If you want these benefits, concierge medicine might be for you

As a resident, it’s alluring to consider different practice options once you finish training. One option may be concierge medicine, in which members pay a fee for the luxury of the vigilant attention of their HCP. But what is concierge medicine, and how do you break into this field?

Concierge medicine in a nutshell

Concierge medicine involves a smaller patient panel, which permits for extended visits, continuous follow-up, and a focus on preventive care and wellness. This approach ensures high-quality, individualized attention. Concierge medicine options are available in both primary and specialty care. 

Concierge medicine may appeal to certain physicians—especially those with an interest in lifestyle medicine (LM). 

“Both LM and concierge medicine strive to provide patients with improved quantifiable outcomes, enhanced well-being, and a deeply personalized patient experience,” according to a concierge and LM medicine physician writing in the American Journal of Lifestyle Medicine.^[] “While lifestyle medicine (LM) has been increasingly recognized for its value in preventing and managing chronic disease, the conventional primary care practice has struggled to be a financially viable model for this time-intensive, highly personalized approach.”

The author added, “Its corollary—a career- and life-saving change for physicians—is particularly noteworthy for LM practitioners who value time as the most precious commodity both personally and professionally.”

Regarding remuneration

An article in Scientific American explains the costs involved.^[] In addition to collecting fees from members for their concierge membership, concierge physicians typically bill private insurance or Medicare for certain services. In other words, the concierge patient pays two fees: one for insurance and the other for membership.

The cost of membership varies widely and depends on access. Harvard Medical School data indicates that the mean monthly cost for concierge care is $200, but it can range up to $30,000.

The balance of concierge care

Concierge care comes with its detractors, who claim it exacerbates health inequities. The Scientific American article takes up this issue.

“While there are variations on the model that come at a lower monthly cost (and cut insurance out of the picture altogether), skeptics question why physicians and patients feel the need to circumvent the traditional U.S. health care model at all. Those providing and receiving concierge care say it is the only feasible way to access value-based care in a system that has historically rewarded quantity over quality. But some experts say the shift toward the concierge model points to inherent flaws in the nation’s long-standing approach to health and wellness and could exacerbate existing gaps in access to primary care.” 

Critics of the practice specifically worry about how the roughly 12,000 concierge practices extant allot more primary care physicians to fewer patients, which is suboptimal in light of a dearth of PCPs to begin with. Nevertheless, this concern may be offset by the better quality of care and increased levels of preventive care proffered to these fewer patients, but whether this yields substantial cost savings for patients and health systems over time is not yet known.

Other criticisms leveled at concierge medicine—also called “boutique” or “retainer-based” medicine—are that it could increase the burdens placed on providers and thus limit access to care. It can also be considered elitist because few patients can afford the retainers. 

Writing in the Yale Medicine Magazine, a long-practicing internist who made the switch to concierge medicine acknowledges these detractions, but, on the other hand, he sees this type of practice as a potential panacea for burnout.^[] For him, making the switch meant that he was able to have “basically unlimited time with [patients], to be able to care for them in a very holistic way and to have balance back in my life.”

Breaking into concierge care

There are a couple of ways to enter concierge medicine. Some physicians work for years in the traditional model and gather a base of patients to care for as a self-employed provider outside of traditional clinics or hospitals.^[]

Alternatively, as mentioned by Scientific American, physicians can pair with already established concierge medical companies, which can act as “agents” that provide physicians with a small panel of patients and take care of billing. This route is more immediate.