Acquiring a Membership Practice: My Rapid Journey from Employed Physician to Thriving, Independent and Joyful Concierge Doctor

April 21, 2021
Carrie Cardenas, MD

I was stuck and seeking a way out.

If asked to describe my transition to concierge medicine in three words or less, the most apt phrase would be ‘carpe diem’ (seize the day). While I had been considering this practice model for some time, when the opportunity did arise, a lightning-fast response was needed to make it a reality. With the support of a dedicated team of experts, my experience acquiring a well-established concierge practice in San Diego was swift, seamless and sweet, as detailed below.

Start by rewinding to my first 15 years as an Internal Medicine physician. Initially I cared for patients at my own clinic and then as part of an award-winning post-acute care program to ease patients’ transition from hospital to home. My yearning to return to a practice centered on building relationships with patients became stronger each year, but with it came the realization that traditional fee-for-service models had evolved in exactly the opposite direction, and rushed, often impersonal visits had become the unfortunate standard of care. Concierge medicine appeared to present an ideal solution, with a sustainable practice model based on membership fees and a greatly reduced patient panel that allowed for personalized, extended visits. However, as a hospital-employed physician at that time, I understood that I was missing the essential component for success: long-standing relationships with established patients in my community.

I was stuck and seeking a way out. When I learned that two highly regarded physician partners were looking for a successor to purchase their concierge medicine practice in 2018, I knew I had found my solution. The husband-wife team had built an exceptional practice over more than three decades, with hundreds of loyal patients and a reputation for clinical excellence. The only drawback: the timeline for finalizing the acquisition and starting the transition was extraordinarily tight – just 90 days.

My emotions ran the gamut, from fear and anxiety to excitement and eager anticipation. Overriding all was the strong feeling that this was a once-in-a-lifetime opportunity. I needed to confirm that, however, before making the leap. With the help of Specialdocs Consultants, a company well-versed in concierge medicine transitions, we used every minute of that whirlwind three-month period to literally pull apart the practice and determine if the acquisition would be feasible. We considered everything from the current stability of the practice to the vibrancy of the surrounding neighborhood. After checking every box, we then developed a transition plan that was both thorough and speedy – a combination not often achieved - and I entered into my new life as a concierge doctor thrilled but also well aware of challenges that may be ahead.

Most prominent was the fact that the quick ramp up meant minimal opportunity to gather knowledge of patients or gain their confidence before taking the reins of the practice. Every single patient I saw during the first year was new to me. To ease the transition, I retained all staff possible because the patients were much more comfortable with a new doctor if they also saw the same nurse who had drawn their blood for the last 20 years. An early worry was when the medical assistant, who was considered the backbone of the practice by many, had to leave due to unforeseen circumstances. Despite concerns that patients may not stay, I was pleasantly surprised to see this did not turn out to be the case at all.

I am gratified to report a retention rate of more than 90% of the practice’s existing patients, and I’ve since added many more of my own. In a traditional setting, it would have been nearly impossible for me to attract so many new patients in such a short period of time.

At first I also heard a lot of ‘that’s not how our other physician would do things.’ I realized I was coming into a culture that may not be perfectly aligned with my vision, but with patience and time, I built trust. In early 2020, another long-time dream was achieved when my husband Dr. Hector Cardenas joined the practice. Together we have introduced a series of changes and new programs and nothing has been more satisfying than to hear patients say how much they love these offerings. While the pandemic put a pause on our well-attended monthly ‘Walk with a Doc,’ we continued to reach out to patients regularly with informative email updates, creative video messages and an easy-to-use telemedicine platform.

What I love most now is that I know every patient so well. My days are full and busy, with plenty of time to delve into all of their issues, and listen to their stories – nothing is more essential to the best care. I’m also able to visit with my senior patients at home, senior living facility or hospital. The human experience often lost in the traditional type of practice is fully realized in the concierge model.

If you’re considering this unique path to concierge medicine, I wholeheartedly recommend it, and offer you these nuggets of advice:

  • Bring in the experts early. Of all the factors involved in a successful acquisition, working with consultants such as Specialdocs is key, as they bring tremendous insights and experience to the process. I leaned on them throughout the transition period and still do.
  • Thoroughly explore the potential for new patient recruitment in the immediate community. There is likely to be at least some attrition when you take over a concierge practice, and you want to be aware of changing demographics and ensure the area is growing and vibrant.
  • Build in a period of guaranteed support from the retiring physician. Ideally, he or she will be available to introduce you to patients and provide reassurance that the coming changing of the guard is a welcome one, fully endorsed by them.
  • Realize that it takes time to reshape the practice according to your vision. You may be coming into a culture that doesn’t reflect the way you hope to practice, but gradually roll out changes that will make it your own.
  • Keep your eye on the prize. Any change comes with some challenges, but know that at the end of this one, you’re going to have a truly phenomenal model for patient care. Remember to care for yourself throughout the process by practicing what you preach to patients: eat well, exercise, get sufficient sleep and manage stress.

Carrie Cardenas, MD, Co-Owner of Cardenas Internal Medicine, San Diego, California.

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For more information on opportunities to acquire an existing concierge physician practice, visit Specialdocs.com and watch our webinar “Acquiring a Legacy of Success”

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