A growing number of primary care doctors are going into concierge medicine, meaning they charge patients a flat fee of often a couple thousand dollars a year, or more, to be part of their practice.
They’re still a minority, but between 2018 and 2023 the number of practices charging an annual fee almost doubled, according to a study from Harvard.
Concierge doctors still bill insurance, too, but charging that annual fee means they can afford to have fewer patients on their roster and give the ones they do have a lot more time and access.
When Dr. John Siedlecki first started working as a primary care doctor in Virginia almost 30 years ago, he loved it. Physicals were an hour long, follow up appointments were 20 or 30 minutes, there was plenty of time to spend with patients. It was great.
But it didn’t last.
These days, he said, “the patients you’re taking care of tend to be older, sicker, they take more time.”
Yet primary care doctors have less time. Reimbursement rates have declined over the years, so doctors make less money now, per patient, than they used to.
“And so there’s more pressure to see more patients, who are more complicated, who take more time,” he said. “There’s more requirements for you to ensure you’re giving them good care. And so it tends to lead to a lot of burnout amongst providers.”
That is what happened to Siedlecki. He started to burn out, seeing about 25 patients a day and consulting on cases with the nurse practitioners and physician assistants at his private family practice near Richmond, Virginia. Then, two years ago, his partner retired, which left him as the only doctor at the practice. It wasn’t sustainable. He decided to transition over to a concierge model and start charging patients an annual fee of about $2,000.
A growing number of primary care doctors are going into concierge medicine, meaning they charge patients a flat fee — often a couple thousand dollars a year, sometimes much more — to be part of their practice. In exchange, patients get longer visits and better access to their doctor; doctors get to have fewer patients on their roster and spend more time with them. Unlike direct primary care practices, which also charge patients a fee, concierge practices bill insurance, too.
Both models are becoming more popular. They now account for an estimated 10 to 20% of practices.
“It’s still a niche product, but it’s a growing niche product,” said Wayne Lipton, the founder and managing partner of Concierge Choice Physicians, which helps doctors implement concierge programs.
When Lipton founded the company 20 years ago, it was difficult to get doctors interested in the model. Now it’s “booming,” he said, among both doctors and patients.
“There are fewer people going into primary care,” he said, “and given the realities of the economics of practice, [doctors] really are compelled to see a fairly large number of people per hour.”
For patients, ever since the pandemic, “getting appointments became tougher and tougher. That and also, if you’re looking to have a new primary care doctor, that was getting to be more and more difficult,” Lipton said. “If there’s no convenience left at all in medicine, there are going to be some people who are willing to pay for convenience. It’s as simple as that.”
Dr. Shantanu Nundy, a primary care doctor near Washington, D.C., is not concierge, but he hears versions of this from colleagues all the time now.
“I get this phone call at least monthly,” he said, “from people who are saying, ‘hey, like, what do you think about concierge medicine? Should I consider it?’”
Almost everyone he knows who is considering it is just hitting a wall in traditional practice, overwhelmed by the relentless pace, paperwork, and insurance demands. But he said doctors are also torn about turning to the concierge model.
“I think on one end, they want to do it for the right reasons, which is, hey, I want to just get back to taking care of patients,” Nundy said. “And on the other side, they’re going to be taking care of a lot less patients, and doesn’t that mean that more patients aren’t going to have doctors?”
There is already a shortage of primary care doctors in the U.S., particularly in rural areas.
“So absolutely there’s a theoretical risk that as more doctors go into concierge medicine that means that the burden on the remaining physicians is higher and higher,” he said.
There’s also a risk that it will become increasingly difficult for patients who can’t afford the fees, or don’t want to pay them, to find a new doctor.
When Katie Wang got an email a few years ago that her longtime primary care doctor in New York City was going concierge, she was disappointed.
“I really liked my doctor, really trusted her, and didn’t want to go and find somebody else,” she said.
But she didn’t really want to shell out $2,000 a year to stay, either. Then she found a lump in her breast. “I decided, well, if this lump is something significant,” Wang said, “then this is not really the time to be looking for a new physician, right?”
The lump was significant; Wang had breast cancer. So she paid the $2,000 and stuck with her doctor. And she’s actually seen a big difference since the practice went concierge.
“I mean, huge, huge difference,” Wang said. “You know, previously it would be ten minutes, maybe, in and out kind of a thing. Now she has more time to spend with me and also to prepare. So to me, it was completely worth it in that regard. I feel like I’m getting much better care.”
And better access. It’s common in concierge practices for patients to get their doctor’s cell phone number and effectively be able to reach them 24/7. That’s possible because concierge doctors can afford to have fewer patients.
Before Dr. John Siedlecki switched his practice over, he had 3,800 people on his roster. Now he’s down to 600.
It’s a relief, but it was also a tough decision.
“Morally, you still want to take care of all these folks who have trusted you and pay to come see you and you get to know them and their families,” he said. “And so that’s the difficulty in the decision, when you have to sever some of those relationships.”
He also worries about how many doctors are going concierge near him, in Richmond, and the added pressure that puts on an already-strained healthcare system.
But for Siedlecki personally, it was the right choice.
“No question. I would absolutely do it again,” he said. “I am more rested. I am not as stressed. I am absolutely practicing medicine the way I feel it should be practiced and the way I want to practice.”
Spending more time and taking better care of patients.
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