Reimagining Primary Care Through Virtual Access and Radical Equity with Dr. Paulius Mui
Welcome to Episode 3 of the Ardexia Podcast where we speak to leaders, clinicians and advocates for better healthcare. This week, we talk to Dr. Paulius Mui, a family medicine physician who founded X Primary Care and recently launched a virtual direct primary care practice where patients pay what they can afford.
Primary care in America is broken. Physicians burn out trying to deliver continuous care in a system that only reimburses 15-minute appointments. Patients struggle to access their doctors between visits. And the invisible work—care coordination, specialist referrals, between-visit communication—goes largely unpaid and unrecognized.
Dr. Paulius Mui decided to build something different. Not by waiting for system reform, but by creating a practice designed around what patients actually need: accessible, continuous, relationship-based care without financial barriers.
The conversation revealed something important about healthcare innovation: sometimes the most impactful changes come from refusing to ask permission to be different.
The Invisible Work of Primary Care
Dr. Mui explained why primary care is uniquely challenging: "What people think primary care does is that tip of the iceberg. It's what they see. We get noticed when something doesn't work, but when the machine is humming, that's because a lot of things get done in the background."
Care coordination. Helping patients navigate to the right specialists. All the between-visit communication that falls outside traditional billable encounters.
"Care like being sick is a continuous experience. You don't get sick from nine to five and then pick it up the next morning."
This disconnect—between how illness actually works and how the healthcare system reimburses care—drives primary care physician burnout. Technology makes doctors more accessible through patient portals, but that accessibility often becomes unpaid labor.
Dr. Mui's solution? Redesign the payment model entirely.
Pay What You Can: Virtual Care Without Financial Barriers
His virtual direct primary care practice operates on a fundamentally different model:
No episodic billing - Patients aren't limited to scheduled appointments. They have unlimited access via text, phone, or video.
Pay what you can afford - No income verification, no sliding scales. Patients determine what they can pay.
Virtual delivery - Removes geographic barriers and matches the reality of how people live and work.
Small by design - A panel of 100-150 patients, roughly 10% of his time, while he builds a technology company the rest of the time.
When I asked if this model is financially sustainable, his answer was honest: "The reason I created this unrealistic, unsustainable model is because I did not want to give up medicine."
The practice exists to keep him connected to patient care while building technology. It's not designed to scale in the traditional sense. It's designed to provide exceptional care to a limited number of patients who need it.
As our mutual colleague Matt Sakimuto taught him: "Time can make up for touch."
"With virtual care and a payment model that doesn't think about episodic care, we can text every few hours throughout the day and actually figure out: is something going to resolve on its own? Can you symptomatically manage it or do you need to escalate it?"
This is how primary care should work—continuous, accessible, relationship-based. Virtual delivery enables a level of responsiveness that traditional in-person practices struggle to achieve.
On the Table vs. At the Table
We discussed why so many clinician innovators leave traditional medicine for technology companies.
His observation: "Traditionally clinicians have been on the table and not at the table."
In organized medicine, change moves slowly by design. "I understand that these larger entities exist to pump the brakes, to prevent bad things from happening. But that also has a double-edged sword where very little actually gets done."
Meanwhile, technology companies welcome clinical perspectives: "The right ones tend to be humble and are actually welcoming a perspective that isn't theirs. And they're way more optimistic. It's much easier to influence optimists than pessimists."
This explains the migration of clinicians into tech. Not because they reject medicine, but because they want their expertise to shape how care gets delivered.
But Dr. Mui made a critical argument for why clinicians must be in leadership roles, not just advisory positions:
"Sometimes you really want to have people around that think beyond term sheets and P&L. Technology is an amplifier. If you digitize a bad process, you get a bad digital process. When startups wind down, people's lives are destroyed. Patients get left out cold. Care is interrupted. There are real repercussions when people's health is involved."
The reference point: the Facebook whistleblower story. When business pressures and systems conspire to create products that harm people, the consequences scale rapidly with technology.
In healthcare, failed startups don't just lose investor money. They disrupt patient care.
Physician Market Fit: A New Framework
Dr. Mui coined a useful term: "Physician Market Fit."
In business, Product Market Fit occurs when the market pulls your product out because demand is so strong.
Physician Market Fit is similar: "There's so much need that you just get pulled into this ecosystem if you're ready for it."
Readiness requires learning business terminology, understanding incentives, and becoming what he calls a "translation layer" between clinical and technical domains.
"I just admire engineers because they're magicians. They can make something from nothing. That is a skill set I'm building up myself just out of pure curiosity."
This curiosity—the willingness to learn domains outside medicine—distinguishes clinicians who succeed in innovation from those who remain frustrated by the pace of traditional healthcare change.
What Innovation Actually Means
His definition of innovation is refreshingly simple: "To me, it's just doing something new and not necessarily asking for the permission to be different."
Medical training self-selects for people comfortable with one correct answer. But patient care and innovation both live in gray zones.
"You have to really be comfortable with that discomfort."
He's building his company without external funding, which allows focus on problems that aren't immediately profitable. "I think it gives people an opportunity to find a really hard problem, work towards it, and then maybe down the road benefit from that compounded effort."
This mirrors primary care itself: incremental improvements that compound over a lifetime. Slow, sustainable, focused on long-term outcomes rather than rapid scaling.
Why He Refuses to Leave Clinical Practice
Despite building a technology company that could command his full attention, Dr. Mui dedicates 10% of his time to seeing patients.
Why?
"I did not want to give up medicine because I think it really humbles you. It reminds you how difficult things are and how difficult care is for patients. That's just a really good reminder to be close to the problem."
Staying close to the problem keeps innovators grounded. When he had to navigate Massachusetts medical licensing—mailing forms with stamps, wet signatures that then get faxed—he experienced firsthand the friction patients and clinicians face.
"It has been a great learning experience and I think I have a lot of appreciation for people who've actually gone through this and pulled it off themselves."
This appreciation for difficulty, for barriers, for the gap between how systems should work and how they actually work—this is what prevents innovation from becoming disconnected from reality.
The Bottom Line for Healthcare Innovation
Three principles emerge from this conversation:
1. Equity Doesn't Require Perfect Systems Dr. Mui didn't wait for insurance reform or policy changes. He built a practice where patients pay what they can afford. It's small, not traditionally scalable, and it matters.
2. Innovation Is Refusing to Ask Permission The most impactful changes come from people who identify problems and build solutions without waiting for institutional approval.
3. Stay Close to the Problem The best healthcare innovators maintain clinical practice. Not because they lack other options, but because distance from patient care creates distance from reality.
Dr. Mui practices medicine 10% of his time. That 10% informs everything else he builds. It keeps him honest. It keeps him focused on what matters.
For anyone interested in direct primary care or clinician innovation, his advice is simple: "Meet other people who are asking similar questions like you. You don't need to have the answers to start doing something."
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Listen to this episode on Spotify or Apple
Find out more about Dr. Paulius Mui:
XPC and their mission to advance Primary Care
His work at XPC that automates chart reviews: https://platform.xprimarycare.com/