Direct Primary Care Break-Even: 643 Members At $75K Monthly Revenue

Fixed costs $14.0K/mo Base overhead

Contribution margin 86.5% After variable costs

Break-even revenue $16.2K/mo Revenue target

Break-even timing Month 7 Model break-even

Break-even calculator

Test monthly revenue, variable expenses, and fixed costs against the break-even point for a membership-based medical practice.

Lean Base Full

Monthly revenue Revenue sets the margin available to cover fixed costs. $ Lower sales Higher sales Variable expenses These rise with revenue, like supplies and telehealth or EHR fees. $ Lower costs Higher costs

Money available to cover fixed costs $174,271 $199,167 revenue - $24,896 variable expenses

Margin ratio

87%

Covers fixed costs

Yes

Fixed monthly costs This is the monthly cost base contribution margin must cover. $ Lower overhead Higher overhead

Break-even chart Revenue Total costs

Which expenses are fixed and which move with member revenue?

Cost classification

Break-even is only reliable when rent, insurance, salaries, supplies, platform fees, and marketing are treated by how they actually behave. Misclassifying fixed overhead as member-level spend can make Month 7 break-even look safer than it is.

Expense	Cost	Break-Even Treatment	Common Mistake
Clinic Facility Rent	Fixed	Use $8,500 per month across the monthly planning range.	Spreading rent per member and hiding the real overhead floor.
Medical Malpractice Insurance	Fixed	Use $2,500 per month before member revenue covers variable spend.	Tying malpractice insurance to visit count instead of coverage period.
Primary Care Physician	Semi-fixed	Model salary in FTE steps: 1.0 FTE in the first year, rising to 3.0 FTE by Year 5.	Treating physician labor as fully variable by appointment.
Registered Nurse	Semi-fixed	Model salary in staffing blocks: 1.0 FTE in the first year, rising to 3.0 FTE by Year 5.	Adding nurse expense per patient instead of by staffing capacity.
Billing and Administrative Specialist	Semi-fixed	Start at Month 13, then scale from 1.0 FTE to 2.0 FTE by Year 5.	Including this role in launch-month break-even before it starts.
Medical Supplies and Diagnostic Materials	Variable	Apply 8.0% of first-year revenue, stepping down to 6.0% by Year 5.	Burying clinical supplies inside office overhead.
Telehealth Platform and EHR System Fees	Variable	Apply 5.5% of first-year revenue, stepping down to 3.5% by Year 5.	Treating usage-linked platform fees as a flat software bill.
Annual Marketing Budget	Semi-fixed	Use $120,000 in the first year, then scale annual spend as the member base grows.	Counting all marketing as $85 CAC and double-counting acquisition spend.

How does break-even change across lean, base, and full direct primary care launches?

Scenario table

Break-even moves mostly with fixed cost load. Cut rent and support hires, and the revenue floor drops fast; add staff and scale the panel, and the practice needs a lot more monthly revenue to stay above water.

Planning figures only: these scenario results come from the model assumptions and are not guarantees.

Scenario	Monthly Revenue	Variable Costs	Fixed Costs	CM Ratio	Operating Profit	Break-Even Signal
Lean launch, lower fixed load	$82.3k	$11.1k	$44.4k	86.5%	$26.7k	Lower fixed commitments pull break-even down to about $51.3k a month, so Year 1 sales leave room.
Year 1 base launch case	$82.3k	$11.1k	$64.8k	86.5%	$6.3k	Year 1 revenue clears break-even by only about $7.3k a month, so the cushion is thin.
Year 3 scale case	$324.0k	$37.3k	$107.8k	88.5%	$179.0k	Scale lifts the panel enough to keep revenue well above the roughly $121.8k break-even floor.

What breaks the break-even plan for this direct primary care practice?

Stress test

At the base plan, $82,250 in monthly revenue sits about $7,299 above break-even, so the cushion is real but not wide. Slower member growth, higher rent or staffing, and a 1-point margin slip can erase it fast.

Stress Case	Changed Assumption	Break-Even Revenue	Revenue Gap	Risk Signal
Current plan	No change.	$74,951	$7,299 cushion	Small cushion, so volume still matters.
Revenue shortfall	Monthly revenue falls by $10,000 to $72,250.	$74,951	$2,701 gap	A modest sales miss pushes the plan below break-even.
Fixed-cost pressure	Monthly overhead rises by $10,000.	$86,512	$4,262 gap	Rent or staffing inflation wipes out most of the cushion.
Margin pressure	Contribution margin falls 1 point to 85.5%.	$75,861	$6,389 cushion	Each 1-point margin loss costs about $823 a month.
Combined pressure	Revenue is $10,000 lower and overhead is $10,000 higher.	$86,512	$14,262 gap	A small cushion turns into a clear monthly loss.

What should the founder verify before signing the lease and hiring ahead of demand?

Founder checklist

Don’t lock in the lease or add headcount until the model clears break-even on rent, salaries, and member mix. For this practice, that means 643 memberships, $116.50 blended Year 1 dues, and enough cash to survive the Month 6 trough.

1Fixed Load$14.0K/mo

Verify rent, utilities, malpractice, office, compliance, and liability stay near the $14,000 monthly fixed load, with $8,500 of that in rent, because fixed costs hit break-even before member margin does.

2Staffing Burn$490K/yr

Verify the Year 1 team really fits the $490,000 salary load for the physician, registered nurse, medical assistant, practice manager, and marketing manager, because hiring too early can wipe out early EBITDA.

3Panel Capacity643 members

Verify the clinic can hold at least 643 active memberships before adding more sign-ups, because that is the model’s break-even panel size.

4Blended Dues$116.50

Verify the 45% individual, 30% family, and 25% small business mix really produces $116.50 in blended Year 1 dues, because a cheaper mix pushes the break-even count higher.

5Acquisition Flow$120K / $85 CAC

Verify the Year 1 marketing budget and customer acquisition cost (CAC) can convert individual, family, and small business leads fast enough, because demand has to arrive cheaply to support payback.

6Launch Cash$552K / $250K

Verify you can fund the $250,000 launch capex and still keep $552,000 cash through Month 6, with electronic health record, telehealth, patient portal, compliance, and referral setup live before opening, because break-even lands in Month 7.