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.”

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Live Oak and Moss

Live Oak Bonita Cemetery

At the end of a busy day at the office the drive home is often routine. It’s easy to focus on the traffic and news on the radio. Sometimes a diversion will literally fly across the road in front of the car in the form of a Wood Stork or Great Egret. Bald Eagles live here too and seeing one soaring above the hustle and bustle of civilization always takes me to a different frame of mind.

As I came to a stop at the corner of Imperial and Bonita Beach Road, I glanced toward the west with the sun in my eyes and was struck by the beauty. The small cemetery is fronted by a very large Live Oak tree draped with Spanish Moss. It’s always there, but I don’t always ‘see’ it as I did today. Serene would be the best description of the scene–a tree, gravestones, and the setting sun. Being in the moment is the key to ‘seeing’ things in a different light.  It was brief–the stoplight changed to green–but the day was changed, forever.

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YJHM: Samuel K. Parish, “All Saints House”

YJHM: Samuel K. Parish, “All Saints House”.

This essay was published in the Yale Journal for Humanities in Medicine. It is one chapter from my novel pending publication, The Blind Caduceus.

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Reading — Keep Calm and Carry On

The photos of people reading in London after WWII bombing blitz. Making the best of a bad situation. I wonder what books they are reading? ImageImage

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To Read is to Fly: Reading, Around the World

Reading– the key that unlocks the door to the rest of the world.

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Literary Influences: The Citadel


Some books pass through your mind like wind through a desert with no effect. Other books, The Citadel included, enter the mind and heart and stay with permanent effects.

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