Debunking the 5 Critiques of Concierge Medicine
“Once upon a time, the ‘NOW accepting new patients’ sign was the standard signal for patients that their doctor was ‘in the box’ and ‘open for business.’ It was a marathon most doctors would HUMBLY endure in the service of patients and ultimately one day call a career. Though as the years went by more doctors saw that entering the practice felt more like a penalty box than an altruistic calling. And today’s healthcare marketplace isn’t giving doctors much choice anymore FOR a long career. HEALTHCARE TODAY is riddled with bureaucracy, ambiguous prices, visits that feel like speed-dating, and unwelcoming environments where both patients and doctors are running on empty. Enter cash-pay, membership, executive, preventative, routine and subscription healthcare (and all of its current iterations, labels and price points). For a few thousand doctors today in the U.S. and abroad, these cash-pay, subscription-based healthcare delivery business/practice models have become one of the few prescriptions and solutions available to both doctors and patients to treat patient and physician burnout in our chaotic, cold, unfriendly and overcomplicated healthcare marketplace. And let’s be honest, healthcare today is more like a maze than a place of refuge or healing. Doctors in these practice models have rediscovered their passion for healthcare – and patients, well, they’re sitting on the other side of these Doctors and rekindling that personal bond with their physician that they honestly thought had gone extinct!”
I’ll be the first to admit I might be wrong about some of my conclusions and opinions, like you, I’m not perfect. The older I get the quicker I am to confess to my shortcomings. Maybe it’s age, maybe its wisdom or maybe it’s just that I’m not the smartest person in the room, never way nor ever will be. But over the years I’ve read A LOT about concierge medicine, the pros, cons, and so much more! Some good, most inaccurate and some downright rude. Yet often today and I’d say in the past 3-5 years since the pandemic, the op/eds are usually written by stalwart critics, typically who already work in healthcare and probably look for things to criticize because it’s easier to say something mean in today’s culture than give a compliment — and these same stalwart healthcare archetypes trot out the same tired arguments — or, there’s a patient who gets their feathers ruffled and writes an letter to some editor who then a month later does some lazy reporting and interviews people in the article to achieve a desired result.
But, it’s not all bad out there! there’s actually more good than bad out there about this industry — and more often than not you won’t find it online. You’ll hear about it from the patient or physician sitting on the other side of the exam room from you.
But I’m not naive to not that critics of concierge medicine (or whatever YOU wanna call it!) frequently prefer to argue that the business model (which is what it truly is) worsens the physician shortage in the U.S. by essentially funneling doctors into a business or medical practice model that primarily caters to wealthier patients, thus limiting their availability to the general population.
That said, I am of the persuasion that this argument doesn’t hold a lot of water and for a few reasons:
Myth 1: Concierge medicine adds to the physician shortage
I would say this is false — but it really depends on how you and I approach the problem and whom we talk to in healthcare today. I can always find affirmation and voices about topics that validate my feelings or assumptions, right?! I’m sure you can as well.
For example, I had an HVAC Tech just last week look at the one 10-year old A/C unit and tell me we needed a whole new unit for about $6,000. On another service call with a different HVAC Tech. later that same day, he concluded that we’ve got 5 more years on the same unit, he thinks he fixed the leak and it’s only going to be $550!
Two people, one problem, varying opinions. That’s fine. It’s all about perspective and in today’s culture, that’s what we have to understand — critics love to lump ‘exacerbate the shortage’ and ‘concierge medicine’ together as if these retorts claim they have some kind of moral high ground. I think it’s just lazy reporting in an attempt to squash the topic of conversation and justify a ‘this is how we’ve always done it’ position. After all, if there’s money where you currently are, you don’t want something unique and different to come along and disrupt the water, right?!
Okay, so there’s different ways to approach this one problem. And, rightly so. So, let’s jump on that grenade.
In all transparency, I’ve never been one to think that the optics of ‘saving jobs’ versus ‘creating jobs’ has ever been a good barometer of success — that is until you sit down on the other side of the exam room from a physician who would rather be anywhere else than sitting with you! That said, it’s not easy being a Physician today, nor is it easy being the patient of a doctor who has to constantly fight the clock, bureaucratic landmines, staff challenges, among other exhausting and needling activities that it takes to be a physician in today’s confusing and impersonal culture. In my perspective, subscription-based and membership medicine healthcare delivery models, often labeled ‘concierge medicine’ (and plenty of other names over the years!) encourages more physicians to stay in the practice of medicine (i.e. saving jobs). In summary, by providing a more manageable workload, these practices can help alleviate the burnout crisis that is widespread in the medical field, ultimately aiding in the retention of more physicians in the workforce (Bodenheimer & Pham, 2010). Disagree all you might with that (and there will always be those that do!), but ‘saving jobs’ and ‘saving lives’ in my mind, is always going to be more important than ‘losing jobs’ and ‘losing doctors.’
ANALYZING THE NUMBERS ACCORDING TO MODELS USED (circa 2025)
Zooming In On Only the Subscription, Membership Model(s)
THE MEMBERSHIP MEDICINE INDUSTRY (circa 2025): According to industry sources from within the Concierge Medicine space, Concierge Medicine Today reports that today there are an estimated 3,000 to 4,000 (total) doctors embracing some version [or iteration] of a subscription-based healthcare delivery approach. Note, it’s estimated that more 25% of that figure (i..e. 4,000) represents specialty practices, probably more but these are conservative estimates. (Concierge Medicine Today; Apr 2025)
Zooming Out On National Impact
BIG NOISE, LITTLE TO NO IMPACT ON ANY PHYSICIAN SHORTAGE (circa 2025): According to industry sources from within the Concierge Medicine space, Concierge Medicine Today reports that it should be noted that these figures (i.e. 4,000 doctors/practices) still only represent a paltry percentage (i.e. 0.363%) of the roughly 1,101,735 total licensed physicians* in the U.S., (Kaiser Family Foundation; Jan 2025) that actively practice in one of these versions of cash-pay, subscription or membership-based medicine today. (Note: KFF data includes currently active allopathic physicians (MDs) and osteopathic physicians (DOs). Special data request for information on active state licensed physicians from Redi-Data, Inc, January 2025 (Kaiser Family Foundation; Jan 2025)
Zooming In On Impact On Primary Care
STILL BIG NOISE but LITTLE TO NO IMPACT ON ANY PRIMARY CARE PHYSICIAN SHORTAGE CRITIQUES (circa 2025): According to industry sources from within the Concierge Medicine space, Concierge Medicine Today reports that these figures (i.e. 3,000. primary care practices) still only represent a minute percentage (i.e. 0.560%) of the roughly 535,012 total licensed primary care physicians* in the U.S., (Kaiser Family Foundation; Jan 2025) that actively practice in one of these versions of cash-pay, subscription or membership-based medicine today. (Note: KFF data includes currently active allopathic physicians (MDs) and osteopathic physicians (DOs). Special data request for information on active state licensed physicians from Redi-Data, Inc, January 2025 (Kaiser Family Foundation; Jan 2025)
Why the numbers conundrum?
This sector of healthcare is quite niche, making it akin to spotting schools of fish when you encounter these practices in the wild! Since cash-pay, subscription-based, membership, and concierge medicine are simply business models rather than distinct medical specialties, there is no federal registry or official national database to verify these physicians' numbers. Consequently, as noted by the Editor-in-Chief of the industry’s trade publication, accurately estimating a specific figure becomes challenging. Nevertheless, despite the public relations hurdles that "concierge medicine" has faced over the last two decades—mostly from within the healthcare industry rather than from potential or current patients—it is estimated by industry leaders that the interest in some form of subscription-based or cash-pay healthcare is increasing at a rate of approximately 6-7% annually.
According to Concierge Medicine Today, long-term data regarding these specific subscription-based patients is still being gathered. Marketplace consultants and physicians advocate for further analysis of this information. More research to validate these prevalent observations should be examined and published. Based on year-over-year observations, practices that operate on a cash-pay subscription or membership model are reporting patient retention and care levels that meet or surpass those of traditional primary care and family practices.
Of additional interest, and largely reflected in the estimated figures, data from Medscape reveals that in 2020, only 17% of clinicians utilized cash-only, concierge, or direct-pay primary care models, based on a survey of over 17,000 healthcare professionals. Among these, primary care providers (PCPs) represented the highest percentage of those accepting cash payments, with 10% of practices implementing a flat monthly fee for unlimited services.
I appreciate what another close friend of mine in this corner of the healthcare marketplace, (who has been practicing for years in one of these models!) recently said: “To minimize harm in medical practice, we must reduce the number of patients each doctor sees daily. This allows them sufficient time to properly address patient needs, think critically about each case, and coordinate care with other practitioners when necessary.” This contemporary concierge and membership-driven personal care model physician from Connecticut emphasized, “It’s unfair to rush patients in and out of the office, merely treating symptoms without exploring the underlying causes. Building trusting relationships with patients is central to what [concierge] doctors strive to achieve every day. I hope every new physician dreams of a future where they can provide high-quality medical care, maintain work-life balance, and build enduring connections with their patients.”
Myth 2: Wrestling with a guilty conscience, critics and your definition of altruism as a physician today
I’ve met A LOT of physicians over the years in this space. Few have a guilty conscience about their decision to be the best Doctor FOR the world. That said, I find it ironic and a bit sad that a bias persists but not entirely from patients and customers of these practices. No, in today’s more contemporary concierge medicine and membership-driven or ‘personal care model’ (PCM) model(s), the bias today I have observes actually comes from ‘inside the house,’ so-to-speak! Yeah, unfortunately, a few vehemently independent, altruistic physicians and even a few Gen X Physicians and some very vocal docs over the years remain frustrated by the bureaucratic challenges in healthcare and don’t want to support these membership-driven or subscription healthcare delivery models citing a laundry list of talking points like they’re elitists, they add to the physician shortage, what about equity and fairness, they’re double dipping, etc.
This just makes me sad because despite the growing recognition of today’s more contemporary concierge medicine and membership-driven or ‘personal care model’ (PCM) model(s) value over the past two decades there are some who work in healthcare each day, feel the fatigue that their colleagues do yet they want to stifle progress and claim the moral and ethical high ground based on things like price and fairness.
Okay, well, if that’s the debate … I think this quote for perspective may inform your conscience: Dr. Jillian Bailey wrote a letter to the Canadian Medical Association Journal in July of 2020 entitled "Emphasizing altruism is problematic for physicians." In the article she wrote “I fear that the call to altruism may lead to worsening compassion fatigue and burnout among my colleagues. I would like to suggest that we encourage each other in the pursuit of meaning in our careers. Altruism and meaning are quite different concepts.” ( Bailey; CMAJ; July 27, 2020; 192 (30) E865; DOI: https://doi.org/10.1503/cmaj.76075)
With all that out there, I’ll say this … “Concierge Medicine is not a problem to be solved in our healthcare marketplace today. It’s a response to the free-market healthcare delivery marketplace. Physicians have wanted price transparency and the elimination of bureaucracy and administrative hassles for years and concierge medicine (in all its many forms today) is a patient-centered response to that. If you’re going to be upset at any group, elected party, etc., look at your colleagues next to you. You wanted price transparency, and you go it! Choice is a good thing FOR Doctors and FOR Patients. Furthermore, there should be absolutely no necessary tension about the value proposition anymore when we encounter Concierge Medicine. Each physician is doing what they believe is best for their patients, and at the end of the day, ‘the patient comes first.’ That’s perfectly acceptable. These membership models each possess unique qualities that appeal to different audiences now. The market has changed, yet the narrative and criticism remain the same. That’s either naïve, uninformed, or closed-minded. They are essentially unique healthcare delivery vehicles transporting patients toward similar destinations: better health! These are physicians following their calling, uniting their hearts and hands to help patients in ways we have yet to fully understand—and they’re doing it in a market and business model that works for them. They shouldn’t be villainized or criticized for no longer wanting to be the best doctor in the world; instead, we should applaud them and say, ‘Thank you for being the best doctor for the world, for your patients, and for your local community!’ Every concierge medicine physician deserves respect from their peers for their differences and shared values. They are trying something new and innovative in healthcare delivery, and the medical community at large should never disparage the practice of medicine or the choices of doctors who take different paths from their own. The world presents high expectations and seemingly insurmountable challenges to all doctors; we don’t need to add to this burden by stifling innovation, entrepreneurship, or creating divisions among colleagues. As Truett Cathy, the CEO of Chick-fil-A, once said, ‘If someone is breathing, they need encouragement.’ Let’s become a community of healthcare educators known for our support and encouragement rather than our criticism. Let’s be a collective of like-minded individuals dedicated to delivering exceptional patient care, encouraging others to pursue their passions, no matter how unique or different they may be in their local communities.”
The U.S. is experiencing an increasing demand for primary care, driven by an aging population and a rise in chronic illnesses. Concierge practices often act as a supplement rather than a replacement for traditional care models, helping to relieve some of the pressure on the healthcare system (Wheeler, 2018).
In conclusion, while the concierge medicine model presents a different approach to care, the claim that it contributes to the physician shortage lacks factual support. Instead, it has the potential to enhance physician satisfaction and improve patient care.
I could say a whole lot more on this topic (and I have here!) but I’ll leave it at that for now.
Myth 3: Health equity and what about fairness?
This is a good one!
So, when it comes to healthcare equity, innovative and disruptive business models that aim to better serve different audiences — they’re all usually very promptly criticized on the basis of fairness and ‘Well, I just don’t think that’s fair!’
Hey, I get it. I probably felt the same way years ago when I got ‘the letter’. I’ll ask you this, why do we see a stagnation in the number of young physicians entering primary care or family medicine each year? We know the answer. It’s because they’re trying to be fair in a system that’s not meant to operate that way. We need more business models trying something different and less inner-collegial discouragement. New healthcare approaches to serving the patient (at all price points!) should be encouraged, respected and eventually, if they work, replicated by more Physicians!
So, I understand your concerns; it doesn’t seem fair, and you’re right, life isn’t fair — and, this is something good parents teach their kids, right?! Yet in today’s healthcare environment fraught with unfairness, we’re encouraging more of the same?! Are you kidding me?! Have you sat on the other side of the exam room lately or recognized the patients by their first name ‘still standing’ there waiting on the other side of the counter from you (or your staff!) that paying exorbitant amounts for today’s visit, that prescription renewal, my EpiPen, or my last emergency room visit isn’t fair either?!
Why do patients put up with this amount of rejection, arbitrary process and high-costs? Well, we do it because if we don’t we risk our doctors office sending us to collections if we don’t pay. How is that fair?!
That’s the process you want to continue? That’s the equitable access for all and fairness experience you want to keep around?! For example, Patients who pay high fees for concierge medicine gain quicker access to appointments, longer time spent with providers, and other benefits, according to a Nov. 15 Boston Globe article.
Why are we so quick to criticize innovation in healthcare? Is it money? Is it fear? Is it lack of understanding? Probably a bit of all that and more!
I’ll tell you this though, I’ve seen fairness in healthcare and as probably the last Canadian on the planet who thinks things like ‘concierge medicine’ are pretty neat, when was the last time a patient was rewarded for arriving early to an appointment with their doctor by receiving just a simple smile from your staff?! We probably can’t remember, right?! How’s that for fair?! Upon closer inspection, I believe the arguments against today’s more contemporary concierge and membership-driven personal care model seems to lose its validity when fairness is considered and used to both morally and financially win any argument (with anyone!). Fairness on whose terms?
Like many physicians I’ve interviewed over the years, I think we do a disservice in medical education circles as well, when we teach young physicians to try to always be everything for everyone and then, reward them by treating them as if they were 6” tall. You know, and I know that when you step into your practice tomorrow, it’s impossible to be fair to everyone. But maybe don’t aim for fairness, as it is unattainable. Instead, TRY to ‘do FOR ONE Patient today what you wish you could FOR EVERY Patient’ – then, rinse and repeat and keep trying.
For example, who here has a Yeti water bottle or Yeti Tundra cooler when something like an Igloo or Coleman would suffice? Do we jump into “cooler” conferences, comment in the media and rant the “cooler” blogs online that it’s so unfair that the ice cooling industry is elitist?! No. Of course not. Should we then color and paint an entire portable cooler industry and label it as elitist and only for the wealthy because a company or three offer high-end options? Is it fair that our local retailer offer a high-priced cooler next to a budget friendly option that easy to carry to the soccer field? No. Of course not. That’s silly.
But we do that in healthcare, and we do it a lot! And from a branding and public relations POV, I think we have a double standard when it comes to the more contemporary versions of concierge and membership-driven personal care models in medicine specifically! Is it because of equality and healthcare for all or is it jealousy? If we’re honest with ourselves, it’s probably a bit of both. Afterall, we’re human and imperfect.
In the A.S. Leadership Podcast, which aims to support business leaders and managers, the concept of ‘Do For One What You Wish You Could Do For Everyone’ was highlighted, stressing the importance of delivering outstanding customer service. I find it fascinating to draw parallels between successful businesses and share these insights with those of you in the healthcare field.
This idea resonates deeply with me in healthcare: ‘Do for one what you wish you could do for everyone.’ However, when discussing more contemporary versions of concierge and membership-driven personal care models with certain critics, they often argue against this principle, insisting that one should not ‘do for one what you wish you could do for everyone,’ because that’s just not fair!
I’ve said it before and I’ll repeat it again, “Today’s more contemporary versions of concierge and membership-driven personal care models are not here to win any arguments, but it exists to serve patients differently. Less expensive and more common cash-pay, subscription and membership models with different patient demographics and service offerings often get associated with this high-end version by critics — but more often than not, the criticism is rendered mute given the fact that just like in business, models evolve. People will sometimes use price and other talking points to justify and dig into their positions, but today’s models in my opinion and from my seat in the waiting room was never intended to do so. Sure, disagreement is rampant in healthcare and it’s unavoidable, but division is a choice. Sure, we can disagree politically, but my faith-based studies like yours have taught us all to love unconditionally. I hope you will learn how to make your case for your own model with a posture of humility and understanding. I also hope you’ll view healthcare politics, opinions and peer ideologies through the eyes of the patient sitting on the other side of the exam room from you.”
So, we must honestly reflect: do we not desire to do for one what we could do for all?
But hey, don’t just take my word for it. Consider the feedback from those around you who express dissatisfaction with their last visit to a doctor’s office. Review the data and responses out there on review sites and medical journals regarding public trust in their current plan-reimbursed physicians and draw your own conclusions from the wonderful data on Patient Burnout from MDVIP over the last couple of years. I’d also argue and the data teases this out over the years from MDVIP, that these types of healthcare delivery models can actually improve the physician-patient relationship by allowing physicians to manage smaller patient panels which in turn, leads to more personalized attention and potentially better health outcomes (Trosman et al., 2019). An, when physicians are not burdened by overwhelming patient volumes, they can deliver quality care more efficiently.
If I could wave a magic wand on healthcare, I think we need more doctors who are willing to be engaged rather than fair and distracted. I don’t know about you, but I’m exhausted as a patient and a parent being treated as just another ‘inconvenient obstacle’ in the way of your next patient! I know this sound harsh, but why do we think physician burnout and patient burnout are so prevalent?
I’ll leave you with this, we’ll call him Dr. B. He’s the son of a seventh-generation Vermont dairy farmer and Dr. B. recently explained that his motivation for shifting to a concierge practice in late 2013 was not solely financial. The 59-year-old family practitioner felt driven to reclaim his autonomy as a physician and return to the fundamental reasons he entered medicine 27 years ago. “I do house calls, deliver babies, and visit hospitals and nursing homes,” shared Dr. D.B., who serves as the Medical Director of a long-term care facility in Vermont. “I waive my annual fee for most elderly patients and allow others to pay in installments. This represents a modern medical practice grounded in traditional values.”
Myth 4: Not a zero-sum game
The notion that concierge medicine diverts healthcare resources from underserved populations I think is often misleading. While some physicians may choose this model, many continue to serve a diverse range of patients, including those from lower-income backgrounds. Additionally, concierge practices can offer care to individuals who might have previously struggled to access healthcare due to time constraints or other barriers.
Myth 5: The elephant in the room, ‘Bespoke Concierge Medicine’
Okay, so, why do luxury services even exist in healthcare? It seems unfair given the altruistic nature of physicians in our culture?
We can debate endlessly (and many have for years!) whether healthcare should be perceived as a right or a privilege, or why varying pricing structures and services are designed for the ultra-wealthy while everyone should have access to the same level of care. Ultimately, healthcare, like it or not, is a business that involves costs and customers.
As a Canadian and an advocate for bespoke concierge medicine and today’s more contemporary concierge care and membership-driven personal care models (PCMs), and I understand these questions and your concerns about fairness, access, shortages and altruism in care are all valid! Somedays I also ponder where I stand on these issues as I age – as I appreciate the feedback from physicians of different backgrounds, price points, friends and family!
But perhaps it’s time to abandon the pursuit of fairness and instead engage with the situation. Here’s some food for thought to kick off our conversation: A lot of healthcare providers today (specifically in primary care) see today’s more contemporary concierge care and membership-driven personal care models (PCMs) and bespoke or luxury healthcare practice models as a problem to be solved. There’s no problem here in my opinion. Doctors over the years have advocated, funded and voted for transparency in healthcare for years! Now you got it and think that the marketplace won’t respond with ‘options?’ Bespoke healthcare services are not a problem to be solved – nor are today’s more contemporary concierge care and membership-driven personal care models (PCMs).
A great article I’d encourage you to read was entitled “Letters Emphasizing altruism is problematic for physicians” by Jillian Bailey and it was published in the Canadian Medical Association Journal in July of 2020. One statement I found poignant was this: Altruism is not the solution. I suggest that we encourage ourselves to reconnect with meaning, our “why” that we are in medicine. (Bailey; CMAJ; July 27, 2020; 192 (30) E865; DOI: https://doi.org/10.1503/cmaj.76075)
You see, bespoke healthcare in my opinion are a public relations and educational opportunity to manage the bias and current tension that exists in the marketplace, particularly among your colleagues who have seemingly made up their mind and would rather criticize Physicians’ entrepreneurial spirit in the name of double dipping, fairness or whatever.
I think a few people who feel this way don’t recognize that luxury healthcare serves a purpose. You and I don’t have to buy a $250,000 luxury car but we certainly don’t all need to drive Honda Civics either. The marketplace now offers a choice for patients and options are a good thing – regardless of your mindset on altruism and healthcare.
One aspect I enjoy studying is the parallels between certain elements of the business market and their relevance to the healthcare sector. In business, different price points exist to serve various consumer segments, including the ultra-wealthy, middle-income consumers, and those on a budget. The same holds true in membership medicine.
Bespke care for the ultra-wealthy programs may typically range from $10,000 to $50,000 annually, yet they likely represent less than 6% of the industry’s overall physician offerings.
For most patients, middle-income consumers have access to today’s more contemporary concierge care and membership-driven personal care models (PCMs) options, with price points ranging from $100 to $750 per month, accounting for roughly 80-85% of the available choices in today's marketplace.
For budget-conscious individuals, direct primary care (DPC) usually costs between $8 and $99 per month, with an estimated 1,500 to 2,500 practices across the country by 2025, depending on your sources.
In the business realm, luxury services, including luxury healthcare, coexist with more affordable options, emphasizing how businesses adapt to meet varying market needs. And options are a positive development, right?
As we know, new products often start at high prices but can become more affordable as competition, technology, or market dynamics evolve. This segmentation is particularly evident in healthcare, where services and products can vary significantly in price due to factors like market segmentation, service quality, insurance dynamics, competition, choice, and geographic differences.
Consider rehab centers, for example. Some offer premium accommodations, while others provide more modest services. Should we hold them to the same standards we apply to both bespoke concierge medicine andtoday’s more contemporary concierge care and membership-driven personal care models (PCMs)? That’s certainly worth contemplating.
Despite our collective love-hate relationship with health insurance, the complexity of insurance coverage can influence pricing. Some services, including elective surgeries, may not be fully covered, resulting in higher out-of-pocket expenses.
Conversely, basic healthcare services often come at lower price points, supported by insurance reimbursements. For instance, urgent care centers typically provide affordable services that are more accessible compared to the higher costs associated with emergency rooms (Urgent Care Association, 2022).
Moreover, competition drives down prices, especially for low-cost healthcare options like community health clinics and telemedicine services, which often provide essential care at significantly lower prices than traditional healthcare settings. For instance, telehealth platforms such as Teladoc offer virtual consultations at a fraction of the cost of an in-person visit (Teladoc Health, 2023).
Finally, healthcare costs can vary widely by location, with urban areas generally experiencing higher prices than rural regions. This variability allows for different price points that accommodate the economic conditions of various regions.