By William Rusnak NueMD |
Concierge Medicine: No Longer Exclusively for the Rich

Practice Management

Concierge Medicine: No Longer Exclusively for the Rich

Date Posted: Tuesday, February 18, 2014


When a physician mentions concierge medicine, she is likely to receive stares from judgmental eyes. Her peers will immediately assume that she is selling out, tailoring to the rich in order to become an overpaid comforter of the wealthy, who are in no way starving for medical attention.

The truth is that concierge medicine is not what it used to be. According to Concierge Medicine Today, of the 5500 practices in the U.S., 66% of them charge less than $135 per month on average. [1] In fact, the overall trend is that concierge practices are charging less and opening their doors to more middle-class patients. Many are even defining themselves as "direct care" rather than concierge medicine, due to the stigma of the name.

Traditionally, concierge practices would charge a retainer fee of somewhere between $125 and as much as $30,000 per month. [1] This fee was charged in addition to standard appointment costs, which were generally collected from insurance companies. One could see why people would mistake this model as medicine for the rich.

Recently, however, many concierge physicians are completely eliminating insurance and accepting only direct payments from consumers. At face value, this looks like another tactic to tailor to high-end clients, but that isn't the case. Eliminating insurance payments allows physicians to cut nearly 40% of their annual overhead! This allows for much cheaper pricing for primary care.

Many direct care practices are charging $50-100 per month, which may include basic check-ups, some diagnostic tests, and even minor treatments. As for medications, elaborate diagnostic tests and other procedures, many physicians have negotiated dramatically discounted prices with outside vendors. Direct care physicians usually end up paying a fraction of the cost when compared to their typical insurance-accepting counterparts.

Anyway, consider this pricing structure of paying $50-100 per month, which ends up totaling around $600 to $1200 per year. Many insurance plans have at least $1000 deductibles, which means patients could be paying $1000 for care anyway. The care they would generally receive would be quick, impersonal, and downright overpriced. As far as your best value, direct care is clearly the better choice.

Back to the accusations of performing elitist medical care. Obviously this model is not going to work for most of the patients in the lowest income brackets or those on government assistance. Having aspirations for this model becoming a complete solution for universal access is unrealistic. Concierge medicine is likely best-suited for those that can afford an extra $50-150 a month for their family's healthcare. This is on par with the average cable and cellular phone bill.

Putting cost aside for a moment, consider the other benefits of eliminating the insurance overhead. For one, a doctor, who likely puts in many hours a week (and will be able to put in more under a direct-care model) keeping-up with the latest medical literature, will not be told how to take care of his patients. There will be no more writing letters to or calling insurance companies as an attempt to convince them to pay for the care that the physician recommends.

Another benefit is that the patient-doctor relationship is reborn. Stress is lowered. The duration of the appointments are appropriate for the individual. Unfortunately, this concept is starting to seem so foreign, especially to those who are growing accustomed to visiting small urgent care centers for minor problems and rarely see their primary doctor for more than ten minutes per year. Direct care providers, on the other hand, will have the extra time needed to answer important questions in person, through email or via text message, which will help maintain a sense of continuity between patient and provider.

Also, don't overlook the fact that concierge providers can negotiate prices with patients. Keep in mind entrepreneurs and self-employed people. The cost of health coverage for them is usually atrocious and most of the plans becomes even more expensive when the Affordable Care Act began to surface. These are the people who direct care may help the most. Coupling a catastrophic plan to a direct care plan will almost always cost significantly less than standard comprehensive plans from insurance companies.

Finally, all physicians go into medicine because they want help people. Many of them are also self-starters who crave independence. Today's hamster-wheel model of primary care is not going to satisfy these souls and will likely lead to burn-out early in their career. Direct care is the answer to those trying to save the private practice physician.

So, considering moving to the direct-care model, but worried about selling out? Relax. Concierge medicine isn't just for the rich anymore!

William Rusnak is a financial investor, writer for NueMD, and entrepreneur. He writes about topics such as healthcare technology, biotechnology, and nutrition. He is currently applying to residencies with plans to practice in Primary Care and Sports Medicine. Outside of his professional life, he is a family man, performing musician, and paleo-diet enthusiast.


1. Wieczner, Jen. "Pros and Cons of Concierge Medicine". http://online.wsj.com/news/articles/SB10001424052702303471004579165470633112630. November 2013.

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William Rusnak

Financial investor


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