The Equity Challenge: Expanding Access to Relationship-Based Care

Category: Future of the Field   |   Publication: Concierge Medicine Today, 2025

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

URL: https://conciergemedicinetoday.com/leadership-hub/lh-ff-03-equity-access

HOW TO CITE: Concierge Medicine Today. “The Equity Challenge: Expanding Access to Relationship-Based Care.” CMT Leadership Hub. 2025. https://conciergemedicinetoday.com/leadership-hub/lh-ff-03-equity-access

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 The most persistent critique of concierge and membership-based medicine is that it restricts access to high-quality primary care to those who can afford a membership fee, potentially worsening healthcare inequality. This article examines the equity challenge honestly, evaluates the structural mechanisms through which the field has attempted to broaden access, and presents the leadership argument that the best concierge physicians engage this challenge directly rather than dismissing it. The article also examines the systemic argument: that physician burnout and the flight from primary care worsens access for everyone, and that a sustainable physician workforce requires practice models that sustain physicians.

KEYWORDS: healthcare equity, concierge medicine access, DPC equity, physician burnout, healthcare inequality, membership medicine, access to care

1. ACKNOWLEDGING THE CRITIQUE HONESTLY

CMT’s editorial approach to the equity critique is direct: the critique is legitimate and deserves honest engagement, not dismissal. A physician who charges $3,000 annually for membership access to primary care has, by definition, made that access unavailable to patients who cannot afford $3,000. That is a real limitation with real implications for healthcare distribution.

Physician-leaders in concierge medicine who dismiss this critique, or who respond only with the point that they have the right to set their own fees, are missing a leadership opportunity and a moral obligation.

2. THE SYSTEMIC COUNTERARGUMENT

The strongest counterargument to the equity critique is systemic rather than individual. The U.S. primary care physician shortage is documented and growing: the Association of American Medical Colleges projects a shortage of up to 48,000 primary care physicians by 2034 [1]. A primary care workforce that is burning out at rates exceeding 50% is not a workforce that can serve anyone well — regardless of income.

Concierge and direct primary care models, by creating sustainable physician practice conditions, contribute to the retention of physicians in primary care who might otherwise leave the specialty or exit medicine entirely. The equity argument for sustainable physician practice models is that burned-out physicians and physicians who leave primary care serve no patients.

3. ACCESS EXPANSION MECHANISMS

The field has developed several structural mechanisms for broadening access to relationship-based primary care:

•       Lower-fee DPC models ($25–$75/month) that bring membership primary care within reach of working-class and middle-income patients.

•       Employer-sponsored access programs that fund membership for employees across income levels as a health benefit.

•       Sliding scale DPC practices that adjust fees based on patient income, serving populations that traditional concierge practices cannot reach.

•       Federal and state legislative proposals to allow DPC membership fees to be funded through health savings accounts, flexible spending accounts, and Medicaid managed care contracts.

4. THE LEADERSHIP RESPONSIBILITY

Physician-leaders in concierge medicine have a leadership responsibility to engage the equity challenge rather than evade it. That engagement may take different forms for different physicians: designing a practice that includes sliding-scale options, advocating for legislative access expansion, contributing to the field’s collective dialogue about equity, or simply being honest about the limitations of their practice model while articulating the systemic problems it addresses.

“The goal is not to promote one model over another, but to explore lessons that improve healthcare broadly.”

REFERENCES

1.  Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. https://www.aamc.org

2.  DPC Alliance. Sliding scale and access-focused DPC resources. https://www.dpcare.org

3.  Concierge Medicine Today. Equity and access editorial coverage. https://conciergemedicinetoday.org