Freelance MD, a community of physicians that gives you more control of your career, income, and lifestyle. Join us. It's free, which is a terrific price. Grab Some Free Deals
Search Freelance MD

Freelance MD RSS    Freelance MD Twitter     Freelance MD Facebook       Freelance MD Group on LinkedIn      Email


2nd MD Special Offer

ExpedMed CME

Medvoy Society of Physician Entrepreneurs

20 Newest Comments
Newest Nonclinical Physician Jobs
This area does not yet contain any content.

Entries in Concierge Medicine (7)


The 3rd Paradigm Shift In Medicine

By Robert Keller MD

We are in the 3rd paradigm shift in medicine.

The first evolution occurred during the American Civil War when medicine developed standards for surgical procedures. The second shift occured during the early 1900 with the introduction of pharmaceauticals and the start of internal medicine. Both of these practices were reactive based medicine; in other words, after the fact medicine. The United States became the center of reactive medicine by developing empirically based evidence to support the treatments. Still, the model was reactive. Thus, we became adroit at treating disease after it had declared itself with symptomatology. The twenty First century now enters the 3 medical revolution: proactive medicine. We now have the ability to develop protocols that predict disease very early in the disase state or more excitingly before the disease expresses itself. Treatments such as stem cells, DNA and protienomonics, advanced labs such as telomer testing, virtual angiograghy are just a few of the prospective ways to prevent disease.

Yet, a challenge remains. How do we as physicians shift to the proactive revolution when the third party carriers reimburse for reactive treatments? Therein lies the rub. It is my contention that a cash based model for paying physicians for proactive services will evolve until the insurance data tables reflex proactive medicine is less expensive that reactive treatments. As we all know, this will take years. So, my advice: begin to incorporate a cash based element into your daily practice. It's good "insurance".

About: Robert Keller, MD is a world renown physician who specializes in cash based proactive medicine.

Submit a guest post and be heard.


Direct Primary Care: RIP Marcus Welby

By Dave Chase, CEO of Avado

Insurance bureaucracy has taken a toll on the family doctor. New practice models plan to change that. Physicians in North Carolina, Seattle, Northern California and elsewhere are proving what the rest of the world already knows. Highly functioning primary care results in less money spent and better health outcomes.

Before House, M.D., there was Marcus Welby, M.D. who epitomized the glory days of healthcare. Dr. Welby knew every one of his patients. If you got sick, he took care of you right away, spending whatever time necessary.

Unfortunately, there’s a radically differently model today that can only be described as a Gordian Knot designed by Rube Goldberg.

It can take a patient days to get in for an appointment, they arrive for an appointment, wait 45 minutes in the crowded waiting room, wait again in the exam room, being charitable they get 10 minutes with their doctor, 15 if they’re lucky. Of course, it’s difficult for him to remember much except for those few notes he scribbled last time. How much can anyone remember about 3,000-4,000 people? If a doctor doesn’t see 30 patients over the course of the day, he’s likely going to be penalized for not hitting his insurance-driven productivity goals. In a typical 10 minute appointment, there’s often no time to go beyond the presenting symptoms and then give the patient a prescription as a way of closing the appointment. Sound familiar?

What happened to the old family doctor represented by Marcus Welby? Insurance killed him.

Today’s insurance reimbursement process severely impedes the delivery of affordable, patient-centered primary care. Whether a doctor is using a paper-based or electronic medical record, much of their time is spent ensuring they properly code billing forms. In many cases, those claims will be denied and the process starts all over again. That doesn’t address a patient needing tests or prescriptions. As reported on CNN, more than 50% of primary care physicians say they would leave practice if they could.

Does one really need insurance for routine primary and preventive care? No. But somehow health care has become synonymous with health insurance. “Insuring primary care is like insuring lunch,” says Nick Hanauer of Second Avenue Partners, a Seattle venture-capital fund that backs one of the new “Direct Primary Care” (DPC) models. “You know you’re going to need it. You know you can afford it. Why on earth would you pay a third party to pay the restaurant on your behalf, adding overhead and taking a big chunk out of the money you pay—and because of the process, have to wait a week to get a table and then have only 10 minutes to eat?”

From my time spent in Patient Accounting departments, it was easy to see why there’s a 40% “insurance bureaucracy tax.” That is money that isn't making anyone healthier. It also doesn’t take into account time and frustration by the patient who is ultimately responsible for care as they have to wade through Explanation of Benefits (that doing anything but explain) and other forms mere mortals have difficulty interpreting (perhaps by design).

Organizations such as MedLion, Qliance and Organic Medicine are demonstrating that they can cut out the fat that insurance reimbursement adds at the same time primary-care doctors can spend more time with fewer patients and still charge low fees. Doctors operating in these models universally state that they are back to practicing medicine the way they were trained. It’s not hard to imagine that more medical students would choose to enter primary care, reversing a disturbing 10-year decline. They have moved beyond the theoretical by setting up these models. Qliance, for example, has shown they are dramatically reducing the most expensive facets of healthcare (Emergency Department, Specialist & Surgical visits) by 40-80% with a panel that mirrors the population as a whole.

How it works

As in the days before insurance, by forming a direct financial and professional relationship with each patient, direct primary care models takes the 40 cents of each dollar that would have otherwise gone into insurance reimbursement processes and puts it into more medical providers, lower fees, longer office hours, and the latest diagnostic equipment. No insurance is required or accepted (though some run hybrid insurance/DPC practices). No complicated billing forms for the typical day-to-day stuff that comes up for your health or even for managing a chronic condition. Many DPC practice offers members same – or next – day appointments plus 24/7 access to a physician. Visits are typically scheduled for an unhurried 30 minutes so that health-care providers can spend the necessary time and conduct the necessary tests to accurately diagnose an illness or provide appropriate wellness counseling. Comprehensive physical exams, included in the monthly fee, typically last an hour or more. When I visited Qliance’s clinic, the waiting room was an oxymoron — no one was waiting most of the time. The only person waiting during the 90 minutes I was there was a person waiting while their family member was having an appointment.

Qliance members choose a personal care team of both a physician and a nurse practitioner who get to know each patient very well, since they see only one-fourth the patients that a typical insurance-based physician does. Members pay only $49 to $89 per month for as much primary and preventive care as they need. On-site digital X-rays, first fill pharmacy and many common lab tests are included in the monthly care fee. MedLion has a roughly similar model charging $59 per month regardless of age and just $10 per visit (they offer discounts for senior citizens and children). It’s so affordable it’s being extended to a farming community with many migrant workers who have difficulty obtaining insurance.

The goal of DPC practices is to make the highest quality primary and preventive care affordable and accessible to all, rich or poor, insured or uninsured. Unlike insurance, they do not prescreen members on the basis of health.

Direct Primary Care practices do recommend health insurance to its patients—but not traditional low-deductible insurance. “Insurance should be used for catastrophic illnesses, not routine care,” explains internist Dr. Garrison Bliss, a national pioneer in direct primary-care practices and Qliance’s cofounder. “A high-deductible health-insurance plan combined with Qliance can save 30 percent to 50 percent off the total cost of comprehensive care. It provides better access and service at the primary-care level while maintaining financial protection for serious illnesses.”

At Qliance’s launch event, Washington State Governor Christine Gregoire told an audience of patients and others: “I see someone like Dr. Bliss and I say many of our physicians in this country and in this state went to school because they wanted to practice medicine, not because they wanted to deal with insurance. Not because they wanted to deal with bureaucracy. In fact, they don’t want to deal with any of that; they want to deal with their patients and that’s what they are really good at. And what Qliance has as a vision and a model is to allow doctors to do what they love and what they feel passionate about, to give patients… what they so richly deserve at an affordable cost and with high quality. It is patient safety. It is driving down costs… This is exactly what we and the patients in the state of Washington need.”

Marcus Welby had it right. Primary care physicians are at their best when their primary focus is their patient. Unfortunately, immense amounts of time dealing with insurance burdens have essentially eliminated the Marcus Welby model but modern day Marcus Welbys are fighting back and having great success. It’s exciting to see the spark return to the primary care physicians I’ve met who’ve removed the insurance yoke and are practicing the way they know is best for their patients (and themselves). You might call it “Do it Yourself Health Reform” driven not by politicos but by physicians.

About: Dave Chase ( is a Huffington Post/Washington Post contributor and CEO of, a Patient Relationship Management software company, previously founded Microsoft’s Health business and was a consultant with Accenture’s Healthcare Practice.

Submit a guest post and be heard


One Medical & The Patient Experience: Dr. Tom Lee

The patient experience: so many people talk about improving it, but very few people have actually done something tangible about it.

Dr. Tom Lee is a rare exception: his company, One Medical provides an excellent patient experience in primary care. Here he describes the challenges and pitfalls in delivering a better experience, despite the torturous constraints in the American medical system.

One Medical


Concierge Medicine

Here at Freelance MD we get a lot of questions about various trends in medicine.

One of the most rapidly growing clinical practice models in the US these days is Concierge Medicine, and many Freelance MD readers have expressed interest in learning more about this practice model.  

In Concierge Medicine, a physician cuts out third-party payers and contracts directly with his or her patients.  The patients pay a retainer and the physician agrees to limit the practice size so he or she can provide exceptional access to these patients.

While this model has become very popular with a certain segment of the population and many physicians, it is not without critics.  I wrote a recent article here on Freelance MD about the ethics of Concierge Medicine and the arguments for and against this model. 

Since we've received so many inquiries about Concierge Medicine, I decided to post some resources here about the subject.  In addition, for those of you who will be attending the Medical Fusion Conference this November, you'll be able to hear one of the leading experts on Concierge Medicine, Dr. Steven Knope, discuss the subject personally (and have the opportunity to sit down with Steve individually at our Accelerator sessions).  Steve is the author of the book, Concierge Medicine: A New System to Get the Best Healthcare.  

Here's a video interview with Dr. Steven Knope describing Concierge Medicine:


Here's another interview with Dr. Knope that appeared on FOX Business:


Here's a short video in which I describe Concierge Medicine and how we'll be discussing Concierge Medicine at the Medical Fusion Conference:

For those who want further information on Concierge Medicine, check out the following resources...  


The Ethics of Concierge Medicine by Dr. Greg Bledsoe

The PGA Golf Tour, Concierge Medicine, & Hitting Your Next Shot as a Physician  by Dr. Greg Bledsoe

The Need for Concierge Medicine  by Dr. Steven Knope

New Concierge Medicine Series: Royal Pains  by Mr. Jeff Barson

Health Matters  by Melinda Beck of the Wall Street Journal

Worldwide Wellness in Outside Go magazine

Total Access: Concierge Medicine Puts a New Spin on Healthcare  in The New Yorker magazine

Are Physicians Pawns in Our Healthcare System?  in AzMedicine magazine

Doctors Switch to 'Concierge' Practices  in Arizona Republic


Concierge Medicine: A New System to Get the Best Healthcare  by Dr. Steven Knope


Dr. Steven Knope: Concierge Medicine  on     

Dr. Knope Reveal All  on The Entrepreneurial MD 

Personal Pediatrics Delivers Care Right to Your Bedroom  on  The Entrepreneurial MD 


The American Academy of Private Physicians 

Franchise Models


Personal Medicine 



New Concierge Medicine Series: Royal Pains

Want to know how to start your own concierge medical practice?

Well, you can attend the Medical Fusion Conference and have a chat with Steven Knope MD, or you can tune in to Royal Pains on the USA Network and see what the media makes of a concierge practice setting up shop in the Hamptons. (I've been to the Hamptons a fair amount and it's prime real eastate for this a as a show... much better than the Jersey Shore.)

Click to read more ...


Concierge Medicine, Social Justice & Sex at 100

Some of my medical colleagues who champion the cause of “social justice” bristle when they learn that I practice concierge medicine. 

They fervently believe that it is somehow more noble to practice Soviet-style medicine in America than it is to take professional responsibility for delivering excellent, individualized medical care to their patients.  One of the benefits of being sanctimonious about private doctors who practice in a capitalist model is that you can blame some of the crappy medicine you deliver on your benevolent, utopian system, which claims to be “fair” to everyone.  How convenient.  But what are the consequences of focusing on clinical algorithms, electronic medical records, and the forced “fairness” that comes down from the Politburo?

Today I saw a 99-year-old patient in my office who is on my indigent medical care program.  She pays me $5 per visit, just so that she’s got some skin in the game.  (Quiet…I don’t want my social justice critics to know that I actually see people who can’t afford to pay my concierge fees.)  This elderly woman has diabetes and has been in the ICU twice over the past year with urosepsis, on the sepsis protocol.  Last week she was taken to a local ER at a hospital where I do not practice.  She had a recurrent kidney infection, despite receiving rotating prophylactic antibiotics and intravesicular gentamycin given to her by an expert urologist.  I was never called by the ER physician, because I am merely the patient’s attending physician – a point that is irrelevant to most ER physicians, given that virtually every patient in the ER is now admitted to the “hospitalist team.” 

Instead of admitting this frail, 99-year-old diabetic for IV antibiotics and careful monitoring, the ER physician opted to treat her as an outpatient with generic Keflex.  This would not have been my approach, but I have to agree that it certainly was “cost effective.”  Fortunately, my patient survived this “UTI algorithm.”  The doctor also opted to treat her hyperkalemia with equal efficiency, giving her a single dose of oral Kayexalate, which she promptly vomited after arriving at home.  Luckily, she did not have a cardiac arrest from her hyperkalemia, especially in light of the fact that they did not bother to hold her ACE-inhibitor, which was contributing to her elevated potassium.

As my patient left the ER, the medical team dutifully handed her the ubiquitous, and always helpful, discharge instruction sheet.  This document no doubt met all hospital and governmental regulations for educating people about pyelonephritis and hyperkalemia.  Although my patient is legally blind and cannot read standard print, I’m sure she found this 4 page document very comforting.  More importantly, the purveyors of social justice can rest assured that they followed all of the guidelines set forth by the Politburo and did their duty to deliver the same level of care to everyone, regardless of income, ethnicity or social standing.   

Had my 99-year-old patient been able to read this information sheet, I’m sure she would have found it helpful to know that she should “refrain from having sexual intercourse until after all of her kidney infection symptoms had resolved.”  I don’t know about you, but there is nothing that irritates me more than seeing a non-compliant, centenarian who continues to have sex while being treated for an active pyelonephritis.  The only way to prevent these elderly nymphomaniacs from reseeding their genitourinary tracts is to put it in writing!

What we are now seeing is just the beginning of medicine by administrative committee.  If you think I am misusing the term “Politburo”, just wait until you see what happens under the Department of Health and Human Services in the name of ObamaCare.


Dr. Steven Knope Joins Freelance MDs Physician Writers

The physician community Freelance MD today announced the addition of Dr. Steven Knope to its growing team of contributing physician writers.

"We're excited to have Dr. Knope on board" said Dr. Gregroy Bledsoe, one of Freelance MDs Founders. "Dr. knope's expertise and depth of knowledge around Concierge Medicine and direct pay patient care gives use a point of view that we know our physician readers will find valuable."

Dr. Knope has received local and national media attention for his work as an uncompromising patient advocate and opponent of the HMO industry. He has been covered in the New York Times, Forbes Magazine, Arizona Daily Star, Money magazine and The Wall Street Journal. In his fight against a local HMO, Nobel Peace Prize Laureate and inventor of the cardiac defibrillator, Dr. Bernard Lown, praised Knope as “courageous” and “deeply principled.”

About Dr. Steven Knope
Dr. Knope is a board-certified internist and sports medicine expert. He completed his premedical studies at Columbia University and graduated with honors in internal medicine from Cornell University Medical College in 1988. He completed his residency training at UCLA, where he was awarded the first Sherman Melinkoff Teacher of the Year Award. He has served as Chief of Medicine, Chairman of the Department of Medicine, and Director of the ICU in the Carondelet system in Tucson, Arizona. He is a pioneer in the field of concierge medicine, opening one of the first concierge practices in America in December 2000. He authored the first book on concierge medicine entitled, Concierge Medicine; A New System to Get the Best Healthcare (Praeger, 2008).

About Freelance MD
Freelance MD is an active community that gives physicians around the world intelligent information to gain greater control of their medical practice, income, and lifestyle.

Join Freelance MD

Freelance MD is an active community of doctors.

All rights reserved.