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Starting From Zero: The First 18 Months of a New Concierge Practice
Most concierge advice assumes you already have a panel to convert. Opening a new practice from scratch is a different decision. Nobody is left behind, but nobody is waiting for you either. The climb to a sustainable membership takes longer. This brief lays out what the first 18 months require, with a checklist for the decisions that should be settled before you sign a lease.
New in October 2026. Built on the launch chapters of CMT’s books, checked against current federal guidance and national data.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
Starting a concierge practice from zero trades one problem for another. You avoid the hardest part of a conversion, the patients who do not follow you, but you open without the loyal panel that conversion advisors screen for. So the cash runway and the marketing plan carry more weight. National data show most new health care establishments survive their first year, but only about half are still open five years later. A realistic new practice spends months on clarity, advisors, structure and registrations before opening. Then it builds membership over a period that can run past 18 months.
“We’ve seen concierge medicine succeed in every career stage.”
Should I start a new practice or convert my existing one?
It depends on what you bring with you. Conversion starts with patients who already trust you but leaves some behind; a new practice leaves no one behind but starts with no members. Part 1 compares the two side by side.
Go to the full answer ↓What happens in the first 18 months?
Roughly: clarity and advisors, then structure and money, then systems and registrations, then opening and the first members, then an honest review against plan. Part 2 has the month-by-month timeline.
Go to the full answer ↓How much money and runway do I need?
No verified, current figure exists for concierge start-up costs, so CMT does not publish one. Federal small business guidance says to count at least a year of monthly expenses and to know your break-even point. Part 3 includes a break-even calculator.
Go to the full answer ↓What registrations and rules apply to a new practice?
A business entity under your state’s rules, an NPI, a deliberate Medicare decision (enroll or opt out), payer credentialing if you bill insurance, a membership agreement reviewed by counsel, and HIPAA and compliance basics. Part 4 walks the sequence.
Go to the full answer ↓How do I know if I am ready?
Use the launch readiness checklist in Part 5. It tracks the decisions that should be settled before you sign a lease or announce an opening date.
Go to the full answer ↓Two roads into concierge medicine
CMT’s 2022 book framed it as a choice between starting up and starting over. Most of the industry’s playbook was written for the second path, converting an established practice, and its screening questions show it. Advisors look for years in the same community and a large panel of patients seen in the last two years.1 Practice Insight A physician opening a new practice has, by definition, none of those advantages on day one.
That physician is also swimming against a national current. Fewer physicians work in private practice or own a stake in one than a decade ago, and membership practices themselves are increasingly affiliated with larger organizations.2,
Start from zero or convert: what changes
| Question | Converting an existing practice | Starting a new practice | Evidence type |
|---|---|---|---|
| Who are your first members? | Existing patients who choose to join; advisors screen for a large, loyal panel | Nobody yet. Every member is recruited from the community | Practice Insight |
| Who is left behind? | Patients who do not join, with ethical and state-law duties to help them transition (Brief No. 32) | No existing panel is displaced, though leaving an employer can carry its own notice and contract duties | Policy and Law |
| When does revenue start? | Insured revenue may continue during the transition | Only after opening, enrolling and, if you bill insurance, credentialing | Practice Insight |
| What does the brand rest on? | Your local reputation, already earned | A reputation you build in public, from the first phone call | Practice Insight |
| Where is the risk? | Patient attrition and community reaction | Cash runway and the pace of enrollment | Practice Insight |
One consultant quoted in CMT’s 2025 book put the contrast bluntly, arguing that the risks are “far greater” when a physician builds a concierge program from scratch rather than converting with experienced help.5 That is one adviser’s view, and advisers who run conversions have a stake in it. The other side of the ledger is real too: the patients left behind are the most criticized part of conversions, and a new practice does not create that problem.6 Critics also argue that membership medicine concentrates physician time on fewer patients; a 2023 study of conversions in the Journal of Health Economics found that patients of converting physicians used more care and that costs rose.7 Population Data A new practice adds a physician to the membership market without removing one from an existing panel, though the physician may still be leaving patients behind in a former job.
Start by listing what you will bring to day one: patients who would follow you if your contract allows it, referral relationships, a community that knows your name, a spouse or partner who supports the plan, and months of personal expenses you can cover with no practice income. The fewer of these you bring, the longer and more carefully the first 18 months need to be planned.
Eighteen months, from decision to a working practice
CMT’s Editor-in-Chief estimates that the average runway for preparing a membership practice is 12 to 18 months, and says the first steps are about clarity and trusted advisors rather than contracts.8 Industry Research The timeline below sequences that work for a physician who starts with no panel. It is CMT’s editorial sequence, built from the sources in this brief, not a standard; your attorney or your state’s rules may reorder it.
Decide why, and who decides with you. CMT’s 2022 book urges physicians to ask “how” before “how much,” and treats the agreement of a spouse or partner as a precondition.1 Choose the model; Brief No. 37 compares them. Then engage a health care attorney and an accountant. Counsel should read your current employment contract before you give notice, especially any non-compete and malpractice tail provisions.
Fight the battle on paper first. Study the community you will serve, then write a business plan. SBA describes a traditional plan, which lenders commonly request, and a one-page lean plan, and says the traditional version should include a funding request and financial projections.9,
Form the entity and fund the runway. SBA notes that business structure affects taxes, liability, paperwork and the ability to raise money, and that rules vary by state; in states that follow the corporate practice of medicine doctrine, ownership rules for medical practices are stricter.10,
Get identified, then decide on Medicare. Obtain an NPI through NPPES, then either enroll in Medicare through PECOS or file an opt-out affidavit and use private contracts.12,
Build what members will touch. Membership agreement reviewed by counsel, records system, phones and secure messaging, a HIPAA security risk analysis and written compliance basics.14,
Recruit founding members and open. Word of mouth alone is not a launch plan; CMT’s 2022 book calls “if you build it, they will come” a poor growth strategy.1 Train the first team in service, because in a new practice every first impression is the brand.16
Track enrollment against plan, monthly. Protect the access promise as members arrive. Before the first annual renewals come due, hold a formal review. A consultant quoted in CMT’s 2025 book described a lean period after start-up and said building the panel often takes about two years.5 Plan for the climb to continue past month 18.
How long the money has to last
There is no current, methodology-disclosed figure for what it costs to open a concierge practice, and CMT does not repeat older consultant estimates as if they were today’s numbers. What the evidence does offer is a sober base rate for new businesses, and a federal method for working out your own numbers.
New health care establishments do slightly better than private businesses overall, but about 45% of those that opened in 2013 were gone within five years.17 Population Data CMT’s reading: failure tends to come later, when enrollment grows more slowly than the plan assumed and the runway runs out.
Work out your own numbers
SBA advises counting one-time start-up costs plus at least one year of monthly expenses, and ideally five, and defines the break-even point as fixed costs divided by price minus variable costs.18 Policy and Law For a membership practice, the “price” is the monthly value of a membership, and the answer is the number of members you need before the practice covers its costs.
Break-even and runway calculator
The starting numbers are placeholders, not benchmarks. Replace them with figures from your own plan and your accountant.
How physicians have funded launches
When CMT asked concierge physicians how they financed their start, the most common answers were personal savings and assets, extra clinical shifts, credit union or bank loans, and revenue saved from a prior practice.1 Practice Insight
The same chapter warns against spending all your time raising money while the concept itself goes undeveloped.
What federal programs offer
SBA does not lend directly except after declared disasters; it shares risk with partner lenders. Its 7(a) program is its main long-term financing program, and its microloans run up to $50,000.19 Policy and Law
Lenders typically want the traditional business plan described in Part 2.9
Keep fixed costs low
CMT’s 2022 book names leased space as a major expense for concierge practices and advises against taking on more space than the model needs, and against full-time hires before the model is proven.1 Practice Insight
Plan for the “what if”
CMT’s 2025 book asks every physician changing careers the question platitudes skip: what does your financial runway look like if it does not pan out, and what is your exit plan?5 Practice Insight
The registrations and rules, in the order they bite
A converting physician inherits most of this infrastructure. A new practice builds all of it. The sequence below is general education from official sources, not legal advice; state law varies, and a health care attorney should confirm each step.
SBA says the structure you choose affects taxes, personal liability, paperwork and your ability to raise money, and that rules vary by state.10 Medical practices add a layer: in states that follow the corporate practice of medicine doctrine, licensed clinicians, not lay corporations, must own for-profit practices, and some states are tightening these rules.11
CMS lists the steps: obtain a National Provider Identifier through NPPES, then complete enrollment online through PECOS (or on paper if you cannot), pay any application fee, and work with your Medicare Administrative Contractor.12
Opting out requires a written affidavit filed with your contractor and a private contract with every Medicare patient; the opt-out renews automatically every two years unless you cancel at least 30 days before it ends.13 If you enroll and bill Medicare instead, a membership fee may cover only services Medicare does not cover.20 Brief No. 33 covers both paths in depth.
The AMA asks physicians in retainer practices to explain clearly what the fee covers and to keep membership charges separate from insured services.6 For a new practice, the agreement is also the first document every member signs, so it shapes trust from the start.
The HIPAA Security Rule requires covered entities to conduct a risk assessment; the federal Security Risk Assessment Tool is designed for small and medium providers.14 OIG’s voluntary General Compliance Program Guidance describes the seven elements of a compliance program and how small entities can adapt them.15 Brief No. 36 covers cybersecurity for small membership practices.
If you will bill commercial insurers, payer credentialing is a separate process from Medicare enrollment, and each plan sets its own requirements and timing. Start it as soon as your entity and NPI exist, and do not schedule insured patients until each contract is in effect. That is CMT’s editorial reasoning, not a legal standard; confirm timing with each payer.
Before you sign the lease
Check what is true today. The list follows the 18-month timeline, and the meter shows how much of the foundation is in place before you commit to a lease or an opening date. It is a planning aid, not professional advice. For a broader look at fit and model, try CMT’s Readiness and Model Check tool.
Launch readiness checklist
Clarity and advisors
Plan and money
Registrations and systems
CMT survey data on concierge physicians who opened a new practice rather than converting: time from decision to opening, time from opening to break-even, member counts at 6, 12 and 18 months, and how each launch was financed. Report sample size, dates and recruitment method, and report concierge and DPC respondents separately.
Editor: replace this box with CMT survey results (with sample size, dates and recruitment method) before publishing, or delete it.
Know your base rate
Most new health care establishments survive year one. Only about half reach year five, and that is the figure to plan around.
Build on paper first
Finish the business plan, break-even math, runway and registrations before you sign a lease or announce a date.
Lead from the first call
In a new practice there is no reputation to fall back on. Every member’s first experience is the brand you are building.
How this brief was built
CMT started from the launch and start-up chapters of its own books: The Doctor’s Guide to Concierge Medicine (Expanded Edition, 2022), Chapters 5, 7 and 8; Branded: the Concierge Medicine Doctor (2025); and No More Waiting Rooms (2024). These are labeled CMT original and typed Practice Insight because they compile physician interviews and consultant commentary. Older dollar figures in those books reflect the market at the time of writing and are not reused here as current data. CMT then checked the operational steps against federal guidance (U.S. Small Business Administration, CMS, HHS OIG, ONC), the AMA Physician Practice Benchmark Survey, the U.S. Bureau of Labor Statistics Business Employment Dynamics program and peer-reviewed research. Every external source was opened in October 2026.
This brief concerns concierge practices. Combined counts of concierge and direct primary care (DPC) practices are labeled “concierge and DPC combined.” No DPC-only figures are used. Business survival data from BLS describe all health care and social assistance establishments, not concierge practices specifically, and are labeled as such. The timeline and both interactive tools are CMT editorial aids. They are not standards or professional advice.
How to read the evidence types
Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.
Randomized trials and systematic reviews.Best for cause and effect.
Large observational studies and government data.Best for trends at scale.
Surveys, smaller studies and expert consensus.Best for real-world experience.
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.
Statutes, regulation and official guidance.Best for what is required.
What we don't know
- How many concierge practices open each year as new practices rather than conversions. No public dataset separates them.
- Survival and time-to-break-even for new concierge practices specifically. The survival data in this brief cover all health care and social assistance establishments.
- Current, methodology-disclosed start-up cost ranges for concierge practices. Figures circulating in the field are consultant estimates of varying age.
- How enrollment ramps differ by market, specialty, fee level and marketing spend for a practice that opens with no existing panel.
How to cite this brief
External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.
Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.
Related CMT Research Briefs
References
- Concierge Medicine Today (Tetreault M, Sykes C). The Doctor's Guide to Concierge Medicine, Expanded Edition (hardcover). Chapter 5, Start Up, Start Over or Start Again?; Chapter 7, The Departure Gate; Chapter 8, Finance Stuff. Concierge Medicine Today, LLC. 2022. CMT original. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-published book; no outside funder)
- American Medical Association, Division of Economic and Health Policy Research. Physician Practice Benchmark Survey: Physician Practice Characteristics in 2024: Private Practices Account for Less Than Half of Physicians in Most Specialties. Accessed October 2026. www.ama-assn.orgFunding: not stated (conducted and published by the American Medical Association)
- Payerchin R. AMA: physician private practice unraveling due to low payment, high costs, administrative burdens. Medical Economics. May 29, 2025. Summary via Medical Economics of the AMA 2024 Physician Practice Benchmark Survey. www.medicaleconomics.comFunding: not stated (news report)
- Zhu JM, Marsh T, Huntington A, Polsky D, Song Z. Growth in number of practices and clinicians participating in concierge and direct primary care, 2018-23. Health Affairs. December 2025. doi:10.1377/hlthaff.2025.00656. www.healthaffairs.orgFunding: mixed: federal (Agency for Healthcare Research and Quality, R01HS029467) and foundation (Commonwealth Fund; NIHCM Foundation)
- Tetreault M. Branded: the Concierge Medicine Doctor. Concierge Medicine Today, LLC. 2025. Includes commentary by attorney James Eischen (2025). CMT original. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-published book; no outside funder) CMT original
- American Medical Association. Code of Medical Ethics Opinion 11.2.5: Retainer Practices. code-medical-ethics.ama-assn.orgFunding: not stated (American Medical Association ethics policy)
- Leive A, David G, Candon M. On resource allocation in health care: the case of concierge medicine. Journal of Health Economics. 2023;90:102776. doi:10.1016/j.jhealeco.2023.102776. ideas.repec.orgFunding: not stated
- Concierge Medicine Today. Media Desk: quotes from the Editor-in-Chief, FAQs and data. Accessed October 2026. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-published; no outside funder) CMT original
- U.S. Small Business Administration. Write your business plan. SBA Business Guide. Accessed October 2026. www.sba.govFunding: federal (U.S. Small Business Administration publication)
- U.S. Small Business Administration. Choose a business structure. SBA Business Guide. Accessed October 2026. www.sba.govFunding: federal (U.S. Small Business Administration publication)
- Concierge Medicine Today. Legal Experts' Commentary: the rules differ by model, and by what you add (CMT editorial summary of public sources). October 2026. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-published; no outside funder) CMT original
- Centers for Medicare & Medicaid Services. Become a Medicare provider or supplier (NPI through NPPES, enrollment through PECOS). Last modified June 2, 2026. www.cms.govFunding: federal (Centers for Medicare & Medicaid Services publication)
- Centers for Medicare & Medicaid Services. Manage your enrollment: opting out of Medicare (affidavit, private contracts, two-year periods, automatic renewal). Last modified March 4, 2026. www.cms.govFunding: federal (Centers for Medicare & Medicaid Services publication)
- Office of the National Coordinator for Health Information Technology (with the HHS Office for Civil Rights). Security Risk Assessment Tool. HealthIT.gov. Last updated September 18, 2026. www.healthit.govFunding: federal (ONC and HHS Office for Civil Rights publication)
- HHS Office of Inspector General. General Compliance Program Guidance (voluntary guidance; includes the seven elements and adaptations for small entities). November 2023. oig.hhs.govFunding: federal (HHS Office of Inspector General publication)
- Tetreault M. No More Waiting Rooms (a customer service road map for medical offices). Concierge Medicine Today, LLC. 2024. CMT original. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-published book; no outside funder)
- U.S. Bureau of Labor Statistics. 34.7 percent of business establishments born in 2013 were still operating in 2023. The Economics Daily (Business Employment Dynamics data). January 12, 2024. www.bls.govFunding: federal (U.S. Bureau of Labor Statistics publication)
- U.S. Small Business Administration. Calculate your startup costs. SBA Business Guide. Accessed October 2026. www.sba.govFunding: federal (U.S. Small Business Administration publication)
- U.S. Small Business Administration. Loans (funding programs: 7(a), 504 and microloans). Accessed October 2026. www.sba.govFunding: federal (U.S. Small Business Administration publication)
- HHS Office of Inspector General. OIG Alert: charging Medicare beneficiaries for services that are covered (assignment violations). March 31, 2004. hhs.govFunding: federal (HHS Office of Inspector General publication)
Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.
Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.
Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.
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