18 Years in the Insurance System, Then She Built Something Better: Dr. Samantha Mekrut on DPC and Women’s Midlife Health, EP 250
What does it actually take to build a healthcare practice that serves patients well, keeps overhead low, and doesn’t burn you out in the process? In this episode of The Thriving Practice Podcast, Tracy Cherpeski sits down with Dr. Samantha Mekrut — a family physician with more than 18 years in insurance-based healthcare who left the system to found Meristem Family Medicine, a direct primary care practice in Medfield, Massachusetts. For anyone who’s wondered what running an independent practice on your own terms really looks like, this conversation delivers.
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Dr. Mekrut’s approach centers on something the conventional model rarely allows for: time. As a direct primary care provider, she works on a flat monthly membership model — no surprise billing, no insurance middlemen, no ten-minute appointments. Her patients get 30- to 60-minute visits, same-day messaging access, and a physician who actually knows their story. It’s a model gaining serious attention among practice owners who are exhausted by the administrative weight the insurance system demands.
Beyond the business model, Dr. Mekrut has built a specialty that’s both timely and deeply needed: menopause care for women in midlife. With decades of research being revisited and a whole generation of women in their 40s and 50s looking for providers who take their symptoms seriously, she’s filling a gap that the conventional system has largely leftopen.
Key Takeaways
Direct primary care and concierge medicine are not the same. Direct primary care and concierge medicine are not the same. DPC includes all visit services in the monthly membership fee with no additional charges or insurance billing — making it far more affordable than most patients expect.
Eliminating insurance billing overhead is what makes affordable DPC possible. Eliminating insurance billing overhead is what makes affordable DPC possible. The average physician requires 1.7 administrative billers to manage insurance reimbursements — a cost that DPC removes entirely.
Autonomy is the real draw for providers. Autonomy is the real draw for providers. Without insurance companies dictating how care is delivered, Dr. Mekrut can offer services — like annual nutrition analyses — that genuinely benefit patients but wouldn’t be reimbursed in a conventional model.
Women in midlife have been underserved by the conventional medical system, often for decades. Women in midlife have been underserved by the conventional medical system, often for decades. Perimenopause and menopause are not disease states — Dr. Mekrut argues they belong in primary care and prevention, not specialist-only territory.
Community presence is authentic marketing. Community presence is authentic marketing. Library talks, midlife book clubs, and patient education with no strings attached build the kind of trust that no ad spend can replicate.
Q&A
What’s the real difference between direct primary care and concierge medicine?
Both use a membership model, but direct primary care includes all visit services in the monthly fee with no additional charges and no insurance billing. Concierge practices typically still bill insurance and charge copays on top of the membership fee. That distinction is what allows DPC to be accessible at a price point that surprises most people who assume it’s only for wealthy patients.
Can a direct primary care practice actually be financially sustainable?
Yes — and the key is overhead. Dr. Mekrut points out that the average physician requires 1.7 administrative billers just to manage insurance reimbursements. DPC removes that cost entirely. Combined with a streamlined EHR system and a direct scheduling link (no receptionist needed), the model can be lean enough to offer genuinely affordable monthly fees while still building a viable practice.
How does direct primary care handle lab work?
Services performed on-site — strep tests, urinalysis, and the like — are typically covered within the membership fee. For external labs, patients can use their existing insurance or take advantage of a cash pricing arrangement, which Dr. Mekrut describes as significantly less expensive than paying through insurance for those without coverage. It’s one more way the model reduces the financial guesswork patients dread.
Why should menopause care live in primary care rather than with specialists?
Because menopause isn’t an illness — it’s a natural transition that affects half the population, and it belongs in the prevention realm of primary care. Dr. Mekrut makes the case that having a primary care physician who can address menopause alongside general health concerns gives women more integrated, continuous care. She also points to two decades of under-prescribing hormone therapy based on a misreading of the Women’s Health Initiative study — and why a closer look at the data tells a very different story about safety and benefit.
Episode Highlights
The meaning behind “Meristem” — and why a biology background shaped how Dr. Mekrut thinks about growth and healing
How direct primary care differs from concierge medicine, and why the distinction matters for both patients and providers
What a typical Tuesday looks like: two to four patients, unhurried appointments, and no insurance billing in sight
The 1.7 billers statistic — and how DPC eliminates that overhead entirely
Why Dr. Mekrut says she doesn’t need an insurance company telling her how to practice medicine after 18 years of experience
How the Women’s Health Initiative study shaped two decades of under-prescribing hormone therapy — and what newer data actually shows
Dr. Mekrut’s work in Nicaragua training community health workers, and how that experience shaped her view of community-based care
How library talks and midlife book clubs build genuine patient trust — without selling anything
What comes next for Meristem: hiring intentionally and growing a team without losing the culture she’s built
Memorable Quotes
“It just takes the guesswork out of coming in to see your doctor. If you’re sick, you just come in — you don’t have to worry.” — Dr. Samantha Mekrut
“I really don’t need an insurance company to tell me how to practice medicine.” — Dr. Samantha Mekrut
“Menopause is not an illness. We really want to keep it in that prevention realm of primary care.” — Dr. Samantha Mekrut
“If someone doesn’t know about my practice, they can’t benefit from it.” — Dr. Samantha Mekrut
“Decoupling primary care from insurance — that’s my way of voting with my feet.” — Dr. Samantha Mekrut
Dr. Samantha Mekrut built her practice around a simple but powerful idea: that good medicine shouldn’t require financial guesswork, rushed appointments, or a system that prioritizes billing over patients. For practice owners wrestling with burnout, overhead, or the tension between doing right by patients and running a sustainable business, this episode is a reminder that a different model is not only possible — it’s already working. Learn more about Meristem Family Medicine at [url— please verify], find menopause provider directories through The Menopause Society at menopause.org, and explore thrivingpracticecommunity.com for resources to help you build a practice that truly thrives.
Guest Bio:
Dr. Sam Mekrut is a board-certified family physician, Menopause Society Certified Practitioner (MSCP), and the founder of Meristem Family Medicine, a direct primary care practice in Massachusetts. She has spent nearly two decades in community and women’s health, including leadership roles as Medical Director at the Edward M. Kennedy Community Health Center in Framingham and previously with Optum Student Health Services. Her work has centered on expanding equitable access to care, developing high-functioning clinical teams; and advancing maternal–child health, obstetrics, and gynecologic care, alongside teaching and mentoring medical students, residents, and advanced practice providers.
Today, Dr. Mekrut focuses on innovative, relationship-based care through the DPC model, with a particular emphasis on evidence-based primary care, menopause care, and midlife women’s health. She is passionate about empowering patients, supporting a healthier and more sustainable healthcare ecosystem, and promoting more joy and fulfillment in clinical practice
Find Dr. Mekrut:
Website: MeristemFamilyMedicine.com
Instagram: @meristemdpc
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