Chapter 29: Concierge Medicine

Direct Access, Private and Concierge Medcine

[Going Off the Grid with Boutique Practice and Retainer Medicine]

By Suzanne R. Dewey

I was going to leave medicine. Carpentry started to sound like a very good career option to meDr. Alan Sheff


In traditional primary care practices today, physicians typically have 2,500 – 3,500 or more active patients on their panels and see 20-25 patients each day in rapid 10 to 15 minute intervals.  This kind of patient load makes it difficult for the primary care physician to effectively deliver care to those patients suffering with chronic illness or to address preventive measures.

Today’s medical system demands that physicians see increasingly greater numbers of patients per day.  Subsequently, they are spending decreasing amounts of time with each patient resulting in declining patient satisfaction. Office-based physicians reported a weekly average of 73.7 office visits, 12.7 hospital visits and 11.1 telephone consultations.  Primary care physicians averaged more encounters per week compared with other specialists. Harris Interactive reports: “The average time a doctor spends with a patient is down to 15 minutes or less and continues to diminish, putting enormous stress on both physicians and patients.

For the physician, choosing to deliver medicine in a concierge or direct access model, at a minimum, allows for longer appointments with patients to address concerns and focus on prevention. More time with the patient creates the ability to monitor wellness screens and to get to know the patient in a more robust manner.

For the patient, they can see their physician on his/her own terms and with a list of concerns and not feel rushed.  They can see their physician on the same day they contact the office.  Often they have the time to discuss specialist’s reports for better coordination of care and they can focus on prevention and maintaining wellness.

Participating physicians report more time to devote to patient care and advocacy, as well as continuing medical education and family life. The result is a revolution in preventative care and a return to a more personal relationship between doctor and patient.

According to a recent CNN report, concierge medicine was virtually unknown a decade ago; in 2005, there were approximately 500 physicians taking advantage of the practice model.  In 2010, according to the Society of Innovative Medical Practice Design (, there are 5,000 physicians practicing concierge medicine.

More here: ORDER:

Dictionary of Health Economics and Finance:


12 thoughts on “Chapter 29: Concierge Medicine

  1. Concierge Choice Physicians

    The Concierge Choice Physicians Program is a membership program for a maximum of 600 patients.

    Patients joining a CCP program pay an annual membership fee to receive a comprehensive screening physical performed that goes beyond the scope of most regular physicals.

    The revenue from this program allows MD/DOs to reduce practice size gradually and increase the time spent with participants in the program.


  2. Concierge Medical Practice Marketing

    While most concierege doctors rely heavily upon patient and professional referrals, few doctors have any kind of ongoing strategy to build their relationships in order to win their fair share of the direct care market.

    That’s a shame, because in the real world doing good work is essential – but simply not enough.

    What’s worse, if you are like most practitioners, you’ll probably find that 80% of your referrals come from a handful of referring doctors or patients. If one of your key referral sources were to move, die, change allegiances or retire, what would the consequences be to your bottom line?

    The good news is that this book and chapter on CM can help you build, grow and maintain referral relationships, even if you are shy, extremely busy or don’t have a big budget.

    Ann Miller; RN, MHA

  3. Perhaps the ultimate level of concierge medicine is exemplified in a firm like

    Its’ global principals were developed according to the medical systems and protocols for the President of the United States, senior White House officials, and members of the President’s cabinet.


  4. A Hybrid Medical Practice Business Model

    Some physicians looking for the steady income and slower pace of concierge medicine who have not wanted to give up their traditional practice have found a new solution: a hybrid practice that lets them devote a small percentage to the retainer side while keeping their roster of traditional patients.

    So far, the full concierge model has not proven to be very popular. Researchers determined that only about 750 physicians have gone to such retainer-only practices. The hybrid model is being promoted as an alternative by Concierge Choice Physicians.

    Any thoughts?

    Ann Miller RN MHA

  5. The Micro Concierge Medical Practice

    Dr. Tomas X. Lee, an MBA from Stanford University, approached venture capitalists from the firm Benchmark Capital who invested several million dollars in a new type of concierge medical practice for the masses.

    Called One Medical Group, it represents a new model for primary care that aims to set a nationwide example. With 31 physicians in San Francisco and New York, it offers most of the same services provided by personalized “concierge” medical practices, but at a much lower price: $150 to $200 a year.

    One Medical Group doctors see at most 16 patients a day; the nationwide average for primary-care physicians is 25. They welcome e-mail communication with patients, for no extra charge. Same-day appointments are routine.

    And unlike most concierge practices, One Medical accepts a variety of insurance plans, including Medicare.
    Your thoughts are appreciated.

    Dr. David Edward Marcinko MBA

  6. Retainer Medicine

    Retainer based practices: Primary care physicians find that their incomes have been flat or reduced, their work hours increased, their time with each patient shortened and their frustrations with insurers heightened dramatically over recent years.

    Some are just saying “I can’t take it any longer” and switching to a different type of practice model. Some simply will not accept Medicare, telling their older patients that they must either pay out of pocket or go elsewhere.

    Others are converting to “retainer-based” practices. Here the patient pays a flat fee each year, often $1500 to $2000, in return for having their PCP available by cell phone 24/7 and responsive by email. Appointments within 24 hours are guaranteed. The physician will see you in the ER, take care of you in the hospital and do home or nursing home visits as needed at no extra charge.

    But, you still need your insurance in case you have need to see a specialist, have tests or imaging studies or are hospitalized. So the cost to you is extra. This is very disruptive of the standard approach today but I predict it will become very common in just a few years.

    Source: Stephen C. Schimpff, MD

  7. “Monthly Retainer” Practices Growing

    Family physician Steven Butdorf of Eugene, Ore., was tired of rushing patients through appointments, tired of insurers denying procedures, and tired of paperwork.
    So, according to this article, on Feb. 1st, Butdorf opened Exceptional Health Care, which lets patients pay a set monthly fee in return for specific health care services – leaving out insurance companies altogether.



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