I've just become aware that the PA who opened a hybrid concierge practice in my local town is taking home about three times what I am as a PCP and that's really opened my eyes and got me thinking that I may be on the wrong horse. I'm curious to find out how much a doctor can make opening a concierge practice and if there's a consensus that it's a good business idea, or at least taking a closer look at.

I've seen a couple of posts by Steve Knope MD on this site but nothing really recent. Does anyone have experience with or thoughts on using some kind of direct pay model as a primary care doc? Are here common pitfalls or land mines? Thoughts welcome since I'm completely in the dark on this.

this just seems like a new trend for the wealthy, but since +40% of the salary is going out the window for today’s physicians, i surely cannot blame them for trying to earn a bit more by targeting the “rich”.
i also did not know that such practice existed in real life. (since that new tv series about a blacklisted doctor making house calls for the wealthy community aired recently, i thought such thing existed only in the tv world)

Let’s not beat around the bush or lie to ourselves people. This is health care for the rich, plain and simple. Doctors want a better, more flexible lifestyle with better compensation, so they pursue concierge medicine. They don’t want to waste 3 hours in surgery on an injured construction worker, worrying whether workers comp is going to pay their bill.
The poor get screwed, the rich win–just as things always have been.
A lot of people don’t become doctors purely (as in 100%) out of some innate, endless source of altruism. This is the sad truth.
Dear Tony, what exactly is “base level”? You mean, low, crap level, right? You do know there’s a doctor shortage?

My doctor is changing to concierge service as of Jan 1. I can't fathom paying her $2,100. for one super duper exam, so I've been looking for a new doctor. I had a couple people recommend the same one, but it turns out her practice is also changing to concierge soon.

My father was talking about this trend with a retired surgeon. The surgeon said that all these young doctors figure they're going to be like the guy on "Royal Pains".

Granted, the initial thrust of the concierge movement was aimed at rich populations. There are, however, models to pursue a concierge (or direct patient pay) practice that is highly beneficial to the proverbial 99%. One model is dubbed the "Robin Hood" model. Maintain a limited clientele that pay for a higher level of service and these "rich" clients essential pay for the ability to provide affordable or free medical care to people who can't pay for the higher tier of service. Have insurance, yes, but use it for what it was designed for... emergencies (i.e. pay highest deductibles and use the savings to invest in a direct patient pay practice). This way the patient gets far superior service for the normal routine medical services, but still has a fallback for emergencies. All while paying the same or less out of pocket and doing away with the headaches and limitations of dealing with insurance for non emergencies such as checkups.

A good point that I have also heard Dr. Knope make is best illustrated in the form of a question. What is a greater moral and medical travesty? To provide low quality medical treatment to 40 patients a day and to not be allowed to provide care that you know as a physician that a patient needs because of the restrictions of insurance company compensation? or to provide the highest quality care to, say 10 patients a day and be able to bring you full medical knowledge and skill to bear, unhampered by big brother insurance looking over your shoulder and telling you what you can and can't do, whether or not it's in the best interest of the patient? It's something to think about.

I'm seeing some misinformation regarding this concept.

First, while I don't doubt there are current students/interns/residents who have seen Royal Pains and want to emulate this, the reality is concierge medicine existed before the show. This is more a case of art imitating life, not the reverse.

As far as flexibility, it's not as flexible for the physician as you may think. As a concierge doctor, you are on call 24/7. Your patients are paying for 24/7 access to your care. Even with partners, splitting the call is still a lot. And to go on vacation, you need to find another concierge doctor to cover you.

It's also not as lucrative as it sounds. I've talked with several colleagues who started such a business and the patient interest was not there. They wound up doing it part time or closing it all together and going back to their old job.

Finally, as a patient you can't go to too high a deductible. If you need blood work, x-rays, etc, you need an insurance that will cover for these tests. It's not covered by the cost to your concierge doctor. They don't have their own lab and radiology.

So, in short, while in certain places this can work, it's far from a sure thing.

I know this isn't the political board but even as a Rebublican I don't agree with concierge practices. Probably because I doctor I know has one but also has a car covered with Obama stickers. I just can't believe the hypocrisy. I for one am totally offended.

This makes no sense. As a patient in a concierge practice I can still see any doctor I want, and my insurance will cover it. My MD makes referrals to other MD's (specialists) all the time.

I consider it a benefit to have one person "overseeing" my medical care (not my decisions). If you've ever had responsibility for an elderly person's care, you know how nuts it gets. My mother had three different doctors prescribing a total of 12 medications that interacted with one another. Each medication helped one condition but worsened another etc. etc. It was impossible to get the drs to communicate regularly, and that likely hastened my mother's death.

My MD doesn't use "physician extenders" unless you count the people who draw blood, do EKG's etc. If you have a question the MD answers that same day, by phone or email.

To the PP who says she opposes concierge medicine "even though she's a Republican," how about opposing the present system in which very many people have no medical care at all? I'd be happy to pay the taxes necessary to ensure that everyone has access to decent medical care. Once we get that in place come back and we'll talk about inequality in respect to concierge medicine.

Betty,

When you get referred to other doctors, are they also concierge doctors or do you need to use insurance to pay for them? Are your blood work costs coverred by your concierge expenses? X-rays? What about hospitalizations?

Also, do you have issues with Physician Extenders (PA's and NP's)?

I agree with you Dr. Koniver. Perhaps this whole 'concierge doctor' thing is just new to most people that they find it hard to accept it and be well adjust to its terms.

How, do you think, this should be termed appropriately then if 'concierge' is not the right term for it?

My doctor went concierge last fall and I couldn't be happier. For less than the cost of a smartphone data plan I get a lot more attention, no more PA's or nurse practitioners. I'm solidly middle class and I see $1,500 as well worth what I'm getting. My doc is so much happier as well, and always says the surgeons and every growing populations of hospital and insurance execs are welcome to pick up any slack. They've never volunteered for the past, oh, 4 decades.

Physicians are starting direct pay because insurance paperwork and reimbursement is a pain, not because they want to earn more.

If you want to target the greedy in healthcare, look to healthcare "managers", malpractice attorneys, pharma execs, and insurance companies.

Most doctors go into concierge model of practice with the good intention of delivering high quality care. For me its going to be a big drop in income since I am going to limit myself to only 200 patients delivering them the most excellent care . Its not about money. Money comes from seeing 40 patients a day not by limiting your panel to 200.

This is a better way to deliver healthcare by eliminating all the paperwork and government intervention. This is a far better approach than our trend towards obamacare. This can be made to work for everyone. lets get government out of the way.

I agree wholeheartedly with Dr. Koniver. Feel free to do "conceirge", but I would not recommend calling it that. And whatever you do, DO NOT let some other "Conceirge Franchise" take any of your money!!! They are not creating any value whatsoever and you don't need them to give you a website or a name.

It would be so much better for doctors and patients and then entire practice of ambulatory medicine if we weeded out all the unnecessary middle men that make our lives so much more difficult: insurance companies, conceirge companies, marketing groups, lawyers, etc.

We are in a service industry and it is totally ok for people to pay for that service. The practice of medicine is to earn a living and it is entirely justified to earn a good income. Nobody paid for our educations besides us, we carry a lot of responsibility and risk, AND do not forget that this is a career choice that we want to keep lucrative so we can continue to attract the best and brightest. Isn't that how Wall Street, Hospital administrators and Big Pharm justify their CEOs earning tens of millions of $$$. I think it's just fine if a doctor makes $250,000 and should not feel guilty about it.