Sunday, December 6, 2009

Concierge Medicine

A significant percent of people do not know what "concierge medicine" is. Also known as "retainer" practice, concierge is a growing type of medical practice where the patient pays the physician an up front fee (retainer) for services. The fee can range from $100/month to $20,000/year, depending upon the practice and the services offered. The fee usually covers all visits to the doctor, phone calls, more prompt service and email access. Labs, tests, Xrays, referrals to specialists, and hospitalization are not included.

More and more primary care physicians are forgoing the hassle of dealing with insurance companies and Medicare and are becoming concierge doctors. Because of the retainer, physicians can have a smaller practice and be more accessible to patients. The doctors that charge $20,000 a year have only 100 patients and provide "spa" service. (you do the math!) One of my colleagues has a long waiting list!!!

Patients who go to concierge doctors still carry health insurance for other health care but they have easier access to the primary care doctor and both physicians and patients are generally happy with the arrangement. If the patient doesn't feel like it is worth it, they can always just drop out. Many physicians say if they hadn't switched to concierge practice, they would have just quit medicine all together.

Some of the criticism of concierge medicine is that with the shortage of physicians, it only exacerbates the access problem. It is called "elitist" and leaves out the people who can't afford the retainer. Other critics say patients are paying for service that many physicians already provide without a retainer.

Check out the poll on the upper right side and give us your opinion of concierge medicine.


KM said...

Another name some doctors also call it is Boutique

Anonymous said...

Would a Psychiatrist who charges lower fees than one usually would to do therapy (which is rare these days anyway!), but does not accept insurance, just regular payments, be considered "Concierge"?

Animal Lover said...
This comment has been removed by the author.
Toni Brayer, MD said...

KM: Yes, that is another term that is used, however boutique medicine can also include doctors who accept insurance but also offer other self-pay services like botox or home visits that are not covered by insurance.

Anon: Many physicians no longer contract with insurance and and have "cash" only practices and the patient gets reimbursed (if they can!) by their insurance. There is no up front retainer and that is not considered "concierge" in the same way.

KM said...

One doctor I know who does Boutique has started doing after hours counseling. And is a Family Practice doctor. And like you said has now also started taking insurance for somethings.

Anonymous said...

Thank you for writing this article. It really opened up my eyes to your point of view. I was looking for more advice for my own medical needs and found this. Allthough it was not what I was looking for I did find it easy to read and captivating. I was looking for advice on a new medicine. I am using this Mexican pharmacy for my needs as they are owned and run by Americans whom I have grown to trust but I find it hard to get advice unless I see the doctor. Anyway I have gone a bit off topic and want to just thank you for your article.

Michael Kirsch, M.D. said...

Concierge medicine didn't arrive out of nowhere. It is filling a need for physicians who want to spend enough time with patients, while still earning a living. Patients are willing to pay a premium for a high level of personal care, that they are not routinely receiving from conventional primary care practices. While I don't practice concierge, I support the concept. If folks want to pay more for a better car, vacation or medical care, shouldn't they be permitted to do so?

Anonymous said...

Yes they should Dr. Kirsch !! I agree with you.

Anonymous said...

I have a doctor who is not on any insurance panels and you pay cash and then try to get your insurance to reimburse you. I have received a higher level of care and more focused time then with an HMO rushed Physician. This physician has found another way to practice medicine with a smaller practice of patients part time and combine it with another medical dimension of the profession in which to make a living and blend them nicely together. The advantage about this is for the patient is they are not charged the retainer fee, but only for the services they come in for and still get excellent quality care.

Anonymous said...

The majority of respondents (I.e. traditional PCPs; concierge PCPs; office managers; media executives; specialty physicians; health care consultants; traditional family practice doctors; concierge family physicians; national associations; etc.), agree that the term they prefer most to describe retainer-based/boutique/direct care practices is in fact, 'Concierge Medicine.'

November 13, 2009 | By Michael Tetreault | Editor-In-Chief
Concierge Medicine Today

Concierge medicine (also known as "Direct Care" or sometimes thought of and termed "Direct Primary Care") is a term used to describe a relationship with a primary care physician in which the patient pays an annual fee or retainer. In exchange for the fee, doctors provide care.

Concierge medicine has had somewhat of a "brand/identity" issue in the media and health care marketplace. It's also referred to as: membership medicine; boutique medicine; retainer-based medicine; concierge health care; cash only practice; direct care; direct primary care and direct practice medicine. While all concierge medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the amount of the fee charged. There are an estimated 5,000 concierge, or membership medicine doctors throughout the U.S., according to SIMPD. However, there is only one organization tracking the specific number of concierge/direct primary care practices in the U.S. today, Concierge Medicine Today, an online news agency dedicated to educating traditional practice physicians and patients about the cost effectiveness and value these types of practices can provide to both physicians and patients.

This term also refers to those primary care and family practice physicians who have chosen to provide healthcare services in a more convenient, accessible and cost efficient manner to their patients. These physicians charge patients a membership fee ranging from $600 to $1,800/year and higher. In exchange for this fee, concierge practices generally include 24/7 access to a personal physicians' cell phone, same-day appointments with no waiting, personal coordination of care with specialists, personal follow up when admitted to a hospital or ER, house calls, and more.

While a typical physician can carry a patient load of 2,500+ patients, a concierge physician generally limits their practice to between 300-600 patients or more. It has also been referred to as: membership medicine; boutique medicine; retainer-based medicine; concierge health care; cash only practice; direct care; and direct practice medicine. While all concierge medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the amount of the fee charged. There are an estimated 5,000* doctors throughout the U.S., practicing this type of healthcare delivery model. *Source: SIMPD

There is now an online news resource geared specifically towards concierge physicians, primary care and family physicians, patients, and legislators. is the only news and information organization dedicated solely to the distribution of news and information related to all aspects of concierge medicine. Links to articles shaping the nation's view of this movement and connections to dozens of the most popular healthcare blogs discussing concierge medicine and its potential to rescue primary care are also included.


Anonymous said...

Concierge medical practices have increased tenfold over the past four years, resulting in at least 5,000 such practices now, compared with just 500 in 2005, according to the Society for Innovative Medical Practice Design, which projects that by 2012 there will be 17,000 concierge practices.

The society’s chairman, Dr. T.homas LaGrelius, said those numbers are a “guesstimate,” based on a 2008 Physicians’ Foundation-sponsored survey of 300,000 primary care doctors. In that survey, nearly half the respondents said that in the next three years they plan to reduce the number of patients they see or stop practicing entirely.

Source: October 16-22, 2009 | washington business journal

Jonathon said...



November 13, 2009 | By Michael Tetreault | Editor-In-Chief |
Concierge Medicine Today

Direct primary care (DPC) is a term often linked to its companion in health care, 'concierge medicine.' Although the two terms are similar and belong to the same family, concierge medicine is a term that fully embraces or 'includes' many different health care delivery models, direct primary care being one of them.


DPC practices, similar in philosophy to their concierge medicine lineage - bypass insurance and go for a more 'direct' financial relationship with patients and also provide comprehensive care and preventive services for an affordable fee. However, DPC is only one branch in the family tree of concierge medicine.

DPC, like concierge health care practices, remove many of the financial barriers to 'accessing' care whenever care is needed. There are no insurance co-pays, deductibles or co-insurance fees. DPC practices also do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers, which can consume as much as $0.40 of each medical dollar spent (See Sources Below).


According to sources (see below) DPC is a 'mass-market variant of concierge medicine, distinguished by its low prices.' Simply stated, the biggest difference between 'direct primary care' and retainer based practices is that DPC takes a low, flat rate fee whereas omodels, (although plans may vary by practice) - usually charge an annual retainer fee and promise more 'access' to the doctor.

According to Concierge Medicine Today, the first official news outlet for this marketplace, both health care delivery models are providing affordable, cost-effective health care to thousands of patients across the U.S. MDNewsToday is also the only known organization that is officially tracking and collecting data on these practices and the physicians -- including the precise number of concierge physicians and practices throughout the U.S.

"This primary care business model [direct primary care] gives these type of providers the time to deliver more personalized care to their patients and pursue a comprehensive medical home approach," said Norm Wu, CEO of Qliance Medical Management based in Seattle, Washington. "One in which the provider's incentives are fully aligned with the patient's incentives."

References and Sources

"Doc This Way!: Tech-Savvy Patients and Pros Work Up Healthcare 2.0". New York Post. 4/7/2009.

Who Killed Marcus Welby? from Seattle's The Stranger, 1/23/2008

"Direct Medical Practice - The Uninsured Solution to the Primary Medical Care Mess" with Dr. Garrison Bliss (Qliance Medical Group of WA).

"Direct Primary Care: A New Brew In Seattle". Harvard Medical School - WebWeekly. 2008-03-03.

Michael Tetreault Editor-In-Chief Concierge Medicine Today URL: Twitter: E: T: (678) 597-2559

Article Source:

Anonymous said...

A concierge doctor, also known as a VIP concierge doctor or a private doctor is a primary care physician who provides enhanced care to a patient. Concierge practice is also called boutique medicine, internal medicine practice, retainer-based medicine, and innovative medical practice design. Some of the advantages of Concierge medicine include coordinated wellness programs, coordinated prescriptions, more time with the doctor, availability of the doctor via cell phone or e-mail at any time of day or night, availability of home visits and more. An example of a VIP Concierge doctor is Dr. David C. Rosenberg of Jupiter Concierge Family Practice. The address to his office is 2141 Alternate A1A South, Suite 200 Jupiter, Florida. It is located near the Calle Vija shopping center at the corner of Old Dixie Highway and East Indian Town Road in Jupiter. Visit his website at or call 561-743-0005 to get more information about concierge medicine.

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