Evolution of a revolution: Find your best path to concierge success

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Medical Economics sat down with Terry Bauer and Andrew Bonner of Special-docs Consultants, two leaders who helped shape the movement from the inside, to discuss how the model has changed, the paths to concierge medicine for employed physicians, and advice for those who are curiously exploring this approach.

The following transcript was edited for length, style and clarity.

Medical Economics: Concierge medicine is term that has changed its meaning over the years. What is the current definition?

Terry Bauer © Specialdocs Consultants

Terry Bauer: Concierge medicine is effectively membership medicine, an arrangement where a patient pays an annual membership fee for the right, the privilege and the value, of having an intimate relationship with a doctor who cares for a smaller group of patients.

This enables physicians to have the opportunity to ask questions, to listen, to really understand the patient’s perspective. Concierge Doctors will usually spend between thirty minutes to as much as ninety minutes with patients at each visit. This is significantly different than a traditional fee for service model, where the average visit length is less than fifteen minutes. In fact, I was at a conference recently where hospital executives were considering cutting patient appointment times back to ten minutes or less. That is just not feasible, not sustainable, or good for patients or physicians.

Medical Economics: There has been a significant increase in the number of employed versus independent physicians. With that dynamic in mind, what are the opportunities and challenges for the different paths toward concierge medicine?

Andrew Bonner © Specialdocs Consultants

Andrew Bonner: There are increasing opportunities for employed physicians to adopt the concierge medicine model now, whether they leave their employer and start their own concierge practice with the help of company like Specialdocs, join an existing concierge practice, or acquire a concierge practice from a retiring physician or remain in a hospital sponsored concierge practice We have had many conversations recently about the trend of retiring physicians. The phenomena started around the beginning of the COVID-19 pandemic and continues. As a result, there are a lot of opportunities for employed physicians who want to leave their employer and practice concierge medicine.

There are challenges that come with this, too. Terry and I discuss these openly and collaboratively with employed physicians who are considering our model. Right up front, we ask about their employment contract - does it include restrictive covenants, and if so, do these limit their likelihood of success? We also talk about all the business elements that the hospital or other employer (payer, private equity firm or other practice owners) currently provides and now needs to be managed by the physician.

These include finding office space, purchasing malpractice insurance, implementing an EMR and medical billing and scheduling platform and other business owner responsibilities. It can seem like an uphill climb, but we work with them every step of the way to ensure a successful launch and sustainable practice.

Medical Economics: What about specialties beyond primary care?

Andrew Bonner: In terms of the other specialties we work with are those physicians who have an ongoing relationship with their patients. For instance, an orthopedic surgeon or anesthesiologist are not viable candidates for the concierge model. However, preventative/ non-invasive cardiology, rheumatology, endocrinology, neurology are chronic conditions best managed and addressed by sub-specialists who have the time to develop a personal, continuous relationship with their patients.

Medical Economics: Regardless of whether independent or employed, or practice a specialty, what do you see as the key factors to physician success in a concierge model?

Terry Bauer: The most crucial factor is the doctor and their experience and skill set. Do they have clinical skills, training and experience combined with interpersonal, intelligence and communication skills? They need the ability to attract and retain patients with a deep understanding of the patient experience and the health care system overall. Those are the first things we evaluate.

Second, we analyze their market. Are other concierge doctors in the area, and are they successful? We also look at the size of the market and demographics in terms of median household income and net worth. We explore the number of physicians in the market to determine if a supply and demand imbalance exists.

It is important to note that we have seen success in smaller markets with lower median household incomes and net worths. But the more robust success stories invariably occur in bigger markets with higher household incomes and a number of thriving concierge practices.

Medical Economics: What do you see as the major barrier to conversion?

Andrew Bonner: The primary one is the physician’s readiness to make such a significant change in their practice and their lives – will they succeed? This is why it’s essential to find a trusted partner like Specialdocs, who will conduct an honest and unbiased evaluation of the practice before we move forward to ensure the physician is a good fit, and that we are all confident of their success.

Terry Bauer: The main emotional issue for doctors is fear. Will their patients pay to become members and continue to pay to be part of the practice?

Another fear factor is the expectation that they will need to be available 24/7, with cell phone always on. We help them understand that setting appropriate boundaries for after-hours communications with patients from the start ensures a good working relationship.

Finally, there is the guilt associated with leaving some of their patients behind. It takes time to get to that point when a physician recognizes that it is better to provide outstanding, personalized medical care to 300 to 500 people, versus rushed, transient care to 2,500 patients. That is when they’re ready to make the change happen.

I believe many physicians look at the relentless, ongoing challenges of decreasing reimbursement and high inflation and ask, ‘How canI survive in this environment?’ We have seen a number of doctors retire earlier than expected because they just can’t keep dealing with the pressure. What concierge medicine does is help extend their ability and their willingness to continue to practice medicine.

Medical Economics: What advice would you give physicians who want to know if concierge medicine is right for them?

Andrew Bonner: Reading this article is an ideal first step because it’s never too early to learn about the model and how other doctors are thriving with it. But I would also advise moving fairly quickly to the next phase of finding a trusted consultant partner to evaluate the opportunity for practice success.

The one constant we have heard from our clients over the years is that they wish they converted sooner because practicing in this model has proven to be so rewarding, both personally and professionally.

Finally, I would encourage physicians to realize how valued they are. Patients are increasingly willing to pay for this model to retain a meaningful, long-term relationship with their doctor. They understand the importance of that relationship in ensuring they receive prompt, personal attention and care that goes well beyond acute needs to proactive prevention and enhanced well-being. That is not just a trend, but a real shift in the way people view their health care, and why I am so optimistic about the future of concierge medicine.