Illustration: Olivier Heiligers
The premiere episode of the Scrubs reboot, which debuted just a few months back, finds internist J.D. (played by Zach Braff) working as a concierge physician, having succumbed to the financial reality of the American health-care system. In a montage, he makes a house call to apply a liquid bandage to a man’s toe with a gleaming pool visible through the window and examines another patient’s unabated four-hour erection while sipping tea. Later, he spends hours at the bedside of an older woman who seems to be mostly well but has been hospitalized as a precaution after fainting. By the end of the first episode, however, an internal wake-up call has whisked him out of this soulless milieu — in which patients pay him untold sums in exchange for VIP amenities — and planted him back on an inpatient hospital floor among grateful, less-rich sick people. The implication is clear: Doctors who ditch the masses to only serve the wealthy are sellouts — not heroes worthy of a TV plotline. They are also ubiquitous enough to be part of mainstream culture.
A 2025 report noted that from 2018 to 2023, the number of fee-based practices grew by 83.1 percent and estimated that between 10 and 20 percent of primary-care physicians now work within them. These practices include concierge medicine and direct primary care, where patients pay a fee not necessarily for high-end amenities but for an easier time getting an appointment or a call back. In both concierge medicine and DPC, physicians say they see fewer patients and offer better care. Since DPC doesn’t accept insurance, doctors also say it allows them to avoid certain Sisyphean administrative tasks. They also tend to earn more income without pulling 12-hour days. Proponents see membership medicine as the future of primary care, a win-win system that benefits everyone — except, of course, the millions who can’t afford to buy into it and are increasingly likely to struggle to find a primary-care doctor at all.
The rise of concierge and DPC medicine is far from the only factor feeding the shortage. Pandemic burnout–driven exits from the field and baby-boomer doctors retiring are known contributors as well. In many cases, departing docs don’t get replaced with younger ones because PCPs are now notoriously underpaid relative to other specialists. One study found that 31 percent of medical-school students who intend to pursue primary care switch specialties once they realize they may struggle to repay their student debt. A 2024 survey revealed that only one in five current PCPs feel adequately compensated, and another report found that in 2026, they are earning, on average, $298,000 per year to a specialist’s $417,000.
Still, experts say, the shift to concierge medicine is something of a warning signal. “When a physician converts to one of these models, there are fewer physicians available to treat the general population,” says Jordan Weiss, an assistant professor at the NYU Grossman School of Medicine who studies health and aging.
Currently, the nation is some 13,000 PCPs short of what the population requires, and it’s been predicted that by 2038, patients will face a shortage of 70,610 PCPs, or roughly five times the current deficit. More than 100 million Americans do not have consistent access to a PCP. A survey published in March found that 36 percent of patients have struggled to find a PCP who accepts their insurance, and another 36 percent have been told by PCPs that they’re not taking new patients.
Carol DerSarkissian, herself a physician in New York City, says the primary-care physician she has been seeing for ten years works for a health system that recently added a concierge practice to many of the doctors’ caseloads, which has severely limited the time each physician has for their in-network patients. “Once that happened, I had to book at least nine months in advance to see her,” she says. “I liked her, but now I go in and it’s a 15-minute visit. The last time I was there, she was talking about the concierge practice, and she’s like, ‘Yeah, I enjoy those more. I get more time.’ And I was like, Wow, you shouldn’t be saying that to me.” Several New York hospitals, including Mount Sinai and Weill Cornell, have added concierge services to their roster of offerings.
And the problem extends beyond New York. Nicole Baker, a marketing strategist in Portland, Oregon, has been in what she calls “doctor-shopping purgatory” for years. “I try to find a new person every few months, then get frustrated and give up,” she says. For the last several years, she has settled for a provider who once told her she was not prediabetic even though Baker had just received labs confirming the diagnosis. “She realized she was looking at the wrong patient’s file,” Baker says. “I have very little faith in her as a doctor, but I have no choice.”
The ethics of concierge medicine are a contentious topic. A recent Institute of Clinical Bioethics post questioned whether these models contravene the sacred doctrines of medicine: beneficence, non-maleficence, autonomy, and justice. These precepts are perhaps especially pertinent in primary care, which has a reputation for attracting altruistic physicians interested in making a difference in the lives of their patients over years of contact. The American Medical Association also publishes principles to which a doctor must abide, including that physicians shall “participate in activities contributing to the improvement of the community and the betterment of public health” and “support access to medical care for all people.” The upshot of the institute’s post was that concierge medicine can be ethical with safeguards, but problems will inevitably arise. But arguing that membership-based models, particularly at the very expensive concierge level, align with these ideals requires mental contortion not all doctors are willing to undertake. The author of an article in the AMA Journal of Ethics wrote that participating in this style of medicine would “corrode” his sense of duty to his patients. “Just focus on this: What is the meaning of a patient-physician relationship if it can be terminated abruptly and for such coarse reasons?,” he writes.
Marc Price, a family doctor in Malta, New York, has resisted the concierge model for the same reason. “I like that connection with the patients. I like that they come in and they don’t just see whoever is on that day; they point to me and say, ‘That’s my doctor.’ For me to throw that away, it feels wrong.” Price says that while one concierge service, MDVIP, has “been courting me for years,” the patients unable to follow him there would haunt him. “I’m still idealistic, unfortunately,” Price says. Plus, while concierge medicine increases members’ health-care spending by 30 to 50 percent, it does little to improve mortality, on average, a 2023 study found.
There is no shortage of concierge clinics in New York City, and new ones seem to be opening all the time. Private Medical on the Upper East Side charges around $40,000 a year for adults and $25,000 for children. With five locations in the city — only two of which are accepting new patients MD2, a concierge primary-care clinic, runs slightly cheaper at $2,500 per month. One practice, Sollis, touts itself as a VIP version of urgent care: You might go if you sprain your ankle or get a bad sunburn, but you can also get a physical or request labs, which suggests some patients might use the service as a kind of ad hoc primary care. Scott Braunstein, chief medical officer at Sollis and former ER doc at Cedars-Sinai, tells me he sees the concierge model and the way it tiers patients as a “healthy, natural correction” to a system that doesn’t work, which may “put pressure on that system to do better.” He adds that doctors are leaving their practices “in other ways — retiring early — so I wouldn’t say concierge is part of the problem.” Sollis also charges less than other places, Braunstein points out. (Membership starts at $4,000 per year and goes up to $12,000.)
The criticisms of concierge medicine may explain why even established outfits seem loath to acknowledge the dark side of their business. For this article, I approached several doctors from a concierge practice offering both primary and specialty care with locations in New York, Palm Beach, and Beverly Hills, as well as seasonal home services in the Hamptons. The practice charges an annual membership fee of $20,000 to $70,000 per person. A company spokesperson learned of my inquiries and emailed me directly. “With a clinic, institute and non-profit arm,” the email read, the organization “doesn’t fit the mold of concierge medicine” and therefore could not comment. It was a strange statement, in part because it was illogical and in part because it suggested that simply admitting what the company offers could harm its brand.
On the flip side of the membership-based service debate is a more nuanced picture — one not of craven PCPs abandoning patients for cash but of circumstances that have pushed them to the brink. As Weiss puts it, “these physicians are responding to a broken system.”
A PCP’s patients fall into one of three categories: well people who need a checkup; people visiting for ongoing disease management; and sick people, usually with common ailments like respiratory infections and UTIs, but whose symptoms may indicate a more serious or complex problem. A straightforward annual well visit for an existing adult patient nets a PCP an average insurance reimbursement of $128, while an established patient’s sick visit nets between $80 and $120, depending on insurance and location. (By contrast, an orthopedic surgeon performing a knee replacement might receive a reimbursement of $2,000 for that two-hour procedure — roughly what a PCP will earn seeing 15 patients.) These relatively meager sums incentivize PCPs to take on huge patient panels to keep their clinic’s lights on. And unfortunately, this large caseload comes with ceaseless unpaid administrative work. Specialists perform administrative tasks, too, but can often afford to hire medical coders to help. Because PCPs operate on some of the thinnest margins in medicine, hiring sufficient support staff is often a nonstarter.
Kelsey Smith opened a DPC practice in Stillwater, Oklahoma, in 2021. She charges $175 a month for adults and $125 per month for kids. (There is a maximum fee of $350 per month for a family.) She describes a daily avalanche of busywork in her old practice, spending her life chained to the exam table by day and to electronic health records by night. “I would stay up till midnight and still not be caught up,” she says. “My husband would ask, ‘What are we doing this weekend?’ I’d be like, ‘I don’t know what you and the kids are doing, but I’m working on charts.’” Now, she keeps a smaller patient panel, seeing ten a day versus 30, and gives each patient a half-hour instead of 15 minutes. If a patient emails with a question, she simply answers it instead of asking them to come in so she can bill them. “Under the insurance system,” she says, “you don’t get reimbursed for your time and wisdom unless you have somebody walk through your doors.”
Overloaded doctors aren’t generally great doctors. Smith says at her old practice, her medical assistant would tell patients to prioritize their concerns — that is, “pick your top two” — due to the doctor’s time constraints. And Sharifa Glass, a Houston pediatrician who now runs her own concierge service, says in her old practice, she used to get hassled by the corporate administrators for spending too much time with patients. “They would say I was taking too long. That felt like poor health care to me,” she says. I spoke with several physicians who’ve made the switch to DPC or concierge, and most said some version of the same thing: I’m so much better at my job now.
When I asked a few of these doctors how they felt about the patients they no longer see, the ones who couldn’t afford to join their membership-based practices, they revealed something startling. If I hadn’t made the switch, they told me, I was going to have to leave medicine altogether, and then I’d be seeing no patients. Weiss says, “people argue that concierge medicine or DPC isn’t right. But it has developed for a reason. You don’t have to fight it — you just have to make staying in traditional practice more viable.”
All of the PCPs I interviewed who have moved into membership models painted their career choice as the only solution to an intractable problem. But some in the field are working on alternative ideas that don’t leave lower- and middle-class patients behind. “The first move would be shifting away from pure volume toward a model that compensates PCPs for the time they spend working and also for keeping their patients healthy,” says Weiss. “Some kind of blended payment model where a practice gets an amount based on health outcomes rather than just a fee per visit.” Other proposed solutions have included 2024’s bipartisan Pay PCPs Act, which aimed to nudge the Centers for Medicare & Medicaid Services into better rewarding PCPs who achieve positive outcomes for patients. (The bill appears to have stalled in committee.) Some experts advocate for financial incentives for med students interested in primary care, like more generous deferments on student-loan interest.
Others are working to create tech-based solutions that help patients obtain care. Shulin Zhang, who is 86, told me through a translator that he went without a PCP for three years as a diabetic octogenarian after moving here from China in 2019, having found that few doctors took his insurance, fewer spoke his language, and many weren’t accepting new patients. His stopgap solution was to fly to Beijing to once a year to see his doctor son-in-law, who prescribed him enough medication to last until he made the trip again. He finally found a PCP through Rendr, a non-DPC health-care network designed to help Chinese New York City residents connect with the doctors they need. Meanwhile, AI-driven triage centers and telehealth services like MinuteClinic seek to lift some of the burden on already stretched PCPs, while staffing agencies like Medicus place temporary PCPs in areas lacking them.
Other doctors are trying to split the difference to avoid leaving patients behind. Wayne Strouse, a family physician in the Finger Lakes region, created a hybrid DPC clinic that allows patients to choose their coverage model based on their means and needs. “One of the big knocks on DPC is, ‘Well, we don’t have enough doctors already, and now you’re cutting down your patient panel from maybe 2,000, 2,500 to between 400 and 600,’” he says. “And that’s not true in my practice. I have close to 2,000 charts.” He says his patients who come often usually opt to pay a monthly fee, while those who come rarely pay for each appointment separately. Earlier in his career, Strouse came so close to burnout that he dropped his practice and moved to New Zealand for a year to recover. When the feeling came back a few years ago, he knew the solution was to stop working with insurance companies and switch to a hybrid model.
Curious to know if the cost is worth it, I spoke to a patient who, after fruitlessly searching for an in-network PCP for almost five years, finally made the switch to membership medicine. Yoon Hang Kim, who lives in San Antonio, says one PCP he met with asked for all of his health information before agreeing to accept him as a patient, which he saw as an indication that they were “cherry-picking” potential patients. Another offered him an appointment, but when he arrived, he saw a nurse practitioner instead of the physician he booked. “I felt that was deceptive,” Kim says. He switched to his current DPC partially to solve the finding-a-doctor problem and partially because he wants pricing to be transparent. “It can be very opaque, what’s covered and what’s not,” Kim says. Now there are no surprises. His doctor’s fee is about $150 per month.
I asked Kim what he does for a living. He told me he’s a physician who trained in both family and preventive medicine. “Are you a PCP yourself?” I asked. “No,” he answered. He left primary care behind to pursue integrative medicine. “What’s your practice like?” I asked.
“Well,” Kim said, chuckling, “I’m terrible — it’s a concierge practice.”
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