Building a concierge safety net practice

“So like a concierge doctor?”

That was the most common response upon explaining my future direct primary care practice while in residency. That perception and label really perturbed me. My vision was to care for a diverse group of people. I spent the majority of my residency clinic hours in an urban safety net clinic, but certainly didn’t want to swing the pendulum to the opposite 1%.

To avoid that stigma, I honed my pitch. I stressed the affordability and inclusiveness of a direct modelregardless of a person’s insurance arrangements  — or lack of. The terms “exclusive” or “VIP” were nowhere to be found on my website. I wasn’t even offering “executive” physicals.

To spread the gospel, I hung up flyers at coffee shops and spoke to every local club that would have me. The initial receptions were warm and typically focused on how “cheap” my fees were for someone without insurance.

I volunteered at a local safety net clinic near my practice. We developed a steady stream of referrals from them — primarily uninsured people who didn’t meet the clinic’s financial or residency guidelines. My nurse joked we were the “safety net’s safety net.”

Our first patients were an interesting bunch: diabetic plumbers, homeschooling families, alcoholic bartenders, but very few with homes on the golf course. Most hadn’t had primary care for years. Many had sworn off traditional medicine altogether. The vast majority were uninsured and less than median income.

“I got kicked off my parent’s insurance and was told you take people without insurance.”

“Are you another clinic for uninsured people?”

The conversations with prospective and new patients became quite repetitive. The pitch of affordability had certainly worked. My practice grew steadily, reaching 400 patients after about 18 months, with nearly 80% being uninsured and lower income. Many were driving 50 or more miles because they had no other affordable options.

My patients were extremely grateful for our services and transparency. I was providing them all the features and amenities of a concierge doctor — same-day appointments for the plumber, emailing the bartender, given a toddler stitches at 10 p.m. so his parents could avoid a $2,000 ER visit — but without the valet parking and high price tag.

Unfortunately, perhaps ironically, the quality and convenience of my practice had been diluted by my emphasis on affordability. There was a growing local perception that we were only an option for the uninsured. I had several people report they thought they could not join because they had insurance. One person frankly told me that they didn’t want to go to an “uninsured people clinic.”

Starting 6 months ago, I retooled to highlight our quality and convenience first, then affordability. We have seen an increase in insured and middle-upper income families joining  — primarily quoting our “concierge” services as the reason why. I am now nearly at full capacity but still over 70% of our patients are uninsured.

Now, whenever people ask me, “Are you a concierge doctor?” or, “Are you that doctor for uninsured people?”, my answer is less defensive.

W. Ryan Neuhofel is a family physician and owner, NeuCare Family Medicine.

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