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The Patients Left Behind: Conversions, Continuity and the Duty of Transition
When a primary care physician converts to a membership model, most existing patients do not follow. What happens to them is the most consequential, and least measured, part of every conversion.
Updated October 2026: evidence grades replaced with evidence types; funding disclosed on every source.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
In the only national survey that measured it, physicians who converted to retainer practice kept on average just 12% of their prior patients. The rest must find new care in a system where more than 30% of adults already lack a usual source of care. The AMA's ethics guidance asks converting physicians to facilitate transfer of care for patients who don't join, and some states set notice rules. A structured, documented transition plan is both the ethical floor and the field's best answer to its critics.
“How you leave your old patients is the first chapter of your new practice's story. Handle it with care and your community remembers. Handle it carelessly and that's the only chapter anyone tells.”
How many patients follow a physician into concierge practice?
In a 2005 national survey, converting physicians kept on average 12% of their prior patients. CMT found no more recent national figure.
Go to the full answer ↓What are my obligations to patients who don't join?
The AMA Code of Medical Ethics asks retainer physicians to facilitate transfer of care for patients who decline. State medical board rules on notice and records may also apply.
Go to the full answer ↓How much notice do patients need?
It depends on your state. Ohio, for example, requires notice at least 30 days before the last date the physician will see patients, plus emergency care and records access during that period. Many practices give far longer. Ask counsel.
Go to the full answer ↓Why does this matter beyond my practice?
Because primary care access is already strained. More than 30% of U.S. adults lacked a usual source of care in 2022, and the AAMC projects a primary care physician shortage of up to 40,400 by 2036.
Go to the full answer ↓What does a good transition look like?
Long notice, warm handoffs to named physicians, prioritized help for high-risk patients, prompt records transfer and clear communication. See the CMT Transition Standard in Part 4.
Go to the full answer ↓Most patients don't follow, by design
Conversion is a panel-size decision before it is anything else. A physician who goes from more than 2,000 patients to a few hundred members is, by arithmetic, sending most patients elsewhere.
What ethics and law ask of converting physicians
The AMA Code of Medical Ethics Opinion 11.2.5 sets the professional standard for retainer practices. Among its duties: participation must be voluntary, terms must be clear, and physicians should "facilitate transfer of care for any patient who chooses not to participate," including continuing care under existing insurance where local alternatives aren't available.4 Policy and Law
State law adds specifics. Ohio's medical board rules, for example, require written notice at least 30 days before the physician's last date of seeing patients, information on obtaining records and alternatives, continued emergency treatment for up to 30 days, and an offer to transfer records with the patient's authorization.5 Policy and Law Other states differ, and patient abandonment claims are governed by state law.
The ethical floor
- Voluntary participation
- Clear, honest terms
- Facilitated transfer of care
- Same quality of care for all patients still in the practice
The legal floor (varies by state)
- Advance written notice
- Records access and transfer
- Interim emergency coverage
- Payer contract notice terms
Why one practice's decision is a community issue
A single conversion in a well-served suburb is absorbed. Several in a shortage area are felt. The field's critics focus on exactly this effect.
The Health Affairs authors who documented 83% growth in membership medicine practices (concierge and DPC combined) from 2018 to 2023 framed the core question as what the growth means for patients who remain in traditional primary care.6,
A conversion plan is judged by how it treats the patients who leave, not just the members who stay.
"The best doctor for the community" means taking responsibility for the transition, even for patients who will never pay a membership fee. That responsibility is also the most persuasive answer to the equity critique in Brief No. 26.
The CMT Transition Standard
A practical, voluntary standard for physicians converting all or part of a practice. It goes beyond the legal minimum on purpose. Review every element with a healthcare attorney.
Is our transition plan complete?
What the data show about who follows
“The three biggest questions physicians ask us are: Can this work for me? How do I tell my patients? What happens to my workload?” CMT's Editor-in-Chief estimates the average runway to a conversion at 12 to 18 months, and advises physicians to “know your why, talk with your family, surround yourself with a trusted business advisory and consulting team.”11 The 12 to 18 months is an editorial estimate, not survey data.
In the Journal of Health Economics study, patients who joined were slightly older, had fewer chronic conditions and were more likely to be white than those who left.9 The 43% figure is CMT inference applied to conversion: the Patient Study measured what patients value, not what they did when a physician converted. No verified source reports the share of patients retained at conversion, notice periods used or transition services offered, so practices that document theirs will be adding new evidence.
Do the math first
Know how many patients will need new care, and where they will go, before you announce.
Exceed the minimum
Longer notice, warm handoffs, priority for high-risk patients.
Document and share
Record what you did. Transition data is the field's best evidence of responsibility.
How this brief was built
CMT reviewed the AMA Code of Medical Ethics, a national survey of retainer physicians, state rule summaries, federal workforce projections and primary care access data. State rule examples are illustrative; CMT did not survey all 50 states. Nothing in this brief is legal advice. Conversion figures draw on the Journal of Health Economics study (via Penn LDI), a 2005 national survey and the CMT Patient Study (self-selected respondents).
How to read the evidence types
Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.
Randomized trials and systematic reviews.Best for cause and effect.
Large observational studies and government data.Best for trends at scale.
Surveys, smaller studies and expert consensus.Best for real-world experience.
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.
Statutes, regulation and official guidance.Best for what is required.
What we don't know
- Current retention rates at conversion, which likely vary widely by model and fee.
- Health outcomes of patients who do not join: whether they find new care, how quickly, and with what effect.
- How many practices use hybrid models specifically to avoid displacing patients.
How to cite this brief
External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.
Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.
Related CMT Research Briefs
References
- Alexander GC, Kurlander J, Wynia MK. Physicians in retainer ("concierge") practice: a national survey of physician, patient, and practice characteristics. Journal of General Internal Medicine. 2005;20(12):1079-1083. pure.johnshopkins.eduFunding: mixed: professional society (AMA Institute for Ethics), foundation (Robert Wood Johnson Clinical Scholars Program) and academic (MacLean Center for Clinical Medical Ethics)
- Milbank Memorial Fund and Robert Graham Center. The Health of US Primary Care: 2025 Scorecard Report. Summary via AAFP, March 20, 2025. www.aafp.orgFunding: foundation (Milbank Memorial Fund; The Physicians Foundation)
- Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. March 2024. www.aamc.orgFunding: professional society (AAMC; analysis conducted for the AAMC by GlobalData Plc)
- American Medical Association. Code of Medical Ethics Opinion 11.2.5: Retainer Practices. code-medical-ethics.ama-assn.orgFunding: not stated (American Medical Association ethics policy)
- Bricker Graydon. Ohio State Medical Board issues new rules on terminating the physician-patient relationship and notifying patients when a physician leaves a practice. 2013. www.bricker.comFunding: not stated (law firm analysis)
- Zhu JM, Marsh T, Huntington A, Polsky D, Song Z. Growth in number of practices and clinicians participating in concierge and direct primary care, 2018-23. Health Affairs. December 2025. doi:10.1377/hlthaff.2025.00656. www.healthaffairs.orgFunding: mixed: federal (Agency for Healthcare Research and Quality, R01HS029467) and foundation (Commonwealth Fund; NIHCM Foundation)
- Johns Hopkins Carey Business School. Fee-based primary care is rapidly rising in U.S., hastening doctor shortages for the public. December 2025. carey.jhu.eduFunding: not stated (university news release)
- Rossheim J. The concierge catch: better access for a few patients disrupts care for many. KFF Health News, republished by WUSF. July 2024. www.wusf.orgFunding: not stated (news report)
- Hinckley J. Concierge medicine drives higher health costs without extending lives. Penn Leonard Davis Institute of Health Economics. September 18, 2023. ldi.upenn.eduFunding: not stated (research summary by Penn LDI)
- Concierge Medicine Today, LLC. CMT Patient Study: patient segmentation by satisfaction with current doctor and importance of insurance or Medicare compatibility (561 patients answering all four rating questions, 2018 to 2024). CMT Research Brief No. 9. Self-selected respondents. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-conducted; no outside funder) CMT original
- Concierge Medicine Today. Media Desk: quotes from the Editor-in-Chief, FAQs and data. Accessed October 2026. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-published; no outside funder) CMT original
Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.
Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.
Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.
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