A year ago, I embarked on a voyage at the leading edge of modern-day health care. I abandoned my traditional office-based practice of 2000 patients for a much smaller membership (concierge) model. My reasons were varied. They mostly focused on the dwindling time and concentration afforded by so-called  “advances” in medicine, such as electronic medical records and the ever-increasing deluge of paperwork that plagues today’s physician. As I begin year 2, I would like to share a few things I have learned.

Surprise, Surprise

When I announced my practice transformation in early 2013, I was met with a range of responses. Many patients congratulated me vigorously and expressed great interest in the new practice structure. However, as the start date grew near and eventually passed, I was continually surprised by who actually signed up and who did not. Many who questioned me excitedly disappeared as the date grew near, while others who feigned indifference became the first patients of the new practice. There was literally no way to predict.

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Don’t Blame the Benjamins

Of course it’s about money, right? Well, actually, I found that wealth had very little to do with the makeup of my concierge practice. I had many wealthy and loyal patients who decided to find new doctors. On the other hand, I was amazed at how many of my poorer patients were calling to set up payment plans. As I come to the end of my first year, I find the economic makeup of my practice is as varied as ever. Rich, poor, middle class: I see them all.

Money Buys Access

Time and again, new patients express one main reason for paying the extra money to join my practice: access. Your average patients are tired of waiting days to have their doctor return their call or weeks to have prescriptions filled. They want to dial a number and get an immediate response. When a patient calls my office, the phone is answered by my assistant or by me. Calls are returned within minutes. Oddly, I believe for most people this aspect is just as important as the actual quality of medical care.

What’s Old Is New Again

Unlike in the past, care has become compartmentalized. I am the only physician I know who still follows patients in their home, the office, the hospital, and the nursing home. The venue may change, but the doctor doesn’t. This is very comforting to patients, especially the elderly and chronically ill.

Conflicts of Interest

Once a patient is paying you a yearly fee, saying “no” becomes more difficult. The requests for unnecessary tests, antibiotics, and pain medications will always be there. Concierge physicians face the daunting task of providing high-quality and appropriate medical care without caving into the requests of “VIP” clients. It is helpful to remember that these patients chose you for your outstanding abilities and caring bedside manner in the first place. Appropriate treatment always comes first. 

In summary, my practice transition has been both rewarding and challenging. As I begin year 2, I feel more aware of the issues listed above and will continue to learn as I go.  

The trend toward concierge and direct-pay models of medicine continues to grow. I hope the above discussion helps provide insight to those providers who are thinking of making the leap.