Hey, doc! When are you going concierge?

doctors bag

I’ve been asked this question many times in my twenty-three years of practicing medicine, although mostly in the last five years. Concierge medicine, in a nutshell, is when a doctor asks for an annual pre-paid fee to give his/her enrollees more direct, convenient, timely, personal care compared to the traditional model. For example, most of us in primary care practice have 2000 -3000 patients under our care. In a concierge practice, the doctor would send a letter to all his panel of patients describing the new practice model and telling them that the first 300-500 who sign a contract and submit the fee will be on-board while the remaining patients will need to look for a new doctor. The annual fee per patient can vary from $1500 to $3000 and that is in addition to insurance billing.

Most concierge doctors I know are great doctors. The patients seem happy with the personal attention and ease of access to the doctor. The financial benefits to the doctor are usually better in a concierge practice, although some concierge practices have failed due to mismanagement.

Everyone wins, right? Wrong! Only a few winners come out in the concierge model. The physician and the patients with the financial means to enroll are the winners. The roughly 85% of the rest of the patients have lost. The primary care shortage is made worse as the residual patients are left looking for a doctor still accepting new patients.

Concierge medicine is a good thing for very few. I am interested in a healthcare system that expands coverage and primary care access. I didn’t choose family medicine to get rich, so from that standpoint I succeeded. I chose family medicine as a service industry not a profit industry.

The following article by author and Boston Globe columnist, Alex Beam, gives a personal story about concierge medicine.


The answer to the question, “Hey, doc! When are you going concierge?” is, “It is not in my foreseeable future.”

About blindcaduceus

Dr. Parish is a full-time physician in Addiction Medicine and Family Medicine in Naples Florida. He is a Kentucky native and alumnus of the University of Kentucky College of Medicine. His thirty years of experience has varied from non-profit and for-profit medical groups in addition to private practice. He is a member of the American Society of Addiction Medicine, American Academy of Addiction Psychiatry, Thoreau Society, and life member of the Ralph Waldo Emerson Society.
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1 Response to Hey, doc! When are you going concierge?

  1. Mark Moskowitz says:

    Hi Sam,
    Like you, I think concierge fails the ” fish test “. I would never go into it, either. I’m the only Spanish-speaking oncologist in Collier and i get a lot of satisfaction ( and free Latin food ) caring for these folks. But I am lucky I have other revenue streams to support this luxury. When I was a general internist I had to limit the number of no-pays I saw.
    What gripes me is hearing people say they can’t afford $1500/year, at least in Naples. Most people spend more than that per year on restaurant meals. I took my mom to a concierge doc after her longtime internist retired; the new doc found 2 potentially very serious problems that had been overlooked by this poor guy who had to see 30-40/d to keep the lights and water on. There’s a difference between being poor and being a poor-mouth.

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