The Most Popular Model in the Room: Understanding Second Generation, Personalized Care Medicine
Not Bespoke. Not DPC. This Is the Version Most Physicians Choose — and Most Patients Never Knew Existed.
By Concierge Medicine Today | Knowledge Center | Educational Content © 2007–2026 Concierge Medicine Today, LLC. All rights reserved.
Educational resources provided by Concierge Medicine Today are designed to support professional learning and informed decision-making for physicians and practitioners. Content is offered for educational purposes only and does not constitute medical, legal, or financial advice.
The Version the Headlines Keep Missing
If you have read a news article about concierge medicine in the past ten years, there is a good chance it described one of two things: a physician in Manhattan or Beverly Hills charging $40,000 a year to shadow billionaires on yachts, or a low-cost, no-insurance, direct primary care practice charging $75 a month and championing a cash-only revolution.
Neither of those is the most common version of concierge medicine in America today.
The most common version — the one most physicians choose when they make the transition, the one most patients quietly join when they decide their current doctor's office is no longer working for them — sits confidently between those two poles. It is not bespoke luxury medicine, and it is not a stripped-down cash-only subscription. It is what the industry has come to call the Personalized Care Model, or PCM — and it is the quiet engine driving sustained growth across the concierge and membership medicine landscape.
"Although concierge medicine started out as a concept for the affluent nearly 20 years ago, over time, the PCM models in the subscription-based and membership medicine space have taken a decidedly middle-class turn — and a lot of people don't recognize that," says Michael Tetreault, Editor-in-Chief of Concierge Medicine Today, the industry's independent trade publication. "The average consumer today no longer equates concierge medicine with only the affluent. From the mid-1990s to present day, concierge medicine has matured into countless less expensive and affordable subscription-based healthcare delivery service variations within our local communities."
What a Personalized Care Model Actually Is
The Personalized Care Model is, in structural terms, the second generation of subscription-based healthcare delivery in the United States. It evolved from the original bespoke concierge model of the 1990s — borrowing its foundational philosophy of smaller patient panels, direct physician access, and an emphasis on the physician-patient relationship — while adapting that philosophy for a far broader patient population and a more sustainable physician business model.
In practice, PCMs share several defining characteristics:
Annual membership fees typically range from $1,500 to $2,800 per patient, though regional variation exists. This places the model well within reach of middle-class and upper-middle-class households — not a niche product for the ultra-wealthy, but a genuine healthcare choice available to a wide range of working Americans.
Patient panels are intentionally and structurally limited to 200–600 patients per physician. This is the mechanism that makes everything else possible. In a traditional, insurance-reimbursed primary care practice, physicians routinely carry panels of 2,000 to 3,000 patients — and the administrative and scheduling pressure that comes with that volume leaves little room for the kind of extended, unhurried care that defines the concierge experience. (Rittenhouse, D.R. & Shortell, S.M., 2009; JAMA; "The Patient-Centered Medical Home")
Same-day or next-day appointments are standard, not exceptional. Patients are not triaged through voicemail trees or scheduled six weeks out for a concern that is worrying them today.
Extended visit times — typically 30 to 60 minutes compared to the national average of 13–16 minutes in traditional primary care settings — allow physicians to address the whole patient rather than the symptom of the day. (Tai-Seale, M. et al., 2017; Annals of Family Medicine)
Direct physician communication — by phone, text, or secure messaging — is a built-in feature of the model, not an add-on premium.
Most PCM practices also continue to accept insurance for covered services, meaning the membership fee covers access and time, while insurance handles procedures, labs, and specialist referrals within the existing coverage structure. The American Academy of Private Physicians estimates approximately 75% of concierge medicine practices accept insurance alongside their membership fees — a fact that is routinely overlooked in media coverage that frames the entire model as a cash-only proposition. (AAPP, as cited in Software Advice, 2023; softwareadvice.com)
The Sweet Spot in the Marketplace
Concierge Medicine Today estimates there are currently approximately 2,000 or more PCM-style practices operating in the United States, many of them aligned with national conversion enterprises and organizational consultancies that assist physicians in transitioning compliantly into membership-based practice structures. These organizations — including well-established names in the space — provide operational support, legal structuring guidance, patient communication frameworks, and ongoing management infrastructure that lowers the barrier to entry for physicians who want to make the transition but are not certain how to build the infrastructure themselves.
Three primary business model structures are used by physicians operating in the PCM space:
Full Conversion: The practice transitions its entire patient panel to a membership model. Patients who choose not to join the membership are referred to other providers.
Hybrid Model: The practice maintains a portion of its traditional, insurance-billed patient panel while opening a separate membership tier for patients who want enhanced access.
Segmented Model: The practice creates distinct service levels within the practice — differentiating between standard and enhanced-access patients — allowing for gradual transition rather than full conversion. (SignatureMD, 2025; signaturemd.com)
Each model carries different financial, operational, and compliance considerations. Physicians exploring the space are well-served by working with experienced legal and consulting advisors before selecting a structure.
"I would define it simply by saying that physicians elect to reduce their patient panels to much more manageable sizes so they can provide the care their patients deserve," explained one CEO of a national concierge medicine conversion company to Medical Economics. "The practice size typically is reduced from 2,000 to 3,000 patients to 300 to 500. The practice becomes more manageable at that size, and as our affiliated doctors tell us, they have the time to think, plan, dig deeper with their patients, and really focus on health, wellness, and disease management — not just the symptom of the day." (Mazzolini; Medical Economics, 2023)
Who the PCM Patient Actually Is
The target audience for second-generation concierge medicine is not the ultra-high-net-worth individual of the bespoke tier. It is the middle-class and upper-middle-class patient who has grown quietly exhausted by a healthcare system that feels impersonal, rushed, and reactive.
Research identifies four primary patient segments driving PCM adoption:
Middle and upper-middle-class patients seeking individualized attention that the traditional system no longer provides — people who are employed, insured, and still frustrated. (Ralston, R., 2021; Journal of Personalized Medicine; "Personalized Medicine: A Paradigm Shift in Healthcare")
Chronic disease patients who require consistent, attentive management of conditions like diabetes, hypertension, cardiovascular disease, or autoimmune disorders — conditions where the difference between good and poor outcomes often comes down to physician contact time and continuity. (Zhai, P. & Harris, J., 2020; American Journal of Managed Care; "The Future of Personalized Healthcare")
Health-conscious individuals who prioritize preventive care, wellness planning, and proactive health management — patients who want a physician relationship built on staying healthy, not just treating illness.
Aging populations — older adults managing multiple chronic conditions who need a physician who knows their full picture, not a rotating cast of urgent care providers who have never seen their chart.
The conversion company CEO quoted above put the market demographics plainly: "A median household income above $75,000 and a median household net worth of $250,000 has proven to be sufficient for patients to make this valuable investment in their health. I don't want anyone thinking this is only for people in Beverly Hills or New York City." (Mazzolini; Medical Economics, 2023)
This matters. It pushes back against the persistent narrative that concierge medicine is a product of privilege, and repositions it as a product of choice — a deliberate decision by patients who have weighed the cost of enhanced access against the cost of continued frustration and decided the investment is worth it.
The Research Behind the Model
The question of whether PCM-style concierge medicine actually produces better health outcomes is no longer a matter of anecdote or ideology. It is a matter of data — and the data is increasingly clear.
A landmark 2020 study from MDVIP found that the personalized primary care model substantially decreased costs for diabetic patients, including measurable reductions in unplanned hospital admissions, emergency room visits, and outpatient expenditures. By year five of enrollment, MDVIP patients showed statistically significant lower Medicare expenditures compared to a matched comparison population — not because they were receiving less care, but because they were receiving more preventive care earlier. (MDVIP, 2020; mdvip.com)
A 2016 peer-reviewed study published in Population Health Management reinforced these findings, demonstrating that a primary care model anchored in personalized preventive care achieved definitive cost savings and improved health management within three years of adoption. These results confirmed earlier research published in the American Journal of Managed Care (2012) proving the same pattern. (MDVIP/Population Health Management, 2016; AJMC, 2012)
A separate MDVIP-affiliated study documented a dramatic reduction in hospitalizations and an estimated $300 million in savings attributable to increased physician contact time in membership-based practices. (MDVIP, 2012, 2013)
The mechanism behind these outcomes is not mysterious. When a physician has 300 patients instead of 2,500, they have the structural capacity to catch things early, follow through on referrals, check in proactively, and know which patient is likely to skip their follow-up if no one calls. That capacity does not exist at traditional panel sizes regardless of how skilled or motivated the physician is.
A 2018 study published in BMJ Open made the continuity-of-care case broadly: greater continuity with a personal physician was associated with lower rates of emergency hospital admissions and reduced mortality across patient populations. (Pereira Gray, D. et al., 2018; BMJ Open)
Why Physicians Choose This Model
The clinical outcomes data is compelling. But for physicians considering the PCM transition, the more immediate question is often personal: What will this do for my career, my workload, and my relationship with why I went into medicine in the first place?
The current state of traditional primary care in the United States provides the context. A 2024 MDVIP/Ipsos survey found that 60% of primary care physicians feel they need to rebuild trust with patients in the post-pandemic period, and that 1 in 3 patients are reaching a "burned out" threshold on a Patient Frustration Index measuring common healthcare pain points across major demographic groups. (MDVIP/Ipsos, 2024; mdvip.com)
Physician burnout has become one of the defining challenges of American medicine. The American Medical Association has documented that more than 50% of U.S. physicians report at least one symptom of burnout, with primary care physicians among the most affected specialties. Administrative burden, loss of autonomy, inadequate patient contact time, and moral injury — the gap between the medicine a physician wants to practice and the medicine the system allows — are consistently cited as the primary drivers. (AMA, 2023; ama-assn.org)
The PCM structure addresses these drivers directly and structurally, not aspirationally. Fewer patients means less administrative volume. Direct relationships mean less intermediary friction. Sustainable revenue from membership fees means less dependence on reimbursement cycles that reward volume over value. As one concierge physician noted at a recent Concierge Medicine Forum gathering: "I still work long hours and into the night. I just use my time differently now — and I'm a lot happier. And so are my patients, my team, and my family."
Still Growing — and Still Leading
It is worth stating plainly what the market data confirms: concierge medicine — and the PCM model specifically — has not been displaced or diminished by the emergence of direct primary care or other low-cost subscription alternatives. It remains the dominant and most widely adopted form of subscription-based healthcare delivery in the United States.
Grand View Research estimates the concierge medicine market will grow at more than 10% annually through 2030, driven by increasing patient volume, financial stability from reduced insurance dependence, and improving physician quality of life. (Eastwood, B.; HealthTech Magazine, December 2022; healthtechmagazine.net)
Concierge Medicine Today applies a more conservative estimate of 6–7% year-over-year growth based on direct industry observation, physician interviews, and expert outlook — a figure that deliberately avoids the evangelistic projections that sometimes characterize industry reporting in this space.
Precedence Research, in a December 2023 press release published on Globe Newswire, reported that the U.S. concierge medicine market grew from $6,633.91 million in 2023 to $6,958.51 million in 2024, expanding at a compound annual growth rate of 5.70% through 2032. The global concierge medicine market is projected to surpass $34.27 billion by 2032, up from $19.12 billion in 2023. (Precedence Research, 2023; globenewswire.com)
These are not the numbers of a niche trend fading under competitive pressure. They are the numbers of a model that has proven its value to physicians and patients alike over three decades, and that continues to attract new entrants at a steady pace.
A Disruptive Innovation — By Definition
Understanding why the PCM model has grown as consistently as it has requires understanding something about how markets evolve when incumbent systems fail to adapt.
Clayton Christensen's foundational work on disruptive innovation — first published in The Innovator's Dilemma (1997) and expanded substantially in subsequent research — describes a pattern that appears repeatedly across industries: a new model emerges, often in an underserved or overlooked segment of the market, offering a simpler or more accessible alternative to the incumbent. Critics from within the established system dismiss it. Early adopters prove its value. The model scales. The incumbent eventually faces the reckoning it spent years avoiding. (Christensen, C.M., 1997; Harvard Business School Press)
"No matter how one perceives or understands concierge medicine, most people's first reaction to these novel healthcare delivery concepts is typically curiosity," Tetreault told a gathering of physicians in Atlanta. "It's no surprise that much of the criticism directed at these business models comes from a small group of entrenched healthcare professionals who overlook a well-known and essential business principle: disruptive innovation."
The examples are familiar — Netflix displacing video rental, Uber reshaping transportation, TopGolf redefining the driving range experience. None of these companies asked for permission from the industries they disrupted. They identified underserved demand, built a model that served it better, and let the results speak. (Christensen, C.M., Horn, M.B. & Johnson, C.W., 2008; McGraw-Hill)
"The concept of fairness has not proven effective in healthcare," Tetreault continued. "We must move beyond fairness and actively engage with those waiting on the other side of the exam room. Concierge medicine has revitalized the careers of many physicians — and to those who argue that it worsens the physician shortage, I would emphasize that five words from my doctor carry immense weight. It costs little to support a physician's entrepreneurial ideas."
The Most Common Myth
The most persistent myth about second-generation concierge medicine is the same one that has shadowed the entire industry since its inception: that it is a product exclusively for wealthy patients, practiced by physicians who have turned their backs on the broader community.
"If you were to ask me how most headlines about concierge medicine should accurately read," says Tetreault, "I would say this: 'The existence of a wealthy clientele in urban areas prompts a few healthcare practices to develop and promote luxury health services — but there's also less expensive and very affordable programs and practices out there too.'"
The median household income threshold cited by industry conversion leaders — $75,000 annually, with a net worth of approximately $250,000 — describes a demographic that includes teachers, nurses, engineers, small business owners, and skilled tradespeople. It describes, in short, the American middle class. And it describes a population that is increasingly choosing to make a direct, personal investment in their own healthcare rather than accept the default of a system that has demonstrably failed to prioritize their time, their relationship with their physician, or their preventive care.
"Annual fees today in most concierge medicine practice environments simply reflect the level of personal attention and service that a doctor provides," says Tetreault. "And noticeably, patients are deciding to make a personal investment in their own healthcare. It's no longer about being the best doctor in the world. It's about being the best doctor for the world, for your patients, and for your local community."
Further Reading and Resources
Ralston, R. (2021). "Personalized Medicine: A Paradigm Shift in Healthcare." Journal of Personalized Medicine.
Zhai, P. & Harris, J. (2020). "The Future of Personalized Healthcare." American Journal of Managed Care.ajmc.com
Christensen, C.M. (1997). The Innovator's Dilemma. Harvard Business School Press.
Christensen, C.M., Horn, M.B. & Johnson, C.W. (2008). Disrupting Class. McGraw-Hill.
MDVIP. (2020). Personalized Primary Care Reduces ER Visits, Hospitalizations, and Outpatient Expenditures for Diabetic Population. mdvip.com
MDVIP/Population Health Management. (2016). Personalized Preventive Care Yields Decreased Costs and Better Health Management. liebertpub.com
AJMC. (2012). Personalized Preventive Care Leads to Significant Reductions in Hospital Utilization. ajmc.com
MDVIP/Ipsos. (2024). Patient Frustration Index Survey. mdvip.com
AMA. (2023). Physician Burnout Data. ama-assn.org
Pereira Gray, D. et al. (2018). "Continuity of Care With Doctors — A Matter of Life and Death?" BMJ Open.bmjopen.bmj.com
Tai-Seale, M. et al. (2017). "Time Allocation in Primary Care Office Visits." Annals of Family Medicine.
Eastwood, B. (December 2022). "Concierge Medicine Creates Better Patient Outcomes." HealthTech Magazine.healthtechmagazine.net
Precedence Research. (December 2023). U.S. Concierge Medicine Market Size Forecast. globenewswire.com
Mazzolini, C. (2023). How Would You Define Concierge Medicine? Medical Economics. medicaleconomics.com
SignatureMD. (2025). Eight Steps for Transforming Your Practice to a Concierge Model. signaturemd.com
AAPP / Software Advice. (2023). Concierge Medicine Salary and Definition. softwareadvice.com
Rittenhouse, D.R. & Shortell, S.M. (2009). "The Patient-Centered Medical Home." JAMA.
© 2007–2026 Concierge Medicine Today, LLC. All rights reserved. CMT is an independent publication and is not affiliated with any health system, hospital network, or vendor organization. Content is for educational and informational purposes only and does not constitute medical, legal, or financial advice.