CMT Knowledge Library

How Membership-Based Physician Practices Emerged and Evolved

Introduction

Concierge medicine is a membership-based healthcare model in which patients pay a recurring fee to a physician or medical practice in exchange for enhanced services, smaller patient panels, and a more personalized care relationship.

The model first emerged in the United States during the 1990s, at a time when physicians and patients were increasingly confronting structural changes in the healthcare system, including growing administrative complexity, expanding managed care networks, and declining time available for physician–patient interaction.

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Over the past three decades, concierge medicine has evolved into a diverse category of medical practice structures that includes independent physician practices, health-system affiliated programs, specialty concierge models, and hybrid approaches combining insurance billing with membership services.

This article examines the historical development of concierge medicine, including its origins, early growth, and continuing evolution within the broader healthcare system.

Early Origins: The 1990s

The origins of concierge medicine are generally traced to the mid-1990s, when a small number of physicians began experimenting with retainer-based practice structures.

One of the earliest widely cited examples was the founding of MD² (MD Squared) in Seattle in 1996. The practice was designed around a small number of patients paying a retainer fee in exchange for extensive physician familiarity and highly personalized care.

At the time, many physicians were expressing concern about changes in healthcare financing and the rise of managed care systems, which often emphasized cost control and higher patient volumes.

Some physicians began exploring whether smaller patient panels and membership-based relationships could allow them to spend more time with patients while maintaining financial sustainability.

These early experiments marked the beginning of what later became known as concierge medicine.

Expansion in the Early 2000s

During the early 2000s, concierge medicine began receiving broader attention within the healthcare community.

One of the earliest academic analyses of concierge medicine was published in JAMA in 2005. The study described concierge medicine as a retainer-based practice model in which physicians charge patients an annual fee in exchange for enhanced services and physician accessibility.¹

The study noted that concierge practices often offered:

• smaller patient panels
• extended appointment times
• enhanced physician familiarity with patients
• preventive health planning
• coordination of specialty care

At the time, concierge medicine remained relatively uncommon, but it sparked debate within the healthcare community about physician availability, patient choice, and the structure of primary care delivery.

Some observers expressed concern that concierge practices might reduce the number of physicians available to traditional primary care patients. Others argued that the model represented one of several ways physicians were attempting to respond to structural pressures within healthcare.

Membership-Based Care in a Changing Healthcare Environment

As concierge medicine gained visibility, other membership-based approaches to healthcare began appearing in the marketplace.

These models shared some structural similarities—such as recurring patient membership fees—but often differed in how they interacted with insurance billing systems and how services were structured.

The emergence of multiple membership-based care models reflected broader experimentation within healthcare as physicians sought ways to reduce administrative burden, improve continuity of care, and create more sustainable practice environments.

Although these models developed along different paths, the growth of membership-based healthcare highlighted increasing interest in alternative approaches to primary care delivery.

Concierge Medicine in the 2010s

During the 2010s, concierge medicine continued to evolve as physicians experimented with different membership-based practice structures.

Several trends contributed to the continued interest in concierge medicine during this period.

One was the growing concern about physician burnout. Studies published in Mayo Clinic Proceedings and other medical journals documented rising levels of physician burnout associated with workload, administrative burden, and practice environment pressures.²

Another factor was the growing recognition that many physicians had limited time available for patient interaction in high-volume practice environments.

A widely cited time-motion study published in Annals of Internal Medicine found that physicians in ambulatory practice spent nearly two hours on electronic health records and desk work for every hour of direct patient care.³

For some physicians, concierge medicine represented one approach to redesigning their practice environment in a way that allowed more time for patient relationships and care coordination.

Expansion Beyond Independent Practices

Although concierge medicine initially developed primarily within independent physician practices, variations of the model began appearing in other healthcare settings over time.

Some hospitals and health systems introduced concierge or membership-style programs designed to offer smaller patient panels, longer appointments, and enhanced physician familiarity with patients.

Examples of these programs have appeared in areas such as:

• executive health services
• hospital-affiliated concierge internal medicine practices
• enhanced-access primary care programs

Because healthcare organizations vary widely in structure, these programs can differ significantly in how they are implemented.

Specialty Concierge Medicine

While concierge medicine initially emerged within primary care, membership-based approaches have also appeared in some specialty areas.

Examples observed in the healthcare marketplace include concierge-style practices in:

• preventive cardiology
• dermatology
• internal medicine subspecialties
• women’s health
• longevity and preventive medicine programs

The evidence base for specialty concierge medicine is still developing, and the peer-reviewed literature on these models remains limited compared with primary care.

For this reason, descriptions of specialty concierge models are best understood as market observations rather than fully established academic categories.

Concierge Medicine, Today

Today, concierge medicine represents one of several membership-based healthcare models operating within the broader healthcare system.

Practices operating under the concierge medicine umbrella may include:

• physician-owned independent practices
• hybrid concierge models combining insurance billing with membership services
• specialty concierge practices
• hospital-affiliated concierge programs

Because concierge medicine is not defined by a single regulatory framework or practice structure, significant variation exists across practices.

What these models often share is a focus on smaller patient panels, longer physician–patient interactions, and continuity of care relationships.

Looking Ahead

Concierge medicine continues to evolve alongside other healthcare delivery models.

Several factors may influence its future development, including:

• physician workforce shortages
• increasing administrative demands on physicians
• patient expectations regarding familiarity and communication
• advances in telemedicine and digital health tools
• broader experimentation with membership-based healthcare models

It is unlikely that concierge medicine will replace traditional healthcare delivery structures. Instead, it represents one approach among many that physicians may use when designing medical practices that support both patient care and physician sustainability.

Understanding the history of concierge medicine provides useful context for evaluating how membership-based healthcare models may continue to evolve.

Sources

1. Alexander GC, Kurlander J, Wynia MK.
   “Physicians in Retainer (‘Concierge’) Practice.”
   Journal of the American Medical Association (JAMA), 2005.
   https://jamanetwork.com/journals/jama/fullarticle/200028

2. Shanafelt TD et al.
   “Changes in Burnout and Satisfaction With Work-Life Integration in Physicians.”
   Mayo Clinic Proceedings, 2022.
   https://www.mayoclinicproceedings.org/article/S0025-6196(21)00870-5/fulltext

3. Sinsky C, Colligan L, Li L, et al.
   “Allocation of Physician Time in Ambulatory Practice.”
   Annals of Internal Medicine, 2016.

4. https://www.acpjournals.org/doi/10.7326/M16-0961
   

Disclaimer

This article is provided for educational and informational purposes only and should not be interpreted as medical, legal, financial, or regulatory advice. Healthcare practice models vary widely depending on jurisdiction, regulatory requirements, and individual physician circumstances. Physicians should consult qualified advisors when evaluating practice structures or contractual arrangements.