By now you’ve probably heard of the concept of “concierge medicine.”

To me, it’s an idea that’s Win-Win-Lose:

Win: Doctors. Those in concierge practices have chosen to forgo the traditional business model in favor of  charging annual fees that range from $1500 to $15,000 per patient. How much you pay depends on the market, exclusivity factors, and amenities, like comprehensive annual physicals with add-ons like a dermatology appraisal and nutrition consultation. Concierge docs see many fewer patients in their practices than regular primary care doctors. As such, they can spend more time with each patient, and practice medicine in a more deliberate, thoughtful fashion. They are freed from the hassles of complying with and filing insurance claims. MUCH more money flows into the practice, since it’s paid in full on a monthly basis. Summary: fewer patients, more money.

Win: Patients that desire this model and can afford to opt in. They get the satisfaction of having a doctor at their beck and call (cell phone access), services like comprehensive annual checkups with amenities, and if anything goes wrong, their concierge doctor can use his network to get streamlined, coordinated specialty care.

Lose: The rest of us. Very few people can or will opt in to this model. And that’s by design. By limiting himself to the market’s high end, the doctor raises the exclusivity (and revenue) bar. Moreover, with every doctor that opts in to a concierge model, we need someone else to serve the rest of us.

Now come the docs who don’t have a taste for the high end. They struggle with the exclusivity of the concierge model but aren’t happy with the status quo–feeling like hamsters on a wheel and having to always go faster. More patients, shorter visit times, more administrative regulations to cope with.

Hence the advent of the “direct practice” model. Direct, because you pay your doctor on a monthly basis to belong to the practice, but at a more affordable price point-a maximum of $100/month, but usually more around $60. No amenities here, other than access and evaluation by a doctor who knows you well.

There’s a guy I admire named Dr. Rob Lamberts who’s in the throes of making such a conversion. Dr. Rob is boarded in internal medicine and pediatrics, and works in Augusta, Georgia. He’s practiced office-based primary care for adults and children for sixteen years. Rob admits to being kind of a nerd; he started using computers in his medical practice way before it was cool, incentivized, or required. As such, he feels that in that regard he was ahead of the curve.

Rob is also a terrific and funny writer and blogger, and he’s been incredibly transparent about his decision-making process as he’s decided to leave his group practice and switch to a direct practice model.

When good guys like Rob start to feel that working ‘outside’ the system will be more fruitful and productive than making change inside the system, I worry that the transformation of health care will be slower and more painful for all of us.

John Schumann is an internal medicine physician who blogs at GlassHospital.