You Shouldn’t Take Advice on Running a Restaurant from Someone Who Has Only Planned a Picnic

In a previous post I discussed how consultants and gurus prey on physicians seeking authentic alternatives to traditional healthcare models.

Today, I’d like to discuss another delightful irony: the rise of DPC “experts” who’ve either abandoned Direct Primary Care altogether or are running practices so small that calling them a “panel” is generous—their “panel” is more like a book club.

Before we dive in, I want to be clear: not all DPC leaders fall into this category. There are genuinely successful DPC physicians providing authentic guidance based on real experience. But here’s the ironic twist—these legitimate leaders are usually too busy actually running successful practices to spend their days proclaiming their thought leadership on social media. They’re leading by example, rather than through LinkedIn posts, messages in Facebook groups and fancy Instagram Reels espousing their latest “groundbreaking insights.” The loudest voices often belong to those with the least relevant experience.

The Fishing Derby Dilemma

Picture this: You’re prepping for your first fishing derby, palms sweaty, desperately Googling “how not to embarrass yourself at a fishing tournament.” Along comes this guy—crisp fishing vest, fancy hat with more lures than a Christmas tree, speaking in hushed tones about “secret honey holes” and “tournament-winning techniques.”

You’re frantically taking notes when you casually ask about their tournament experience. Turns out, they’ve been fishing maybe six times total, caught three guppies, and their biggest “tournament” was a company picnic where they came in dead last. But hey, they’ve watched a lot of fishing shows and—most importantly—they know people. You know, connected people.

This scenario perfectly captures what’s happening in the DPC world today.

The Scale Problem

Leadership in Direct Primary Care requires more than theoretical knowledge—it demands the hard-won wisdom that comes from building and sustaining a thriving practice. Yet we see some position themselves as DPC experts while maintaining a patient panel of fewer than 100 patients, or worse, having abandoned active DPC practice altogether.

Let’s do some back-of-the-napkin math here: A sustainable DPC practice typically requires 400-800+ patients, depending on the model and geographic location. A physician with 50-75 patients may understand the basics of DPC operations, but they’re essentially running what amounts to a very expensive hobby. It’s like claiming expertise in restaurant management because you successfully hosted a dinner party for eight—sure, everyone ate and nobody got food poisoning, but that hardly qualifies you to run a busy restaurant.

Put more simply: you shouldn’t take advice on running a restaurant from someone who has only planned a picnic.

These small-scale “experts” haven’t faced the complex challenges that come with actual scale—or to use their “big and sexy” terminology, the really important stuff like operational efficiency at higher volumes, staff management, financial sustainability through economic cycles, patient satisfaction across diverse populations, technology integration, and regulatory compliance complexities.

The irony becomes even more glaring when they give conference presentations about “scaling DPC” or write lofty blog posts about “growth strategies.” Really? Who are they to talk about scaling when they either gave up on DPC entirely or couldn’t even scale their own practice past 100 patients?

The Credibility Gap

Perhaps the most concerning trend involves former DPC physicians who have moved away from active practice but continue positioning themselves as current experts. Healthcare regulations, technology, and market conditions evolve rapidly—yesterday’s solutions may be today’s compliance violations. Active physicians face daily challenges that inform real-world solutions, while former physicians may remember old problems but lack insight into current obstacles. Most importantly, active physicians stake their livelihood on their advice working, while consultants and former physicians face fewer consequences if their recommendations fail.

What You Really Need & How to Choose Wisely

Physicians starting DPC practices need mentorship from individuals who currently operate successful DPC practices with substantial patient panels, have navigated multiple growth phases, and continue facing the daily realities of DPC practice management.

There’s a crucial distinction between mentorship and consultation. True mentors share ongoing, real-world experience and understand your struggles because they face similar ones. Most consultants rely primarily on theoretical knowledge or past experience and focus more on selling services than ensuring your success.

Before accepting advice or paying for guidance, ask three direct questions:

1. “How many patients are currently in your DPC practice?”
2. “What challenges did you face in the past 6 months, and how did you address them?”
3. “Can I speak with other physicians you’ve mentored about their experiences?”

When all is said and done

The Direct Primary Care movement deserves authentic leadership from physicians who have succeeded at the full scope and scale of DPC practice. Don’t take restaurant advice from picnic planners, and don’t take DPC practice advice from those who haven’t mastered the full complexity of successful practice management.

Seek mentorship from those who continue performing at the highest level. Your practice—and more importantly, your patients—deserve guidance from those who have truly mastered the art and science of Direct Primary Care.

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(Editor’s Note: Remember this post is an opinion. I encourage all my writers to embrace free speech. Feel free to comment and discuss your thoughts on this with Dr. Forbush.)