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Entries in Dr. Steven Knope (5)


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 



The Ethics of Concierge Medicine

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

Steve spoke at our 2010 Medical Fusion Conference, but before that event we had never met.  I had seen his book and read excerpts and believed he would be a good person to plug into what we're doing with Medical Fusion, but I really didn't know much about Concierge Medicine and I didn't know any Concierge Medicine physicians personally.

For those who aren't familiar with the terminology, "Concierge Medicine" refers to the medical practice design where patients pay a retainer fee in exchange for exceptional access to their personal physicians.  Physicians agree to limit their practice size to a few hundred patients and give their patients their cell phones, pagers, email addresses, and often make house calls in addition to yearly executive physicals and preventative medicine counseling.  Concierge Medicine is sometimes called "Retainer Medicine" or "Direct Medicine."

Concierge Medicine has been growing over the last few years due to the frustrations associated with primary care-- for both patients and clinicians-- and the development of franchise models like MDVIP.  However, whenever Concierge Medicine is discussed, critics are quick to point out it's weaknesses and cast Concierge Medicine physicians as unethical extortionists.  As an example, in Steve's Concierge Medicine office in Tucson, Arizona, one of the newspaper clips hung on his wall is an article describing his medical practice, and a quote from a local academic physician describing Concierge Medicine as "medicine at its mercenary worst."


So is Concierge Medicine "mercenary" as its critics suggest or a new practice model that is saving primary-care medicine?  Let's look at some of the major issues regarding Concierge Medicine and go from there...

1. Is it ethical for a patient to pay extra money for extra time with their physician?

Most discussions on Concierge Medicine are framed by asking whether it is ethical for physicians to charge "exorbitant" fees in order for their patients to see them.  This is the political equivalent of those squirley political poll questions like, "Do you, as a voter, believe it would be good to have a tax-evading, draft-dodging, ignorant, narcissist as your next governor?"  When the voter answers "no," the polling company reports that voters overwhelmingly are against the candidacy of politician X.  The question frames the debate.

The problem when the discussion of Concierge Medicine begins this way is that physicians are automatically cast as villains.  The "greedy" doctors are simply too money-obsessed to take care of anyone not willing or able to pay these incredibly high fees.

Bu what if the debate is turned around?  What if it's not a "greedy doctor" who is demanding the fee?  What if it's a patient with multiple chronic medical conditions that cannot be solved in the typical 10 minute primary-care visit who is pushing for the change?  What if it's the patient requesting extra time with their physician and to ensure this extra time is willing to pay for the equivalent of 2-3 regular visits a month?

The fact is that Concierge Medicine is a market response to a very broken primary-care system in this country. Patients are driving this change as much as burned-out physicians.  These patients are frustrated and dissatisfied with the current model, and are making their health a priority by investing money and time into their patient-physician relationship.  Many of these patients have multiple medical issues and they need more time with their physician.  They also need someone to help them coordinate their medical care, and have found Concierge Medicine to be a reasonable way to help them improve the healthcare system for themselves.

What's fascinating about this aspect of the debate is that the resource these patients are requesting-- time with their physician-- is the very resource that so many ethicists, consulting groups, and administrators stress is so important to patient satisfaction scores, proper diagnostics, reduced malpractice risk, reduced unnecessary testing, and overall improved clinical medicine.  It's as if the patients read the research and simply got tired of waiting for the system to fix itself.  The patients that gravitate to a Concierge Medicine practice are simply willing to put their money where there mouth is and pay for the extra time they know they need with their physician.  The Concierge Medicine model is actually correcting one of-- if not the-- most glaring problem with modern medicine in the United States: a lack of significant time between patient and physician.

2.  Isn't it more ethical for a physician to stay in the system instead of "opting out" with Concierge Medicine?

This question assumes that the basic primary-care model in the United States is working and those who choose Concierge Medicine practices are messing it all up for everyone else.

The unfortunate truth is that primary-care medicine as it is currently practiced in the United States is not working, not for those who opt out and choose Concierge Medicine or for anyone else.  Those physicians and patients who have chosen Concierge Medicine aren't the cause of this problem, they're a response to the brokenness of the typical primary-care practice model.  In fact, Concierge Medicine could not exist in a market where individuals were getting exceptional healthcare through third-party payers and the standard primary-care system.  The fact that Concierge Medicine has gotten traction is evidence that there are plenty of physicians and patients (ie- willing payers) who are dissatisfied with the status quo.

Here's a very interesting twist to the debate about Concierge Medicine:  if an individual wishes to condemn Concierge Medicine as unethical, does that same individual then defend the current primary-care system where patients are pushed through clinics like cattle and physicians are beholden to third-party payers?  What is more ethical, a patient and physician agreeing on a set fee or a physician who is compromised by the cost-curtailing focus of a third-party payer?  Which physician is the better advocate for the patient?  

3.  Isn't Concierge Medicine only for the rich?

The answer to this question really boils down to your definition of "rich."  

Of course, there are individuals who have zero disposable income and are truly destitute.  Concierge Medicine does not address this very real need.  However, for most people, the issue is not that they lack the funds to afford a Concierge Medicine physician, it simply is that their priority system places greater emphasis on things like cigarettes, alcohol, entertainment, fashion, and luxury than health, and they spend their income in a manner consistent with their priorities.

This discussion reminds me of a letter to the editor that I recently read online written by Emergency Medicine resident Dr. Roger Starner Jones:

Dear Sirs:

During my last night’s shift in the ER, I had the pleasure of evaluating a patient with a shiny new gold tooth, multiple elaborate tattoos, a very expensive brand of tennis shoes and a new cellular telephone equipped with her favorite R&B; tune for a ring tone.

Glancing over the chart, one could not help noticing her payer status: Medicaid.

She smokes more than one costly pack of cigarettes every day and, somehow, still has money to buy beer. And our President expects me to pay for this woman’s health care?

Our nation’s health care crisis is not a shortage of quality hospitals, doctors or nurses. It is a crisis of culture – a culture in which it is perfectly acceptable to spend money on vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance.

A culture that thinks I can do whatever I want to because someone else will always take care of me.

Regardless of what you think of Dr. Jones' letter, the point is that individuals make choices regarding the use of their disposable income, and many in our culture choose to place other priorities above healthcare.

Let's break this down...

MDVIP is the dominant franchise model for Concierge Medicine.  Patients who are members of these practices pay $1500 per year for the privilege of being members of this practice model.  Here's the math:

  • $1500 per year = $125 per month
  • $125 per month = $4.17 per day
  • $4.17 per day = current price of a Starbucks expresso or a pack of cigarettes

So for what most people spend a day on such extraneous things as a cup of premiere coffee or an unhealthy indulgence like cigarettes, these same individuals could have their own personal Concierge Medicine physician.

Yes, there are individuals who cannot afford even this amount per month, and Concierge Medicine does not address this issue (although some are experimenting with a retainer-type practice coupled with indigent care and many Concierge Medicine physicians, including Dr. Knope, spend significant time providing free care to non-paying patients), but no practice model is perfect.  Concierge Medicine could improve access to healthcare of a significant number of working people, if they would only choose to buy into the model.

Additionally, if a patient opens a Health Savings Account that is coupled with a high-deductible insurance plan, pre-tax dollars can be set aside to use towards the costs of a Concierge Medicine physician, making the retainer costs much less expensive for the average consumer.  

In sum, Concierge Medicine is a growing trend that some consumers are using to maximize their healthcare experience.  It is not a system that solves every problem, but I believe it is ethical and it is a solution for some patients.  Instead of criticizing the patients and physicians involved with Concierge Medicine, we should work together to continue to find additional ways to solve the problems with the current healthcare system.  

In future posts we'll be looking more into Concierge Medicine and other non-traditional practice models and explaining how you can incorporate these models into your current practice.


2011 Medical Fusion Conference Faculty and Agenda

At every Medical Fusion Conference we attempt to cover the most pertinent topics for clinical physicians who are attempting to branch out from their clinical careers.  

For 2011, we've once again assembled a stellar faculty comprised of leaders in many diverse niches from around the country, and have included many hot topics that physicians should be exposed to in this ever-changing healthcare environment.

Our 2011 faculty list was recently published here on Freelance MD, but we've added a few more names so I've decided to list our entire 2011 Medical Fusion Conference faculty once again.  Many of these faculty members are authors here on Freelance MD so you can read about their backgrounds and perspectives here. I'm also listing our agenda below so you can get an idea of what's going to be discussed at this year's event.  Remember, the 2011 Medical Fusion Conference is November 11-13, 2011 and space is limited.  If you're interested in attending you can register online or call 866-924-7969 .

Our 2011 Medical Fusion Conference faculty:

Our conference topics this year are wide-ranging and cover many niches within and around clinical medicine.  Our 2011 agenda is the following:

Friday, November 11th
8:00-9:00  Leaving the Tribe, Silbaugh
9:00-10:00  Physician Career Transition, Wendel
10:00-10:30  Break
10:30-11:30  Prescriptions for Financial Success, Mazumdar
11:30-12:30  Living and Working Abroad, Bledsoe
12:30-2:00  Lunch
2:00-3:00  Concierge Medicine, Knope
3:00-4:00  Cosmetic Medicine Profits Blueprint, Barson
4:00-5:00  Real Estate Investing, Taff
5:00-6:00  Should You Get Your MBA?, Cohn
6:00-7:30  Accelerator I
Saturday, November 12th
8:00-9:00  Writing & Publishing I, Silver
9:00-10:00  Writing & Publishing II, Silver
10:00-10:30  Break
10:30-11:30  Internet Entrepreneurship I, Woo-Ming
11:30-12:30  Internet Entrepreneurship II,  Woo-Ming
12:30-2:30  Lunch
2:30-3:30  Product Development, Silver
3:30-4:30  How to be a Rockstar Physician, Barson
4:30-5:30  Independent Consulting, Cohn
5:30-7:00  Accelerator II
Sunday, November 13th
8:00-9:00  Believe Me: The Importance of Building an Unforgettable Brand, Gulati
9:00-10:00  Careers for Physicians in Managed Care and Health Insurance, Peskin
10:00-10:30  Break
10:30-11:30  Introduction to Disability Review, Neuren
11:30-12:30  Online Marketing for Physicians: The Essentials, Quatre


I wanted to make sure I highlighted our two Accelerator sessions at the end of each day.  Our Accelerators are some of our most popular times spent at the Medical Fusion Conference since each faculty and mentor has a table, and participants are allowed to wander from faculty member to faculty member and ask any and all questions of the speakers.  No other event allows you this much face-time with nationally known leaders.  Our participants raved about our Accelerator sessions in 2010 and we know that our 2011 participants will also enjoy this time.  

As you can see from our faculty list and our agenda, Medical Fusion participants will be given exposure to a wide array of interesting topics and significant time with our stellar faculty.  There's no event like the Medical Fusion Conference and there's only one Medical Fusion Conference in 2011: November 11-13, at the Aria Resort & Casino in Las Vegas. Register today to ensure your place at the most exciting and invigorating medical conference in the country.


The PGA Golf Tour, Concierge Medicine, & Hitting Your Next Shot As A Physician

Forget about yesterday and refocus your energies on hitting your next shot.

Well, it's good to be back.  

This past week I had the pleasure of taking a trip out to Arizona where I took in the PGA event at the Ritz-Carlton Golf Club and caught up with my friend Dr. Steven Knope, author of Concierge Medicine: A New System to Get the Best Healthcare .

It was a whirlwind tour, but one that left me with some time to think about the state of clinical medicine and our place as physicians within it.

During the flight to Arizona, I whipped out my new iPad and finished reading Steve's book using the iPad Kindle application.  It's a great read, and for those of you who have questions about Concierge Medicine, I would certainly recommend it.  Be forewarned, the book is not a "how to" book that tells you how to set up your clinical practice in a concierge or retainer style; it's basically a narrative of how Steve ended up in his current form of medicine and some of the arguments for and against the model.  I found it fascinating and after reading it I was even more eager to meet with Steve and bounce some questions off of him.

However, before I met with Steve, I had the opportunity to attend the World Golf Championship-Accenture Match Play Championship on Wednesday.  If you're not a golf fan, basically this tournament includes the top 64 golfers in the world who compete head to head in a single-elimination format until the champion is crowned five days later.

I'm not a golfer, but walking around the course during this PGA event, watching the top 64 players in the world compete, I was really amazed.  Even a non-player like myself could appreciate the talent and dedication it takes to be able to consistently hit shot after shot, all the while battling strong gusts of wind, fairways lined with crowds, and television cameras on every corner.  

What I found most inspiring, though, was not the incredibly placed shots that seemed to occur on a regular basis, but the imperfect ones that took a wrong bounce or caught an errant gust of wind and were pushed into the rough (or worse).  More precisely, it wasn't the bad shots themselves that were all that inspiring as were the responses of the pros who hit those shots.

Yes, there were a few fits of frustration when shots went awry, but to a man, every one of those pros recentered themselves when they went to follow up.  Often enough, when a pro hit a bad shot, he followed it up with an incredible adjustment shot and ended up close to where he would have been in the first place.  I observed multiple shots from bunkers, the rough, and out of bounds, that ended on the green near the hole.  It was as if the player wiped his mind clean as he approached his botched shot and made the best of the situation.  The memory of his "failure" was seemingly forgotten, and his focus was turned towards his current challenge with renewed intensity.

It was a great character lesson, to be sure, and provided me with much to think about as I headed to my meeting with Steve towards the end of the week.

For those of you who do not know Dr. Steven Knope, he was one of the first Concierge Medicine physicians in the country and wrote one of the most popular books on the subject.  He's been interviewed by multiple media outlets and was a speaker at our 2010 Medical Fusion Conference.  Steve is intelligent and candid, and I thoroughly enjoyed talking with him about Concierge Medicine, his practice, writing his book, and his views of the changing face of clinical medicine.

During our talk, one of the things that came up was a recent article that appeared in The Wall Street Journal .  Steve had forwarded me a link to the article prior to our meeting, and we took some time to dissect its meaning for Concierge Medicine and clinical medicine in general. 

In this article, the author points out that the recently passed healthcare legislation has already significantly changed the healthcare landscape.

Here's a excerpt:

The most significant change is a wave of frantic consolidation in the health industry. Because the law mandates that insurers accept all patients regardless of pre-existing conditions, insurers will not make money with their current premium and provider-payment structures. As a result, they have already started to raise premiums and cut payments to doctors and hospitals. Smaller and weaker insurers are being forced to sell themselves to larger entities.

Doctors and hospitals, meanwhile, have decided that they cannot survive unless they achieve massive size—and fast. Six years ago, doctors owned more than two-thirds of U.S. medical practices, according to the Medical Group Management Association. By next year, nearly two-thirds will be salaried employees of larger institutions.

Very interesting stuff.

It seems that many physicians have seen the proverbial "writing on the wall" and are selling out in an attempt to protect themselves from what's coming.

Look, I'm not saying that every physician job in a large institution is a bad one and I'm also not saying that every physician has a desire to run his or her own practice.  However, when the percentage of doctor-owned practices goes from more that two-thirds to approximately one-third in such a short time, something is amiss.

The simple fact is that today, more than any time previously, physicians are under attack.  A clinical physician today was already being squeezed by an out-of-control malpractice environment, falling reimbursements, huge student loan debt, and increasing paperwork and regulation.  With the added pressures of the new healthcare laws, many are simply saying "enough is enough" and throwing in the towel.  Conformity and subservience is preferred to bankruptcy, or so the thinking most likely goes, and at a time when we desperately need physician-leaders, many seem to be simply checking out.

In any event, Steve had some great insights into how Concierge Medicine fits into the big picture of American healthcare these days (more on this in a later post) and when I began thinking about things after our chat, my mind began drifting back to those golf pros from the PGA and how they handle their difficulties on the links.

When I watched those athletes, it became very clear that the line separating their talent was very thin.  On any given day, the winner-- more often than not-- is simply the guy who can refocus himself after a tough go of it and remain mentally tough in spite of trying circumstances.  

As physicians today, it's obvious that we've received more than our share of frustrating circumstances and difficulties. The key, though, is in how we approach these circumstances.  We can check out, certainly, or obsess about the past and "what might have been."  We can stew in our frustration and bask in the collective pity-party in the doctor's lounge, or we can begin looking for ways to move forward.

What if we took a tip from the pros in the PGA and stopped looking backwards and began to look forward once again?  Why not wipe the past away, focus on what we can change,  and begin to move forward?  What if we all stopped worrying about the ultimate outcome and... just hit the next shot.

The purpose of Freelance MD and our Medical Fusion Conference is to provide resources to help all of us do this.  We've assembled an incredible team of career coaches, entrepreneurs, non-clinical job experts, and many other talented individuals to help physicians focus our energies on hitting the next shot well, and begin looking forward with hope instead of backwards with regret.

How do you take the first step?

Well, begin by registering for Freelance MD and joining our community.  We're going to be sending out special information to our members and discounts from our various Select Partners.  

Next, become active in the Freelance MD community.  Don't just read the blog, write a comment or two, let us know your opinion, engage.  We need to hear from you and you'll profit from the lively interaction.

Last, consider attending our Medical Fusion Conference.  The dates are November 11-13, 2011 and we're already getting registrations.  There's limited space so please register early-- we don't want anyone to be left out!  Remember, this year we'll be staying at the incredible Aria Resort & Casino, a Five-Diamond property on the Las Vegas Strip-- a fun place to rejuvenate while connecting with interesting and motivated peers from around the country.

Over the next few weeks we're going to be going deeper into a variety of topics, Concierge Medicine included, and we're glad you've stopped by the blog to check us out.  Thanks for your interest. If you like what we're up to, or even if you don't, please leave us a comment to let us know how we're doing. 


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).

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