Concierge medicine, also known as membership medicine or retainer-based medicine, is based upon a healthcare model where patients pay a flat fee for personalized care. NPR and the Harvard T.H. Chan School of Public Health report that 20% of adults in the top 1% of the population pay an additional fee for direct access to their primary care physician. This model includes direct physician access, 24/7 availability, and convenient extended appointments. Over the past few years, health professionals have seen the model evolve from a luxury service to a more accessible alternative for those seeking premium care, addressing issues like long wait times and a lack of continuity often found in traditional primary care. However, according to a Sermo community poll, 52% of physicians are only ‘somewhat’ familiar with it.
What is concierge medicine?
First emerging in the mid-1990s, concierge medicine allows physicians to address challenges of traditional insurance-based practices, such as high patient loads and administrative burdens. It has since become a way to enhance patient access to medical needs, with more physicians using it as a way to balance professional fulfillment and high-quality care. According to a poll, 35% of physicians said that they believe it offers significant burnout relief in their profession; however only 13% of those surveyed were actively participating in the practice.
Pros and Cons of concierge medicine for physicians
Let’s explore the biggest pros and cons of concierge medicine:
Pros
More time with patients
In a recent Sermo poll, more time with patients was identified as the most appealing benefit of a concierge medicine model. Physicians can dedicate more time to each patient, allowing for deeper engagement and a more personalized approach to care. 24% of Sermo survey respondents agree that the practice allows for deeper connections and more personalized care over traditional medicine, and a general practitioner on Sermo says, “.. to know patients thoroughly, including not only the physical, but the mental, psychological, social, spiritual, and environmental aspects of their being. Only then can you treat them from a truly holistic perspective.”
Smaller patient panels
Concierge medicine practices typically have panels of 400-600 patients, as compared to 2,000-3,000 in traditional primary care practices. One family medicine physician shared, “I’m a concierge Dr. I have just 200 Patients with difficult to treat medical problems that no one else can fix. I take call 24/7 but no one ever texts or call me. Our pts pay $4000 per year to join the practice…I saw 70 pts a day for 30 years. Now I see 8-10 a day and am loving life”.
Improved patient relationships
With more time and less patients, the model allows physicians to build better relationships with patients, leading to a much more collaborative and trusting healthcare experience for all. 32% of physicians agree that patients appreciate the personalized attention and faster response times that concierge medicine provides.
Greater physician autonomy
Physicians have more freedom to make important decisions regarding patient care, basing those decisions on their professional judgement and expertise, without input from external factors such as insurance companies. Most physicians find that they have a personal and focused approach to care but can also create a perception of being exclusive and potentially lead to a tiered healthcare system. A nephrologist on Sermo says that “Concierge medicine can offer personalized and timely healthcare services, often improving patient satisfaction and outcomes.”
Potential for reduced burnout
Physicians have a stressful job, and the 72% of surveyed physicians agree the model has the potential to reduce burnout. They can focus more on patient care rather than administrative tasks and billing, which can lead to better job satisfaction. However, a cardiologist holds the opinion, “For the right type of practice, concierge medicine seems like a great option for both physician and patient. It may reduce burn out but I don’t think this is necessarily the best option for reducing burn out in general.”
More predictable income
The subscription-based model provides a more predictable and stable income stream for physicians as compared to traditional fee-for-service models, often with higher compensation rates.
Cons
Limited patient access due to cost
Some concierge practices offer more comprehensive services, which can result in higher costs and limited access for patients, even those with insurance coverage.
May exclude underserved populations
Due to its high cost and limited access, the model can concentrate resources among a select group of patients and widen the gap between those who can afford premium care and those who can’t. A pediatrician on Sermo warns, “This issue should be discussed with extreme caution, because it has both supporters and detractors. From my point of view, medical practice should be more humanized, making it accessible to the less fortunate”
Financial risk when starting out
Switching to a concierge model can involve financial and business transitions, including setting membership fees and managing the financial aspects of the practice, which is a risk when starting out.
Requires strong business management
Concierge medicine involves managing a small business, including building a patient base, developing a solid business plan, managing finances, and potentially dealing with insurance billing, all of which require strong management skills.
Possible ethical concerns
Ethical concerns may be raised over the potential for high costs and exclusivity. The model is often criticized for creating a two-tiered medical system, where wealthier individuals receive better, more focused care than those with less means who may be underserved or face longer wait times.
Additionally, 60% of surveyed physicians on Sermo agree that the high-cost nature of concierge medicine has the potential to skew the doctor-patient relationship, in the sense that physicians may feel they should cater to the patient’s wants rather than actual medical needs. This may lead to the physician prescribing unnecessary treatments or tests just to appease their clients or justify the patient’s payments.
How can concierge medicine reduce physician burnout?
Burnout is a major concern for physicians, and the model can help reduce this. By allowing doctors to manage a smaller patient panel, they have the ability to provide more individualized care and face less pressure from having a high volume of patients. This also enables physicians to have more time for patients, giving them a more personalized and potentially less stressful work environment.
When asked if physicians on Sermo believe that concierge medicine is beneficial to the healthcare system overall, 38% of physicians said that it will have an overall benefit if it keeps doctors practicing for a longer amount of time, while 25% think it can have both benefits and challenges.
The concierge medicine landscape
Doctors and patients alike are overwhelmed with traditional practices, especially when it comes to the rising cost of healthcare. Doctors are feeling the pressure of being overworked, and according to Freopp, the United States now ranks #7 in the 2024 World Index of Healthcare Innovation, a huge drop from the previous year when they were ranked #6. In the current landscape, concierge medicine is becoming increasingly popular. A higher number of patients are willing to pay a flat fee to have access to the benefits that the model offers, and doctors are taking to the idea of smaller patient panels and greater autonomy. This strongly suggests that a more personalized and relationship-driven healthcare model is in demand, which is why more doctors are choosing concierge medicine, a trend that is expected to continue into the future.
According to Sermo research, when physicians were asked the question “How should we address the equity debate in healthcare models?”, 21% answered by saying that it should be done by ensuring equal access to healthcare services for all, regardless of income or geography. 30% agree with not only that, but also feel that it should be done:
- Through policy reforms that prioritize marginal and underserved communities
- By integrating affordable and scalable solutions into current healthcare systems
- Through collaboration between governments, the private sector, and communities
- By fostering transparency in resource allocation to promote fairness
Is concierge medicine right for you?
What should doctors consider before moving to concierge medicine? It is important to have a strong, loyal patient base, solid financial planning and risk tolerance, and interest in personalized, relationship-based care. Every physician who is thinking about moving to concierge medicine must also have a willingness to manage or oversee business operations and have a desire for more autonomy and flexible scheduling. Concierge medicine requires strong skills and an equally strong work ethic, and it is important to explore the benefits and risks before making a final decision.
What do doctors think about concierge medicine?
Many doctors are moving toward a concierge medicine model, and those who do could be happier. Most doctors feel that it offers a multitude of benefits for them as well as their patients, and makes the delivery of care more convenient. According to a gastroenterologist on Sermo, “Concierge medicine is more akin to how I conceived medical practice would be before I went into medical practice. Reality bites. Nevertheless, there are advantages and disadvantages to everything”.
How to transition to concierge medicine
Transitioning to concierge medicine is a great option for physicians, however, it is a multi-step process. Doctors must notify patients, assess their current practice, and adapt to a change revenue structure. There are also key considerations such as crafting a patient-centered approach, establishing clear communication, and potentially working with a consulting firm for guidance. Physicians need to understand patient demographics, preferences, and willingness to pay for a concierge model, and determine if their current practice model aligns with the goals of concierge medicine and consider potential upgrades or adjustments. The transition to concierge medicine can take time, so be prepared to invest time and effort in the process.
Concierge medicine definitely has pros and cons. Many doctors are enthusiastic about the possibility of reduced burnout, and patients are happy about the improved care that they can get. Although there may be some drawbacks, such as financial risk and ethical considerations, most would agree that the benefits outweigh anything else.
