New primary care doctors are going cash only

Primary care’s woes have been well documented, especially on this blog.

Pressure on reimbursement, combined with rising bureaucratic impediments to the doctor-patient relationship, are both causing primary care physicians to retire early, or seek another career path.

But what about on the other side of the spectrum, namely, newly graduated primary care doctors?

Well, they’re no dummies, as it’s obvious to them how difficult it is to practice primary care in a traditional setting. More of them are opting for cash-only practices from the start.

Josh Umbehr, a prior contributor to, will soon complete his family practice residency, and is busy prepping his concierge practice once he finishes. A piece from The Wichita Eagle publicizes the upcoming practice:

. . . primary care physicians have 3,000 to 4,000 patients; he hopes to limit himself to 400 to 600. Most adults will pay $50 or $75 a month. He expects to turn a profit within a year.

He will see those who need in-person attention, at his office, in their homes or at their workplace. But he expects much of his patient contact to be by phone or e-mail. Most physicians won’t do that because they don’t get reimbursed for it, he said.

Medical students plainly see the low morale and deteriorating practice environment that plagues primary care. Going cash-only provides a path for those who want to pursue primary care, yet are wary of the bureaucratic hassles.

Good for Josh for taking matters into his own hands.

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  • Vox Rusticus

    Good luck to him.

  • anonymous

    good luck to him. it would be awesome if he succeeds. i wonder how many have the option to pursue that after accumulating massive educational debts that need to be paid back, usually starting wtihin 6 mo of completing training? also a very difficult road (but not impossible) as he needs to negotiate a lot of things-employee contracts, lease space, possibly hospital privileges, phone service, laboratory services, credit card services, line of credit, office equipment, possibly emr for prescriptions at least etc. that usually residency does not train you for or pay for.

  • rezmed09

    To anybody who is afraid of “socialized medicine” (as most reform initiatives are falsely being labeled), this is the logical alternative. Allow the free market to work out a solution and the result is a cash driven practice seeing roughly 1/3 the number of patients that a provider could see before with twice the profit. This is the “free market”. It’s not good or bad. And while “it’s just business” it is very personal.

    While this is not my idea of the way to practice medicine, I laud those who practice this way. It will change our medical world, and it will effect revolution, if not reform. If we don’t want reform, capitalism will provide a solution – to those with money. The rest are SOL.

  • Jenga

    It can be done, he may have to moonlight for a bit until he gets ramped up.


    My best wishes on your endeavor. Your plan for independence in your work and in the patient care you will deliver is both inspiring and very very important.

    I only hope that the policy wonks don’t effectively tie state medical licensure to mandatory acceptance of their and/or other insurance policies and thus, snuffing out the spirit and implementation of what has made this once great Country great. Good luck!

    • GivMeABreak

      I take the 13th Amendment!

  • jsmith

    I too wish him good luck. It’s sad that this country is unwilling or unable to induce more smart young primary care docs to do traditional care, but this is where we find ourselves. We PCPs can’t solve this problem.

  • eddoc

    How sad that our flawed system drives us to protect ourselves and our practices through exclusionary processes. BUT I applaud anyone who controls that which can be controlled. If he succeeds, good for him; if he fails it was his failure, not that of the system.

  • Susan

    Wow, what a supportive group here….(sarcasm intended).
    Change is going to happen whether you drive it or let it happen to you. Josh will do fine because he is taking control and his patients will benefit. I”m sure he ran the numbers and figured out he’d “turn a profit within the year,” so saying that he might not succeed is silly. Why start a new venture if you don’t know if it will succeed or fail? I’d pay $50 a month to get better quality care–and I can use my Health Savings Acct to cover it….Yeah, smart move, Josh!

  • Michael Tetrault

    The Concierge Medicine Research Collective, an independent health care research center based in Atlanta, GA has released a 12-month summary of its survey results of the concierge medicine marketplace. The study concluded that at the end of 2009:

    Over 66% of current U.S. concierge physicians operating practices today are internal medicine specialists.
    The second most popular medical specialty in concierge medicine is family practice.
    A surprising finding in this study was the increasing number of concierge ‘dental’ and ‘pediatric’ practices arising since February of 2009.

    “We studied concierge physician growth, the various models used, popular trends, and collected a wide variety of data on different specialties from October of 2007 to December of 2009,” said Michael Tetrault, Executive Director of the Concierge Medicine Research Collective.


    Michael Tetrault
    Executive Director | Editor-In-Chief
    Concierge Medicine Today | The Concierge Medicine Research Collective

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