Physician Perspectives on Concierge & Membership Medicine

My real joy is spending time with patients and trying to help them improve their health. In many practices, the high volume of patients that must be seen reduces the time clinicians can spend with each patient. Our model increases the time available for each patient encounter. I spend about 30 minutes with a patient during our average visit. This is the main reason that most patients give for returning to our practice. People are willing to spend money on something they value, and they value time with the doctor.

This new practice has been truly liberating. I am working harder than ever getting it off the ground but my time with patients is wonderful. And I get to be creative again in how I develop the practice, something that was lost from my previous office.

You will never regret being a doctor IF you work only for patients. But if you don’t work only for patients, you will regret your decision in the end.

My focus is on being a trusted advisor and I don't want to have any potential conflict of interests. For example, a lot of doctors make money on supplements, for me I take that out of the equation. In terms of my practice, I just want to focus on providing the best advice I can give my patients, not worrying about making money off retail.

We’ve always believed in being a patient’s ‘healthcare quarterback,’ so we negotiated highly competitive rates for lab and imaging services within our market. We determined the services most crucial to our patients, educated ourselves about available resources in our community, and created a list of options with full cost transparency.

We try to make it fit into your lifestyle instead of disrupt it. You call the office, you call my cellphone, you text me, email me and we set something up.

The conversion process is not an easy one, my staff and I are cognizant of the fact that we must consistently communicate the benefits of this choice in care, with the challenge to increase my [memberships] numbers and convert other patients.

I received a phone call the other day from a physician in Winter Park, Florida. She was calling just to thank me for answering her questions about [this industry] a few months ago, and encouraging her to start her own practice. Today, her practice is thriving and she said that ‘she is happy with her schedule, her life, and being able to practice medicine the way it is meant to be practiced.’ I was so happy to hear that I helped a fellow physician and colleague, and even more happy to hear that she was doing so well!

In the next 10 years, people are going to want: 1: Be diagnosed and treated within minutes, not days or weeks. 2: Ongoing relationships throughout a health issue. 3: At a price that seems reasonable to them.

The concierge model is a great option for physicians seeking more control over their time, their professional lives, and their ability to care for patients. But it is by no means a financial cure-all. My life is so much better now. It’s a big improvement. I’m enjoying the benefit of more time for my family and my kids, more time to do administrative stuff during the workday rather than after-hours. But it’s not like my financial woes suddenly disappeared, especially during the first year.

There is no substitute for a doctor who one knows and trusts, and who acts exclusively on behalf of one's own needs and interests. Fortunately, many people can have this type of care. For people who are enrolled in high deductible insurance plans, they can apply their annual retainer fee toward their deductible. For people who have flexible spending accounts, they can use the money from that account toward the annual retainer fee. My fee is less than the cost of a daily sandwich lunch or a monthly cable contract. I think if more of the public were aware of how affordable this care can be, more people would be clamoring for it. Access 24/7, prompt appointments, same or next day sick visits, unhurried visits, health care coaching, continuity and advocacy. What is there not to recommend this model of care?

While it is true, as the AP reported, that more and more patients are joining our practices nationwide, the number of patients is not just in the thousands already but in the millions. While it is true that concierge practice is exponentially on the rise, the current number of such doctors is not just in the hundreds but in the thousands, perhaps tens of thousands. Most are below the radar. They work quietly and are never counted by bureaucrats.

My vision is to cultivate a personal patient-doctor relationship amidst a bustling urban community where impersonal professional relationships are the norm. Our practice strives to deliver quality medical care with an emphasis on evidence based medicine, open communication, easy accessibility, and a focus on customer service. These benefits can lead to an overall improvement in how healthcare is delivered and may ultimately improve outcomes.

This is healthcare the way it should be, with zero compromises. It’s about being cared for in the way you would care for your own family member.

I am amazed we have received so much recognition that within a few years an entire field of ‘concierge’ practices emerged nationally. Our practice was designed around this ideology: provide the convenience, accommodation, and best-of-class service you expect from every service provider in your life. The very nature of these relationships necessitates we limit our practice to so few.

If you possess excellent communication skills, around the clock dedication and the desire to promote optimal health in pursuit of excellent medicine, then concierge medicine is for you. It’s the best career choice I’ve ever made.

Our phone trees, answering services, and after hours call-sharing doctors make it unlikely that any given patient will actually speak to their own doctor. So they don't bother, and they seek care wherever it is most convenient.

To those who say concierge doctors are hurting the system by diminishing the number of patients we can care for, my reply is: if you keep doing the same thing year after year, you are going to get the same results! If we don’t focus on salvaging the doctor-patient relationship and allowing the appropriate time for each patient’s care and follow-up, patients will begin to feel their primary care is a waste of time.

There was a time when patients valued their family doctor, trusted our opinion and called us after hours to help decide if symptoms needed urgent attention or could wait.

What I found interesting was that when I left my old practice, I had a 10% Medicare population. That fraction has grown to almost half, suggesting to me that some of the folks most interested in this model are older patients.

Patients were skeptical and reluctant because of how accessible and convenient the service was. They expected to be kept waiting on hold. Some seemed puzzled by the fact that when they called I answered the phone and knew who they were. One patient even inquired as to how come they only had one form to fill out. Direct-access primary care patients who have been referred post hospital discharge, have not been readmitted to the hospital in the last 4 years because I can see them without delay or red tape. In NYC, despite the high number of physicians per patient, particularly on the Upper East Side of Manhattan, direct-access primary care can still be a viable practice solution for patients and providers. It helps patients cut through the red tape that has become expected in accessing health care.

We recognized back in 2000 that health care was moving from personal to a more institutionalized form, and it wasn't what we wanted to do. We felt we needed to have time with our patients, to have the excellence to have the time with patients. Health care has been cutting reimbursement to doctors, which has forced doctors to see more patients, so the time doctors have with their patients have declined. The average time today with patients for most doctors is only 10 minutes.

It took me over 16 years of practicing medicine to finally realize the significance of this timeless painting. At the time, this painting was viewed as iconic due to the public’s desire to be cared for with a single-minded attentiveness. It brought the focus back to the doctor patient relationship. Simply put, it is about the physician being there for his patient. Letting this patient know they are not alone. Sometimes that is all we have to give, but it can be exactly what is needed.

I made the switch many years ago into concierge medicine, or at least a form of it, and I couldn't be happier. I can provide better care and build a strong relationship with my patients. It definitely can be challenging since I make myself available 24/7, however if you can develop a good support structure of other like-minded MDs you can maintain a successful business with less stress than a traditional practice.

It’s a different type of busy … My day is just as long now, if not longer. But, I’m spending a lot more time with all of my patients. In between visits, I’m on the phone checking on people at home.

Instead of just looking at blood, I’m looking at blood, urine, stool and saliva. Instead of just chemistry markers, I’m looking at chemistry, metabolomics (chemical fingerprints of cellular processes), genomics, microbiome (microorganisms), hormone tests, and I’m starting to look at immunology markers. That’s a very different experience. In a perfect world, your body is like the airplane and I’m the co-pilot and we’re using all these tools to identify if there are issues going wrong with the engine.

Running on the discount-insurance based hamster wheel is fatally destructive to doctor morale, patient care and the entire health system.

The art of medicine is the application of all this information and skills we learn and relaying this in a humane way to this one patient in front of you. Which is the only thing that matters at this moment. I am here for you is what each patient deserves to feel. This in my opinion is what separates the good doctor from the great doctor. That skill is innate. Those going into the field for the right reasons have this within them.

The heart of good medicine is care. I think the key to concierge medicine is the personal relationship between doctor and patient.

Selecting only a small population of clients and providing dedicated counseling sessions, sometimes as often as weekly, allows clients to actively participate in their care plan and to move goals forward at a real-time pace. This enables all of us to realize that healthcare can be a positive experience.

Slow and steady growth is ideal in this type of practice because it allows you to offer patients a personalized experience. I’ve found that the word-of-mouth aspect (vs. a billboard advertising approach) has been the most consistent factor in building my practice. I consistently have patients recommending their family members and friends. Getting word of mouth referrals based on high quality care, staff service and patient satisfaction has been a much more effective tool than traditional marketing. And the slow and steady approach ensures that staff can keep up with new patients, as opposed to getting a rush of new caseloads that would be more difficult to manage all at once.

Young doctors are refusing to go into primary care medicine. This is due to the fact that practicing primary care medicine in our current broken system, seeing 30 patients per day, making only one-third to one-fourth of what a specialist makes, have created an understandable shortage of doctors willing to practice primary care medicine. Over the long run, the only way to increase the number of qualified primary care doctors is to make the profession more attractive, both from a professional and financial perspective.

The genetic revolution has already begun, and it is having far-reaching effects on healthcare right now. Our knowledge of how to use this information is increasing at an exponential rate. What this means is that we can now start to integrate genetics into our everyday lives. With comprehensive genetic testing, we launch an innovative strategy against disease, attacking it before it even manifests.

I had to do this to be able to do my job. I get to practice the way I think I can practice best. It’s capitalism at its best.

Patients value speed and low cost most of all for most minor complaints. Even my patients who pay a membership fee … still use these [retail medicine style] health providers. Many patients say, ‘I just did not want to bother you on the weekend, and I was near there anyhow.’ As long as we live in a world of drive-through windows, ATMs, and garage door openers, patients are going to value and pay for any service that gets them in and out quickly, on their time schedule, with their desired objective. We need to learn to adapt, as this delivery model of care seems here to stay.

After being told repeatedly by video doctors that they can’t diagnose or treat what you’ve got and you’ve got to see a doctor in person, after you’ve spent $79, you’re probably just going to hedge your bets next time and instead go to the local urgent care center and blow $300.

I’m 60 years old now and I had to figure out how I could continue to practice medicine, enjoy it and enjoy my life at the same time. This is something I decided to try and see if it works, and so far, it’s working.

Being a good physician is not just about knowing how to diagnose and treat disease. Honestly, that's what books and studying is for. Being a good doctor entails earning the trust of your patients by being honest and forthcoming. It means knowing how to communicate effectively while still remaining sympathetic. It requires you, first and foremost, to be a human being. Put down the book and go talk to your patient. Be a human being. Be a friend. It’s really that simple.

Preventative medicine is now our top priority. The upfront costs associated with genetic testing, inflammatory testing, etc. pales in comparison to the cost of treating chronic disease. Stakeholders are realizing that it is more important to invest in technologies that detect disease at an earlier stage when it is less challenging to treat effectively.

Since 2005, I have been providing comprehensive primary care to families and individuals of all ages in San Francisco. Through mutual respect, careful listening, and collaborative communication, I have built strong long-term relationships with patients and health care providers in the community.