The biggest hurdle is regulatory. There are a number of legal barriers to direct primary care, and the laws vary state to state. Most private practitioners don’t have the choice to start a direct primary care practice because their state laws classify the model as insurance. This makes “scalable” DPC hard to achieve unless these laws change.

The other barrier is the supply of primary care doctors in the first place. There simply aren’t enough primary care doctors to make DPC an efficient scaled model. Family medicine is sadly the lowest paid field in medicine; while DPC can lead to higher salaries for current practitioners, it won’t solve the supply problem in the short term.