What Is Concierge Medicine?

Concierge medicine, sometimes called retainer medicine or membership medicine, is a model of primary care in which a patient pays a recurring fee directly to a physician or practice in exchange for enhanced access, longer visits, and a smaller patient panel. The American College of Physicians defines it formally as "any practice that directly contracts with patients to pay out-of-pocket for some or all of the services provided by the practice, in lieu of or in addition to traditional insurance arrangements, and/or charges an administrative fee to patients, sometimes called a retainer or concierge fee, often in return for a promise for more personalized and accessible care."¹

The American Medical Association's Code of Medical Ethics frames it as a retainer contract: physicians may charge patients directly for special, non-medical services and amenities, but must continue to uphold their core obligations to treat all patients with courtesy, protect patients' rights and dignity, and ensure every patient in the practice receives the same quality of medical care regardless of the contractual arrangement.³

In practice, that usually means a physician who has traded a traditional panel of several thousand patients for a few hundred, in exchange for an annual or monthly membership fee that typically ranges from $1,500 to $5,000 for contemporary programs, with premium and ultra-premium tiers running considerably higher.

The first concierge medical practice, MD², opened in Seattle, Washington in 1996. Frustrated by overcrowded waiting rooms, rushed 15-minute visits, and the administrative burden of insurance billing, Dr. Howard Maron, then the team physician for the Seattle SuperSonics, partnered with Dr. Scott Hall to build a practice around a different premise: a physician who knows a small number of patients deeply, rather than a large panel briefly.²

The model spread slowly through the early 2000s under a variety of names, retainer medicine, membership medicine, direct care, before "concierge medicine" became the term the industry settled on. By 2003, the practice had drawn enough attention that the AMA issued formal ethics guidance addressing it directly.³ Since then, the model has expanded well beyond its original single-practice, high-cost format into a spectrum that now includes hospital-based concierge programs at major academic medical centers, mid-tier independent practices, and direct primary care, a lower-cost, insurance-free cousin of the model that emerged in parallel.

Strip away the marketing language and a concierge practice differs from a traditional one in four structural ways.

Panel size. A concierge physician typically carries 300 to 600 patients, compared with 2,000 to 3,000 in a traditional insurance-based primary care practice.⁴ Earlier research on retainer practices put the range slightly wider, at 300 to 800 patients.^4b Either way, the reduction is the mechanism behind nearly everything else the model promises: more time per visit, same-day access, and a physician who actually knows the patient's history without pulling up a chart.

Fee structure. The patient pays a recurring membership or retainer fee directly to the practice, separate from any insurance billing. That fee typically covers access and service, not the underlying medical care itself.

Insurance relationship. Most concierge practices continue to bill insurance, including Medicare, for covered medical services, while the membership fee itself is an out-of-pocket cost not reimbursed by insurance. The AMA is explicit that the two must be kept separate: a retainer contract cannot be used to charge patients for services insurance already covers.³

Access. Same-day or next-day appointments, direct physician communication outside office hours, and longer visit times are standard features of the model, not upsells.

Concierge medicine and direct primary care (DPC) are frequently used interchangeably, and CMT's own reporting tracks them as adjacent but distinct models. The core difference is the insurance relationship.⁹

Ten years ago, concierge medicine was mostly a primary care story. Today, cardiologists, endocrinologists, OB-GYNs, gastroenterologists, and even oncologists are adopting the model. In CMT's most recent polling of 300 physician readers who have practiced within the concierge medicine model between 2014 and 2024, six specialties accounted for the large majority of respondents.¹⁰

The most rigorous third-party evidence on this question comes from a 2025 peer-reviewed study in Health Affairs, led by researchers at Oregon Health & Science University and Johns Hopkins. Using a national dataset linking public and proprietary practice directories, the researchers found that concierge and direct primary care practice sites grew 83.1% between 2018 and 2023, while the number of clinicians participating in them grew 78.4% over the same period.⁵

The same study surfaced two trends worth knowing honestly rather than glossing over. First, the share of clinicians in these practices who are physicians, as opposed to nurse practitioners or physician assistants, declined from 67.3% to 59.7% over the study period, as advanced practice clinicians took on a growing role.⁵ Second, corporate-affiliated practices increased sharply, while independently owned practices declined from 84.0% to 59.7% of the sample, as private equity and larger healthcare organizations entered the space.⁵

On the size of the workforce overall, sources differ, which is itself worth being upfront about. KFF's State Health Facts reported approximately 1,105,148 professionally active physicians in the United States as of September 2025.⁷ The AAMC's 2025 workforce dashboard reported 1,032,365 active physicians for 2024.⁸ The two figures differ because they draw on different data sources and definitions of "active." Neither the AMA nor any single federal body tracks the exact number of concierge practices nationally, which is part of why industry estimates, including CMT's own, are presented as directional rather than exact.³

Any fair explanation of concierge medicine has to include the access question, because the physicians who defend the model and the researchers who study it are both raising it.

Early research on retainer practices found that physicians in these arrangements cared for fewer Black, Hispanic, and Medicaid patients, and fewer patients with certain chronic diseases, than physicians in traditional practices.^4b More recently, Dr. Jane Zhu, the lead author of the 2025 Health Affairs study, has cautioned that growth in concierge and direct primary care "without a corresponding expansion of the primary care workforce could unintentionally worsen access for patients remaining in traditional practices." She has also noted that the ethical implications are not uniform and depend heavily on how each practice is designed, including whether physicians offer sliding-scale pricing, donate time to underserved populations, or engage with local workforce and access needs.⁶

The AMA's position is that operating a retainer practice is not inherently unethical, but it comes with non-negotiable obligations: enrollment must be voluntary, terms must be transparent, and every patient in the practice, regardless of contractual arrangement, must receive the same quality of medical care.³

CMT's own editorial position, stated plainly rather than as a rebuttal, is that innovation in medicine has historically started in smaller, more focused settings before becoming more broadly accessible, and that the specialties entering concierge medicine today are being driven by relationship and continuity needs, not exclusivity. Readers should treat that as CMT's stated perspective, not as a resolution to a legitimate, ongoing policy debate that researchers, physicians, and policymakers continue to weigh from different angles.