastructure or leadership support. Coordination, integration and follow-through are now core functions of care delivery, yet many organizations are still staffed and structured for a model that assumes most care occurred within a single system.
This creates a capability gap, not just a coverage gap.
Fragmented care requires leaders who can design and manage systems that span settings, specialties and payment models. Without that leadership, the burden of integration falls to frontline clinicians, increasing burnout and risk while reducing the effectiveness of both primary and specialty care.
Why Interim and Specialized Leadership Are Becoming Essential
As the pace of change accelerates, many healthcare organizations are turning to interim and specialized leaders to close capability gaps quickly.
Interim executives and clinical leaders can:
Stabilize operations during periods of transition
Assess where fragmentation is creating risk or inefficiency
Design and implement integration-focused workflows
Build internal leadership capacity while longer-term strategies take shape
For primary care organizations navigating consumer-driven care, interim leadership offers flexibility without long-term commitment — especially when new roles, structures or models are still being tested.
Primary Care is Adapting — But Adaptation Requires Leadership Capacity
Retail clinics and cash-pay practices are not replacing family or internal medicine. But they are reshaping patient expectations and exposing the cost of fragmented care.
Primary care’s strategic role is becoming clearer: not the fastest place to treat a sore throat, but the most reliable place to coordinate the patient’s full healthcare narrative.
Organizations that invest in integration capability and leadership capacity will be better positioned to protect outcomes and support clinicians in increasingly complex environments.
