Myths about concierge medicine

Myths abound concerning concierge medicine (CM). Unfortunately these myths prevent good doctors from converting their practices to CM.  Let’s look at those myths—maybe you need to work on yourself and your own beliefs. If you practice quality medicine your patients will value you and your work and will pay a fee to join your CM practice.  CM is a value story.  If you provide solid value, you needn’t believe these myths–value trumps myth.

The myths:

  •  My patients are not wealthy/can’t afford CM.

– I have a lot of Medicare/Medicaid patients.

  • My patients will not like this concierge idea.
  • My patients can’t do without me.
  • I have bad practice demographics.

– I am rural.

– My patients are too old.

– My patients are too young.

  • 24/7 coverage sounds too hard.
  • Is this legal? What are the ethics?
  • The conversion process will overwhelm me.

My patients are not wealthy.  If your patients value you and your work, you can devise an affordable program.  Patients will find the money to keep you if they value you.  Be creative with pricing if necessary.  You can make it work.  Amazingly, I have patients who live in housing projects who joyfully belong to my practice because they see the value.  Conversely, all of us in CM practice have wealthy patients who say the fee is too high, do not see the value, and do not join.  Patient income generally does not predict CM success or failure.  Perceived value predicts success.  Focus on value and the rest will follow

My patients will not like this concierge idea.  Do not project onto patients negative beliefs, as those beliefs may become unnecessary self-fulfilling prophecies.  Patients’ enthusiasm will mirror your own.  Patients possess a survival instinct and will recognize your opportunity for better care, along with your belief in providing that care.  Moral:  be enthusiastic!  Believe in yourself and your patients will follow.  Above all, emphasize value and opportunity in your CM practice.

My patients can’t do without me.  Primary care doctors are famously codependent.  Get over it.  Patients not seeing the value in your practice can and will vote with their feet.  You do not decide who can live with or without you—patients decide.  Patients who truly “can’t live without me” will see the value and stay with you.  There is nothing unethical about letting patients decide who they need.   Do not project your own needs onto your patients.  Patients who do not wish to stay with you are responsible for their own lives.  Let go of your codependency.

I have bad practice demographics.  You can overcome demographic obstacles by providing great value to your patients.  Patients of all stripes, ages, and locations will stay with you if you take excellent care of them.  For example, farmers in my practice understand, respect and value hard work.  All of my farmer patients signed my contract.  The elderly do tend to value their care more that the youthful, but the health-conscious young will sign-up as well.  Meet demographic challenges by making sure your patients see value.

24/7 coverage sounds too hard.  24/7 sounds impressive, and it does demonstrate value.  Taking call has never been easier for me.  First, with fewer patients in the practice, the calls decrease in proportion to number of patients.  Second, the very patients who respect and value me enough to contract with me demonstrate discretion in calling after hours.  Mutual respect is the norm in CM.  Inappropriate calls come few and far between, so 24/7 call is not hard.

Is this legal?  What are the ethics?  Concierge medicine is legal and is ethical. In CM, you provide a service for which patients pay. If you elect to file insurance, your CM practice needs to provide a non-covered service. Some argue that by charging a fee, you limit access to patients, hence CM is not ethical.  Your response should be, “I need to see fewer patients to practice a high level of care.  I cannot take care of all patients who need a doctor.  It is not my responsibility to see all patients or attempt to cure all of society’s ills.  I just focus on my own patients.”  Explain this truth to your patients. They will understand you.  It is ethical for you to stay alive and in business by practicing concierge medicine.

Conversion process will overwhelm me.  Conversion to a concierge practice is do-able, and challenging.  You have one chance to do it right.  We do not recommend going it alone.  Conversion need not be overwhelming.  Simply ask for help.

If you know in your heart that you need a better alternative than hamster treadmill high volume medical practice, consider concierge medicine.  Do not shoot-down CM based on any of the above myths.  Focus on value.  If you can provide value to your patients and if you want a better life for your patients and yourself, bust these myths and get going.

John T. Kihm is an internal medicine physician and CEO of Concierge Medicine Direct.

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  • Anonymous

    What a great synopsis! I love this concept because it is about an individual making their own decision; in this case to practice medicine on their terms. No interference from government agencies or other professional organizations trying to dictate their practice. In a nutshell, I am trying to practice what I was educated to do on my own terms – so leave me alone and let me do it! This should be the same for other healthcare professions as well. We are making positive progress!

  • Matthew Mintz

    Excellent post. Part of the myths and negative stereotypes come from using the terms “concierge” and “botique” when talking about a retainer practice.  Proponents of this type of model should refrain from using the term “concierge” and use the term “retainer.” See my blog post on this

  • Bob Fabbio

    An affordable alternative is WhiteGlove Health who caters to the masses.  For a fraction of the cost of a physician-based conceirge medicine engagement, WhiteGlove brings medical care to its members – home or work — 365 days a year.   The medical care is delivered by nurse practitioners — the provider you often see when you go to the doctors office anyways.  And WhiteGlove’s healthcare experience is all inclusive of prescription medications and other incidentials.

    • Anonymous

      I had a chance to review your website…kudos for developing a collaborative practice model! I’m not sure what you mean by “provider you see anyways” however. Is there an issue with seeing these professionals? This seems to be a true creation out of necessity with true interdisciplinary collaboration between physicians and APRNs. I am familair with the IOM report on advanced practice nursing and WhiteGlove appears to be an example of all providers collaborating horizontally and on par with each other! I hope your company continues to succeed with this model! Congratulations!

      • Bob Fabbio

        Thanks!  Often you make an appointment to see a doctor and instead see a APRN or PA.  That’s all!

        • Anonymous

          Are you willing to pay extra to see an MD? Remember the MD has many more years of training and this needs to be paid for by someone. 

  • #1 Dinosaur

    That’s just a little too facile. Unfortunately, there really are places where the demographics and economics are such that retainer/concierge medicine will not work. You seem to be implying that failure is the physician’s fault (they don’t “value” themselves enough; they don’t set things up right, ie, not using your program.) Sounds a little like blaming the victim for a failed retainer practice.

  • Margalit Gur-Arie

    What happens if all (or most) of your patients want to stay and pay? How do you reduce the number of patients you see?

    • Terence Ivfmd Lee

      That would mean that he’s doing a fantastic job to have that many satisfied patients. Isn’t that the goal? There are many solutions. He can either extend his hours to see more patients each day. Or he can get an associate. Or he can raise his fees. The problem of having too many patients who all want to pay extra to see you is not exactly a bad thing. Having that many satisfied patients means you’re doing your job as a doctor.

      • Margalit Gur-Arie

        Yes, it is a great thing, but if every doctor out there cuts his/her panel down to a third of what it used to be, what happens to the two thirds of patients who didn’t make the cut?
        Do the remaining conventional docs start seeing even more patients haphazardly? Perhaps we convert hospitalists into PCPs, since concierge docs do go to the hospital, right?
        Just trying to figure out where things are going……

        • Anonymous

          Do you own and control hospitalists to ” convert” at your leisure?

          • ninguem

            There was a time when that same attitude kept women out of medicine. Only so many doctors, lots of sick people, a woman will want part-time work for the realities of childbearing. Can’t have that, the docs had to work full-tilt.

            Result was burned-out doctors…….and misogyny.

          • Margalit Gur-Arie

            No they don’t, but we need to educate more, so everybody can pick their own pace, just like all other professions which do not suffer from mysterious shortages.
            Why aren’t we educating more doctors? There certainly is more than enough willing talent.

          • Margalit Gur-Arie

            I do not, but “conversion” of roles is not uncommon in various professions. The hospitalist role was created by a need, recently, and converted quite a few PCPs. I don’t see why another need could not revert the trend.

  • Samir Qamar

    Good article. Direct Primary Care (DPC) is another option. Our DPC company, MedLion, effectively converts physicians’ private practices into a model whereby government and third party payor interference are minimized. At $59 a month for adults, $39 a month for seniors, and $19 a month for dependents younger than 21, our fast growing network of doctors are not chastised for catering to the elite as some might be in a concierge medical practice. At full capacity, our doctors see half the national average of patients, yet still are able to increase their practice income dramatically, at levels comparable to concierge medical practices. At MedLion, both patients and doctors are happy, and cost is reduced in all aspects of healthcare delivery.

    • Chris OhMD

      Instead of having $59 monthly fee don’t you think patients prefer to pay more for visits and pay less monthly? For e.g. $10 monthly but copay $40-50 per visit. Why not charge more for someone who uses the resources more than those who do not? I never understood this pricing system. I have many self pay patients and they prefer to pay for visits and not monthly..

  • Anonymous

    Interesting perspective, something we never considered. The type of model you’re suggesting is something like NextCare has, which has indeed been successful. At MedLion, we like to steer clear of per-visit-reimbursement systems which are the norm today. Our current model allows for follow-ups that aren’t cost-prohibitive, thus leading to better outcomes.

    • Anonymous

      Basically we are talking about diferences in pricing strategies.  If you provide excellent care and value, nearly any pricing strategy can work.  Our model has the advantage of not undervaluing your hard work, while allowing discounts for those truly in need.  Do not, I repeat, do not sell yourself short.  I make house calls on patients living in the projects who see the value in my work and contract with me. Focus on value, do not sell yourself short, find the model that makes the most business sense to you, then make the change.  We can help.

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