The traditional way of starting a primary care practice was to moonlight in the local ER until you could live off your practice income.
With DPC, opting out is important for growth but the current Medicare regs for opting out severely restrict moonlighting. Docs who want to convert, start or join a DPC practice are faced with staying in Medicare to allow moonlighting at the cost of severely restricting panel growth. Those who opt out can grow their DPC panel faster but have fewer or no (in rural areas) options for moonlighting to finance the transition.
Now that we have Dr Price at CMS, is this something that could be changed? When I talk to potential DPC docs, how to financially survive the transition year(s) is a huge hurdle. Fixing this would speed up adoption of DPC nationally.