The History of Concierge Medicine: How Membership-Based Physician Practices Emerged and Evolved
HOW TO CITE THIS ARTICLE
Concierge Medicine Today. "The History of Concierge Medicine: How Membership-Based Physician Practices Emerged and Evolved." CMT Knowledge Library. 2026. conciergemedicinetoday.net/knowledge-library
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.
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. What began as a small number of independent experiments in retainer-based care has grown, over three decades, into a diverse and expanding category of medical practice that now includes independent physician practices, health-system affiliated programs, specialty concierge models, and hybrid approaches combining insurance billing with direct membership services.
Understanding the history of concierge medicine provides useful context for evaluating the model today — its origins, the pressures that shaped it, the generational changes it has undergone, and the direction in which it continues to evolve.
PART ONE: THE CONDITIONS THAT CREATED CONCIERGE MEDICINE
American Medicine Before the 1990s: Cash-Pay and the Personal Physician
For most of the twentieth century prior to the managed care era, the dominant model of American primary care was built on a direct relationship between a physician and the patients they served. Patients paid physicians directly for services rendered, insurance was used primarily for hospitalization and catastrophic care, and the physician's panel was constrained primarily by time and geography rather than by network contracts or administrative requirements.
This model had its limitations — most significantly, it excluded patients who could not afford to pay out of pocket, which is part of what drove the expansion of employer-sponsored insurance and government health programs across the mid-twentieth century. But it produced something that would become increasingly difficult to replicate as the system grew more complex: a physician who knew their patients deeply, could be reached when needed, and was accountable primarily to the patient rather than to an insurance system or a hospital network.
The personal physician of the early and mid-twentieth century was not a luxury. It was simply how medicine worked for those who had access to it.
The Rise of Managed Care and Its Discontents: 1970s–1990s
Beginning in the 1970s and accelerating through the 1980s and 1990s, the American healthcare system underwent a structural transformation driven primarily by the need to control costs. Health Maintenance Organizations (HMOs) and other managed care structures became the dominant financing model for employer-sponsored insurance, and the logic of managed care — emphasizing cost containment, network contracts, and utilization management — reshaped how physicians practiced medicine.
Some physicians believe the rise of HMOs in the mid-1980s and into the early 1990s resulted in pressure for physicians to spend less time than they wanted with patients. Panel sizes grew. Appointment times shortened. Administrative requirements expanded. Physicians who had entered medicine to build long-term relationships with patients found themselves managing thousands of patients in high-volume practices, constrained by network rules and reimbursement structures that rewarded volume over relationship. Institute for Healthcare Improvement
Physicians enter the field with the intention of helping others. However, excessive workloads, administrative burdens, and the profit motives of health care systems, insurance companies, and pharmaceutical companies create barriers to delivering the care physicians envisioned. Healthcare Dive
By the mid-1990s, a number of physicians had begun to ask a question that would eventually give rise to concierge medicine: what would happen if a physician simply stepped outside this system — and built a practice structured entirely around the relationship?
PART TWO: THE FIRST GENERATION — BESPOKE CONCIERGE MEDICINE (1990S)
The Founding of MD² and the Birth of Retainer Medicine
Frustrated with overcrowded practices, rushed appointments, reactive care, and complex billing processes, Dr. Howard Maron joined Dr. Scott Hall to reimagine primary care. In 1996, the first MD² concierge medical office opened in Seattle, Washington. MGMA
Dr. Howard Maron was former physician to the Seattle Supersonics. He appreciated the high level of care and attention he provided to the team, and wondered why people who were not star athletes could not also have a personal physician. At MD², there were two physicians per office, with each physician caring for just 50 families. MD² charged an annual retainer fee in the range of $13,200 to $20,000 per family. Agency for Healthcare Research and QualityAhrq
Dr. Maron founded MD² based on the belief that delivering exceptional medical care must fundamentally revolve around, honor, and protect the most sacred of relationships — that between a physician and a patient. The core elements of the MD² model were present from the beginning: no-wait, unrushed, completely private visits that allowed physicians and patients to build strong relationships that reached beyond the practice walls. Agency for Healthcare Research and Quality
MD² did not initially use the term "concierge medicine" to describe what it was doing. Dr. Maron preferred the phrase "highly attentive medicine." The term concierge would come later, applied by others to describe the growing category of retainer-based practices that followed in MD²'s wake.
The Characteristics of First-Generation Bespoke Care
What MD² established — and what CMT now refers to as first-generation or bespoke concierge medicine — was a model defined by several characteristics that distinguished it sharply from the managed care world surrounding it:
An extremely small patient panel — 50 families per physician — that allowed for the kind of familiarity that is structurally impossible at conventional panel sizes. Physicians knew not just their patients' medical histories but their families, their travels, their anxieties, and their lives.
A retainer fee structure that replaced insurance billing entirely, creating a direct financial relationship between patient and physician with no intermediary.
An emphasis on availability and accessibility — the physician reachable at any hour, for any concern, regardless of whether it required a formal appointment.
A deliberate focus on prevention, relationship, and the patient as a whole person rather than as a collection of billable diagnoses.
This first-generation model served a very specific patient population: ultra-high-net-worth individuals, executives, and families for whom the cost of the retainer was manageable and the value of the relationship was clear. It was not designed for broad access. It was designed to prove that a different kind of medicine was possible.
Early Academic Attention and Ethical Debate
As bespoke concierge practices began to attract attention in the early 2000s, the model sparked substantive debate 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, noting that these practices offered smaller patient panels, extended appointment times, enhanced physician familiarity with patients, preventive health planning, and coordination of specialty care. Medical Economics
The debate that surrounded early concierge medicine was substantive and not fully resolved. Critics argued that concierge practices represented a two-tiered system — excellent care for those who could afford a retainer, and implicitly reduced primary care capacity for those who could not. Some raised concerns about physicians leaving high-volume practices to serve a smaller, wealthier patient population while the broader primary care shortage continued to worsen.
Defenders of the model argued that physicians who built sustainable practices — practices they could maintain for decades without burning out — ultimately served their patients and communities better than physicians who left medicine early. They also noted that concierge medicine did not create the primary care capacity problem; it emerged as a response to structural conditions that had already produced that problem.
The AMA acknowledged the growing model and drafted guidelines for what it then called "boutique" practices, reflecting the institutional recognition that the model had become a real and expanding feature of the healthcare landscape.
CMT was founded in 2007 as the first independent trade publication dedicated to this field — the same year, coincidentally, that the term "direct practice" first entered state legislation in Washington, clarifying that direct care practices were not affiliated with insurance companies under state law.
PART THREE: THE SECOND GENERATION — CONTEMPORARY CONCIERGE MEDICINE (2000S–2010S)
MDVIP and the Democratization of the Model
The second major chapter in the history of concierge medicine began in Boca Raton, Florida in 2000, when a group of physicians founded MDVIP with a structurally different vision of what retainer medicine could be.
In 2000, at the other corner of the country from MD², MDVIP was founded by a group of doctors in Boca Raton, Florida, among them Robert Colton, MD, Edward Goldman, MD, and Bernard Kaminetsky, MD. For $1,500 a year, the practice offered patients same-day appointments, home delivery of prescriptions, house calls, and 24/7 help. Health Affairs
Where MD² had built around 50 families per physician at $13,000–$20,000 per year, MDVIP built around panels of up to 600 patients at dramatically lower annual fees. Critically, MDVIP opted to bill insurance in addition to charging a membership fee — a hybrid structure that made the model accessible to a far broader patient population, including Medicare beneficiaries.
Since its founding in 2000, MDVIP has achieved 100 consecutive quarters of growth. Today, the MDVIP network includes more than 1,400 affiliated physicians and over 430,000 members nationwide. Fierce Healthcare
MDVIP's growth — and the emergence of other practice management organizations like SignatureMD, founded in 2006 — marked the transition from first-generation bespoke concierge medicine to what CMT calls the contemporary or patient-centered medical (PCM) model. This second generation brought concierge medicine's core principles — smaller panels, enhanced access, longer appointments, preventive focus — to a broader and more economically diverse patient population.
The Contemporary Model's Structural Characteristics
The contemporary concierge model that became dominant through the 2000s and 2010s shared the relational philosophy of the original bespoke model but differed meaningfully in structure:
Patient panels of 225 to 600 patients, rather than MD²'s 50 families. Annual membership fees typically in the range of $1,500 to $5,000, rather than $13,000–$40,000. Maintained participation in the insurance system for covered services, with the membership fee supporting enhanced access and services not reimbursed through insurance. A focus on primary care — particularly internal medicine and family medicine — rather than the ultra-high-service model of first-generation bespoke practices.
By 2010, one quarter of all doctors operating with a concierge medicine model were affiliated with MDVIP. This concentration of a major network within a single organization reflected the practical challenge many physicians faced in converting to the model independently — the patient communication, legal structure, and practice management systems required for a successful conversion were not trivial, and organizations like MDVIP and SignatureMD provided infrastructure that independent physicians could not easily replicate on their own. American Medical Association
The Parallel Development of Direct Primary Care
While the contemporary concierge model was expanding through the 2000s, a structurally distinct membership-based model was also developing: Direct Primary Care (DPC).
DPC differed from contemporary concierge medicine primarily in its relationship to insurance. Where most concierge practices maintained insurance participation for covered services, DPC practices typically refused insurance billing entirely — replacing it with a low monthly membership fee that covered most or all primary care services.
The first legislation recognizing direct care practices as distinct from insurance appeared in Washington State in 2007. The model attracted physicians who wanted to simplify their practice operations by eliminating insurance billing entirely, rather than layering a membership fee structure on top of an existing insurance relationship.
By the 2010s, both models — contemporary concierge and DPC — were growing simultaneously, serving overlapping but distinct patient populations and physician preferences. CMT began covering both as part of the broader membership-based medicine landscape.
Growing Concern About Physician Burnout
The sustained growth of membership-based models through the 2010s was not incidental. It tracked closely with a growing body of research documenting the structural unsustainability of high-volume primary care practice.
The smaller panel size in concierge practices allows the concierge physician to spend 30 minutes or more per visit and several hours on executive-type annual physical examinations. The extra time allows the physician to offer comprehensive assessment and customized treatment plans, including lifestyle and preventive services. Concierge physicians are able to respond to phone and email messages and offer same-day or next-day appointments, with far less time spent on billing and paperwork.
Studies published in Mayo Clinic Proceedings documented rising levels of physician burnout associated with workload, administrative burden, and practice environment pressures. 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.¹
Primary care physicians face growing administrative burden owing to complex insurance rules, implementation of value-based payment, poor usability of electronic health record systems, and an overload of care quality measures — contributing to demoralization and burnout while exacerbating the primary care workforce shortage. Annals of Family Medicine
For the physicians who chose concierge or membership-based models during this period, the motivation was often less about financial opportunity than about professional sustainability. The model offered a structural way to continue practicing medicine — with the time and relationship depth that had brought them to the profession — rather than continuing in a system that had made both increasingly difficult.
PART FOUR: THE THIRD GENERATION AND EXPANSION (2010S–PRESENT)
Direct Primary Care's Growth and Formalization
Through the mid-2010s, Direct Primary Care emerged as a formalized and growing movement within membership-based medicine — distinct from concierge medicine in structure but sharing its fundamental philosophy of direct, relationship-based care financed through patient membership rather than insurance reimbursement.
According to a 2024 AAFP data brief, 9% of family physicians reported operating a DPC practice — a significant increase from prior years — and 94% of DPC physicians were satisfied with their overall practice, compared to 57% of those not in a DPC practice. DPC physicians were also less likely to report burnout, with 49% saying they were experiencing no level of burnout, compared to just 14% of non-DPC physicians. MGMA
The AAFP's formal recognition of DPC as a distinct practice model and the passage of DPC-specific legislation in multiple states through the 2010s formalized what had been an informal movement — and created clearer legal and regulatory frameworks for physicians considering the transition.
Specialty Concierge Medicine
While concierge medicine initially emerged within primary care, membership-based approaches began appearing in specialty medicine through the 2010s as well. Preventive cardiology, dermatology, internal medicine subspecialties, women's health, and longevity medicine programs have all seen examples of concierge or membership-based structures applied to specialty care.
These specialty models vary considerably in their structure and philosophy, and the peer-reviewed literature on specialty concierge medicine remains limited compared with the primary care evidence base. They are best understood as market observations reflecting the broader expansion of the membership-based model beyond its primary care origins.
COVID-19 and the Acceleration of the Model
The COVID-19 pandemic, beginning in 2020, created conditions that accelerated physician interest in concierge and membership-based models across the United States.
Physicians in high-volume traditional practices faced extraordinary administrative and clinical demands during the pandemic period. Many experienced firsthand the fragility of fee-for-service revenue models when patient volume collapsed. The pandemic also demonstrated — to both physicians and patients — the value of direct, accessible physician relationships at a moment of genuine health crisis.
Concierge transition expert SpecialDocs reported rapid growth within its network of independent concierge medicine practices in the wake of the COVID-19 pandemic. As per SpecialDocs CEO Terry Bauer: "During the COVID-19 crisis, it became clearer than ever that our concierge medicine model provides a proven, sustainable path to stability and success for independent physicians." AAMC
Documented Growth: 2018 to 2023
The most comprehensive recent data on the growth of membership-based medicine comes from research published in Health Affairs in 2025.
From 2018 to 2023, the number of direct primary care and concierge practice sites grew by 83.1 percent and the number of clinicians participating in them by 78.4 percent. The share of clinicians in concierge and direct primary care practices who were physicians declined from 67.3 percent to 59.7 percent, while the proportion of advanced practice clinicians increased. conciergemedicinetoday
This growth occurred during a period that included the pandemic, significant primary care workforce pressure, and growing institutional concern about physician burnout — conditions that collectively increased both physician interest in alternative practice structures and patient interest in direct, accessible care relationships.
Despite this growth, membership-based models remain a small fraction of total physician practice. CMT estimates that approximately 4,000 to 6,000 concierge and membership-based practices currently operate in the United States — representing well under two percent of the practicing physician workforce. The field is growing meaningfully but remains far from dominant within American medicine.
The Emergence of Technology-Enabled Models
The late 2010s and 2020s saw the emergence of technology-enabled membership-based care models that blurred the boundaries between concierge medicine, DPC, and digital health. In 2017, a new company named Forward, started by former Google and Uber employees with strong venture capital support, began offering concierge medicine services for the equivalent of $200 per month in 2025 pricing. American Medical Association
These technology-enabled models introduced new dynamics into the membership-based medicine landscape — including venture capital investment, at-scale patient acquisition, and technology-first care delivery models that differed substantially from the physician-led, relationship-centered practices that had defined the field's origins.
PART FIVE: CONCIERGE MEDICINE TODAY AND LOOKING AHEAD
What Concierge Medicine Has Become
Three decades after Dr. Howard Maron opened the first MD² office in Seattle, concierge medicine encompasses a remarkably diverse range of practice structures.
Practices operating under the concierge or membership medicine umbrella today may include independent physician-owned practices, hybrid concierge models combining insurance billing with membership fees, specialty concierge practices, hospital-affiliated concierge programs, technology-enabled direct care platforms, and employer-sponsored direct primary care arrangements.
What these models continue to share — across their structural diversity — is a focus on the physician-patient relationship as the organizing principle of the practice. Smaller panels. More time per patient. Greater physician accessibility. A care relationship that the physician can sustain over years and decades rather than burning through in a high-volume system.
CMT's three-generation framework for understanding the model's evolution reflects the structural differentiation that has occurred within the field:
First generation — Bespoke concierge medicine: The original model, pioneered by MD² in 1996. Ultra-small patient panels (typically 50 families or fewer), very high annual fees ($10,000–$40,000+), serving ultra-high-net-worth patients and designed around total physician availability and familiarity. Represents a small percentage of the total membership medicine market today.
Second generation — Contemporary concierge medicine (PCM): The dominant model today, exemplified by MDVIP and similar networks. Panels of 225–600 patients, annual fees typically $1,500–$5,000, maintaining insurance participation for covered services. This generation brought the concierge model's core principles to a significantly broader patient population.
Third generation — Direct Primary Care: A structurally distinct model that eliminates insurance billing entirely, replacing it with monthly membership fees ($50–$150/month), and emphasizes simplicity, transparency, and operational independence from the insurance system.
Factors Shaping the Field's Future
Several forces are likely to shape the continued evolution of concierge and membership-based medicine in the years ahead.
The primary care physician shortage is among the most significant contextual factors. By 2036, the United States is estimated to have a shortage of 68,020 primary care physicians. The structural conditions that drove physicians toward membership-based models in the 1990s and 2000s — high administrative burden, compressed appointment times, panel sizes incompatible with relationship-based care — have not been resolved. In some respects they have intensified. Institute for Healthcare Improvement
For 2025, 41.9% of physicians reported experiencing at least one symptom of burnout, down from 48.2% in 2023 — a meaningful improvement, but still representing nearly half the physician workforce. The pressures that drove the original concierge medicine movement have not disappeared. conciergemedicinetoday
Patient expectations for communication, accessibility, and personalized care are evolving alongside technology. The patients who built relationships with concierge physicians in the 2000s and 2010s expect the accessibility and communication standards of those relationships regardless of how care is delivered. That expectation is increasingly influencing healthcare design more broadly — and is unlikely to diminish.
Employer-sponsored direct care models represent one of the fastest-growing areas within membership-based medicine. As employers have become more sophisticated healthcare purchasers, the appeal of direct care contracts — predictable costs, measurable outcomes, and employee access to primary care without insurance friction — has grown significantly.
It is unlikely that concierge or membership-based medicine will replace traditional healthcare delivery structures. The models serve a subset of the population and a subset of physicians, and they interact with rather than replace the broader healthcare system that manages hospital care, specialty care, and the full complexity of population health.
What concierge medicine has demonstrated, over three decades, is that a different kind of primary care relationship is possible — one in which the physician knows the patient, has time for them, and can be reached when they are needed. That demonstration has had an influence on healthcare thinking that extends well beyond the practices themselves.
SOURCES & CITATIONS
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Shanafelt TD et al. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians. Mayo Clinic Proceedings. 2022. DOI: 10.1016/S0025-6196(21)00870-5. mayoclinicproceedings.org
Alexander GC, Kurlander J, Wynia MK. Physicians in Retainer ('Concierge') Practice. Journal of the American Medical Association (JAMA). 2005. DOI: 10.1001/jama.294.9.1149. jamanetwork.com
MD². Concierge Medicine Origins. md2.com/our-origins. Accessed 2026.
Adashi EY et al. Growth In Number Of Practices And Clinicians Participating In Concierge And Direct Primary Care, 2018–23. Health Affairs. 2025;44(12):1473–1481. DOI: 10.1377/hlthaff.2025.00656. healthaffairs.org
American Academy of Family Physicians (AAFP). Answers to Six Common Questions About Direct Primary Care. 2024 DPC data brief. Updated October 2025. aafp.org
MDVIP. 100 Consecutive Quarters of Growth. Press release. February 2026. mdvip.com
American Medical Association (AMA). Physician Burnout Rate Continues to Decline, Falling to Nearly 42%.2025. ama-assn.org
Commonwealth Fund. Administrative Burden in Primary Care: Causes, Potential Solutions. October 2025. commonwealthfund.org
CommonHealth Fund. Poor Prognosis: More Than One-Third of Burned-Out U.S. Primary Care Physicians Plan to Stop Seeing Patients. December 2024. commonwealthfund.org
Dalen JE, Alpert JS. Concierge Medicine Is Here and Growing. American Journal of Medicine. 2017;130(8):880–881. amjmed.com
Concierge Medicine Today. Industry Estimates — Concierge and Membership Medicine. 2026. conciergemedicinetoday.net
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ABOUT THIS ARTICLE
This article is part of the CMT Knowledge Library — an independent reference body documenting the concierge and membership medicine field for physicians, healthcare leaders, consultants, investors, and journalists. All articles include citations and are updated periodically. Content is for educational and informational purposes only.
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