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Practice burden or stepping stone?


The author discusses the advantages and disadvantages of a hybrid concierge practice.

I deliberately designed and implemented a stepping-stone hybrid model against the behest of sage advisers, and I share with you my bittersweet experience. For me it was worth it. But for you, well, you will need to decide. First, we view the warts, then the splendor of hybrids.

"That sounds like too much work, having two practices," counseled my father, a semi-retired orthopedic surgeon, on hearing about my hybrid practice plans.


Guess what? Both my father and John were right. Among other things, the hybrid practice is a truckload of work that offers limited value to patients. In the hybrid practice, one offers on-time, more-time appointments to "special" patients while simultaneously trying to catch up with one's hamster treadmill traditional-practice patients-forcing a double life for both office staff and physician. Hybrids offer "two practices within a practice." Personally, I barely could keep up with my old singleton practice let alone two parallel practices. The stress was bad enough in my old practice. With my elegant hybrid, I had more stress and more work.

Next, could I actually succeed in simultaneously offering dueling levels of care within my office confines? The answer: "No!" I only wanted to offer the best to both patient classes. Most hybrid-practicing doctors will admit as much. Increasing quality across your practice without reducing patient numbers equals hard work.

Patients ask, "Why sign up if I can still see you?" Why indeed? With free milk, what's the value proposition for buying the cow? Why should patients join?

After converting my hybrid to full concierge, I surveyed my patients, finding that 96% of them joined simply to remain as my patients. If patients are allowed to stay in your practice without paying extra, why join the "special practice component?" The hybrid is a hard sell, except to patients afraid of later being shed for not signing. With little incentive to join, most patients will not see value.

The hybrid can lead to the full concierge medicine conversion. In business, you should test before leaping. Do low risk before high risk. A hybrid model is essentially low risk-you will not lose patients-possibly just the capital spent on sales and marketing. A full concierge conversion is higher risk. You will lose between 66% to 90% of your patients, and the difference between 66% and 90% is the difference between success and failure. Consider doing a hybrid step before the concierge leap. Here's what I did:

In my solo internal medicine practice, I conducted a prospective nonblinded, case-control study to see whether those signing up for my hybrid concierge would resemble my patients not signing up. I theorized that if hybrid patient characteristics resembled those of my typical patients, then my "total practice conversion" would succeed. My hybrid patient demographics indicated, in fact, that "ordinary" patients would join. My hybrid study results pointed to a successful total conversion. Within 4 months, I began converting the rest of my practice, ultimately converting 40%. I lowered my business risk for the subsequent total conversion by studying my hybrid practice demographics. You could do the same.


The following are advantages of the hybrid model that might apply to your current practice situations:

Viewed as a stepping stone, the hybrid concierge medical practice makes sense. As an end entity, the hybrid model may become yet another burden in your day: more work, more stress for a service of limited value, and appeal only to a fraction of your patients. You decide. The hybrid served my purpose. If you go the hybrid approach, have your conversion consultant anticipate your next step: upgrading to full concierge medicine.

The author is board certified in internal medicine. Send your feedback to

The Way I See It columns reflect the opinions of the authors and are independent of Medical Economics. Do you have an experience you would like to share with our readers? Submit your writing for consideration to

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Jennifer N. Lee, MD, FAAFP
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