Panel Size, Fee Structure, and the Economics of Sustainable Care

Category: Economics   |   Publication: Concierge Medicine Today, 2026

Format: Leadership Education Article   |   Audience: Physicians, Practice Leaders, Healthcare Executives

URL: https://conciergemedicinetoday.com/leadership-hub/lh-ec-02-panel-size-fee-structure

HOW TO CITE: Concierge Medicine Today. “Panel Size, Fee Structure, and the Economics of Sustainable Care.” CMT Leadership Hub. 2025. https://conciergemedicinetoday.com/leadership-hub/lh-ec-02-panel-size-fee-structure

DISCLAIMER: Articles from the CMT Leadership Hub may be cited as educational resources. Content is for educational and informational purposes only and does not constitute medical, legal, or financial advice. For media inquiries or academic research requests, contact the CMT editorial team directly.

ABSTRACT Panel size and membership fee structure are the two most consequential financial decisions a concierge physician makes. This article examines the relationship between these variables, provides a framework for projecting financially viable panel configurations, and discusses the operational and relational implications of different panel size targets. Common errors in panel planning — both too aggressive and too conservative — are addressed with reference to CMT benchmarking data and published direct-care practice research.

KEYWORDS: panel size, membership fee, concierge medicine economics, direct primary care finances, practice planning, physician income, sustainable practice

1. PANEL SIZE AS A LEADERSHIP DECISION

Panel size in concierge medicine is not merely a financial variable. It is a statement of what the physician believes the physician-patient relationship requires. A panel of 150 patients signals a different relational commitment than a panel of 600. The fee structure required to support each panel at a given income level is a function of that relational philosophy, not only a financial calculation.

Physicians should determine their target panel size by first defining what the relationship they are offering actually requires in terms of physician time, then calculating the revenue necessary to support the practice at that service level, and only then setting the membership fee.

2. A PANEL PLANNING FRAMEWORK

A simplified panel planning framework:

1.     Define annual physician income requirement + estimated practice overhead = total annual revenue needed.

2.     Divide total annual revenue needed by intended annual membership fee = required panel size.

3.     Evaluate whether required panel size is consistent with the physician availability and relational quality the membership promises.

4.     Adjust fee or panel size target until the three variables are mutually consistent.

Example: A physician targeting $300,000 in net income with $100,000 in overhead requires $400,000 in annual revenue. At a $2,500 annual membership fee, this requires 160 patients. At $150/month DPC pricing, it requires approximately 222 patients. Each configuration implies different relational capacities and operational designs.

3. COMMON PANEL PLANNING ERRORS

3.1 Setting the Fee Too Low

Physicians who set membership fees conservatively to minimize patient resistance frequently find that they must either carry more patients than the model comfortably supports, or operate at income levels below their financial requirements. Fee adequacy should be calculated from revenue requirements, not from guesses about what the market will accept.

3.2 Growing the Panel Too Quickly

Panel growth that outpaces the physician’s operational capacity to honor the membership’s promises produces early attrition, patient dissatisfaction, and reputational damage that undermines subsequent growth. Sustainable panel-building is deliberate, not maximally aggressive.

3.3 Failing to Review Fee Adequacy Annually

Membership fees set at practice launch should be reviewed annually against inflation, overhead changes, and practice evolution. Practices that fail to adjust fees over time find themselves financially constrained in ways that compromise service quality.

4. PANEL MIX CONSIDERATIONS

Beyond size and fee, panel composition — age, chronic disease burden, utilization patterns — affects the physician’s actual time commitment per patient and therefore the practical capacity of the panel. Practices with panels heavily weighted toward complex, multi-morbid patients may need smaller panels at equivalent fee levels to maintain service quality.

REFERENCES

1.  Garrison GM, et al. Direct primary care: qualitative evidence from physician practices. Journal of Primary Care & Community Health. 2019;10. https://doi.org/10.1177/2150132719875943

2.  Concierge Medicine Today. Panel benchmarking survey. https://conciergemedicinetoday.org

3.  Hint Health. State of Direct Primary Care Report. https://www.hint.com/state-of-dpc