This article appears on the Journal of the American Academy of Physician Assistants’ blog, Musings.
Concierge medicine, also called retainer medicine, is a primary care physician practice model in which the patient pays an annual fee or retainer to be a member of the physician’s practice. This fee only provides access to the physician, and does not cover the cost of any of the medical care provided. The goal of this type of practice arrangement is to substantially decrease the number of patients in the physician’s practice without decreasing his or her income.
In theory, such arrangements let the physician spend more time with each patient and thus provide more personal and thoughtful care, and as a result, the physician will have a more relaxed and enjoyable working environment. In 2014, an estimated 4,000 of 209,000 primary care physicians had converted to concierge practice, accounting for about 2% of the primary care physician workforce.1,2 However, growth of concierge medicine is expected to accelerate in the near future; a 2012 Merritt Hawkins physician survey indicated that 6.8% of all physicians planned to move to a concierge model in the next three years, and 7.5% of physicians under age 40 years planned to make that change.3 In that survey sample, one-third of the respondents were primary care physicians, so if the results were adjusted to account for just those in primary care (only primary care physicians would conceivably convert to a concierge medicine model, although the survey question included responses from both primary care and specialty physicians), then that percentage would increase to 10%, or about 20,000 additional primary care physicians who may go concierge over the next three years. If that were to occur, the concierge model would then account for more than 8% of the primary care physician workforce.
“Growth of concierge medicine is expected to accelerate in the near future.”
The major feature of this delivery model is that the patient pays up front for better access to the primary care physician. Typical plans provide for longer visits, routine yearly examinations, access to more screening processes and patient education materials, as well as access to the physician by phone and email. In moving to concierge practice, the panel size, which is the total number of patients in the physician’s practice, is dramatically reduced. Typically, a primary care physician will have a panel of 2,000 to 2,500 patients, but in a concierge practice, the patient panel size is often limited to 500 to 600 patients. Although this may be desirable for patients who can afford or are willing to pay for this type of care, evidence is sketchy as to whether this model produces better outcomes when adjusted for potentially confounding factors, such as age, income, education and prior health status. Physicians practicing this delivery model extol its virtues—they often mention that they have the time with patients that the current conventional healthcare delivery model doesn’t allow. And patients who pay to participate in this model, although a biased sample of self-selected individuals, also typically sing praises of personalized attention and the assumption that they are receiving a superior quality of medical care.
However, this model is not without critics. Many have accused concierge physicians of abandoning their patients who won’t or can’t pay the annual practice fee when converting from a traditional practice. Ethicists worry that concierge models further divide patients into the economic haves and the have nots, and some worry that the model’s exclusiveness violates a basic principle that primary care access should be universal.4
Richard W. Dehn is a professor in the College of Health and Human Services at Northern Arizona University’s Phoenix Biomedical Campus, and chair of the university’s PA studies department.