Matthew Simone had been burned out more than once. After years in clinical leadership within the urgent care startup space in Philadelphia, he had acquired the skills and the confidence to build something of his own, but he knew it would not be another urgent care. The volume, the metrics, the feeling that patient care was slipping further down the priority list with each passing year; none of it was something he wanted to carry into the next chapter. In conversation with Mehul Agarwal, Founder of HealthCompiler, Matthew described how Direct Primary Care gave him back the parts of medicine he had lost, and what it takes to build a practice from scratch.
Why Not Urgent Care
The decision to leave urgent care was not about one moment. It was cumulative. Matthew had spent years in a space that was becoming more profit-driven, more focused on throughput, and less interested in the quality of the interaction between provider and patient.
"I didn't want to be in a space that was clearly profit-driven and that seemed to care less and less about patients every day and more about volume and metrics," he says.
Direct primary care offered something different. It married the clinical work he had once loved with the kind of life he wanted outside of medicine. He has a young family, is active in his community, and values his time. DPC gave him the balance to be present for all of it without sacrificing the quality of care he wanted to provide.
"It got me excited about patient care again," he says. "Being able to spend time with patients and really build relationships after feeling so rushed and metric-driven for so long was really appealing."
There was another draw: nobody was doing it in his area. Matthew is based near Ithaca in upstate New York, a relatively rural part of the state anchored by a college town. The opportunity to bring something entirely new to his community was part of what made the leap feel right.
Building the Plane on the Way Up
Matthew did not have significant capital to start. He launched HomeSteady Health Direct Primary Care out of his home, then moved into a small office where he has been for some time. He is now approaching the point where a bigger space makes sense. Every step has been funded by what the practice itself generated.
"I felt I had enough confidence in myself and having worked in other startups and having some good mentors," he says. "It was really just a matter of let's go do it and then be reflexive to my community's needs along the way."
He started with core DPC services and added offerings as the practice grew. Hormone therapy and men's health, particularly testosterone replacement, became a significant part of the practice over time. He is passionate about that work and sees it as life-changing for the patients it reaches. Rather than trying to launch with everything from day one, he let the community's needs shape what came next.
A Model Built on Flexibility
Matthew's practice does not operate on a single price point. Beyond standard DPC memberships, he offers concierge-level home visit services for patients who want comprehensive care delivered to them directly. That mix gives the practice financial flexibility: higher-tier members help sustain the growth of the broader DPC panel.
"One member does not equal one member in my particular model," he says.
His goal is to reach around 400 patients. He could manage more, but the number depends on the mix of services and the complexity of the patients he is caring for. Many of the people who find their way to his practice are medically complex, patients who feel underserved by the traditional system and have a lot going on. Adding employer groups, with their more diverse population mix, would help balance that panel and support the long-term sustainability of the practice.
He recently signed his first employer account, a small local business with a handful of employees. It is modest, but it is a start, and he sees the employer side as where the next phase of meaningful growth can come from.
Advice for Those Considering DPC
Matthew does not overthink the advice.
"Just jump in," he says. "There's a tremendous amount of resources out there."
He points to the DPC Alliance, online communities, and a broader ecosystem of providers and organizations that are willing to help newcomers find their footing.
For those worried about capital, he offers perspective. An urgent care startup would have cost him three-quarters of a million dollars or more just to get a building ready. DPC does not require that kind of runway. There are many ways to start with low overhead and grow from there.
"Direct primary care gives you the chance to practice medicine the way you always thought you would," he says, "and to actually be the provider you wanted to be when you first got into healthcare."
Matthew started with no capital, no employer contracts, and a community that had never heard of DPC. Today, his practice is growing, his services are expanding, and he is taking care of patients the way he always wanted to. The model gave him back the things the system had taken: the time and freedom to simply be a good clinician.
"I love practicing medicine again," he says. That is the whole point.