The Rise of Concierge Medicine

Authored by: Mia Hsu

Art by: Aleena Naeem

Concierge medicine, or retainer medicine, is a growing healthcare practice model that emphasizes improved physician access, enhanced customer service, and continuity of quality, personalized care [1]. The majority of concierge physicians are general internists [2]. To access concierge services, patients pay an annual retainer fee typically ranging from $1500-1700 [3]. The fee may increase with patient age. Additionally, while it is not covered by Medicare or commercial insurance, certain practices allow for reimbursement with flexible spending accounts or health savings accounts. Most concierge practices bill Medicare and other insurance for office visits and procedures, and concierge patients still require health insurance for hospitalizations, specialist visits, and tests performed outside the concierge office [2]. 

The concierge medicine model was pioneered by the 1996 establishment of MD2 (pronounced “M.D. Squared”) in Seattle by Dr. Howard Maron and Dr. Scott Hall [3]. In its early years, concierge medicine was primarily viewed as “VIP medicine,” a service only afforded by upper-class patients. However, the number of concierge practices has grown exponentially over recent years, and many practices are now more affordable and accessible, offering hybrid or lower-fee models that cater to middle-income patients [4]. Organizations that recruit concierge physicians and manage concierge practices have also emerged. A prominent example is MDVIP, an American Company founded in 2000 in Boca Raton that operates a network of 1,3000 physicians and serves over 400,000 patients throughout the U.S. [2]. 

The concierge medicine model has many benefits for both physicians and patients. Surveys of concierge physicians have reported higher levels of job satisfaction, attributable to several factors. First, concierge physicians typically care for 300-600 patients, versus 2000+ in traditional models, decreasing physical and emotional burnout while allowing for the development of deeper physician-patient relationships [5]. Second, most concierge practices only have 1-2 employees. This and the smaller patient roster decrease the time spent on paperwork and billing, resulting in a lower overhead [2]. Additionally, the smaller size of concierge practices may foster stronger communication and coordination among office staff, ensuring that patient needs are efficiently addressed. Third, concierge physicians also enjoy greater autonomy in medical decision-making [1]. 

Research has also shown that concierge clinics have higher levels of patient satisfaction compared to their nonconcierge counterparts. Concierge patients enjoy flexible same-day and next-day appointment scheduling and extended patient consultations with shorter wait times. Due to the smaller patient roster, the pressure to rush through patient appointments is alleviated, and physicians can devote anywhere from 30 minutes for standard office visits up to several hours for executive-type physical examinations with patients, ensuring comprehensive health discussions and holistic and preventative patient care [1, 3]. Patients also enjoy around-the-clock physician access through their ability to directly text, call, or email the doctor [2]. Concierge patients frequently communicate higher levels of trust in their physicians and stronger commitment to adhering to their treatment plans, undergoing screenings, and accessing preventative services [3]. Positive interactions with office staff and greater coordination of care also boost concierge patient satisfaction [1]. 

In general, research suggests that concierge medicine reduces emergency department (ED) visits and hospitalizations, potentially resulting in long-term cost savings for patients [1]. Currently, 30% of ED visits in the U.S. are “non-urgent”--delaying these visits for several hours will not increase the likelihood of adverse patient outcomes. When patients rely on ED visits for routine care, they may overspend on healthcare, be subject to unnecessary testing and treatment, and miss opportunities to form longitudinal relationships with a primary care provider [6]. Accessibility of concierge physicians for their patients simultaneously discourages unnecessary ED reliance while promoting earlier detection and management of medical issues, reducing preventable hospitalizations and improving overall continuity of care. Some clinics may also connect directly with laboratories and pharmaceutical companies to secure lower prices for diagnostic testing and medications. Furthermore, concierge medicine may facilitate improved chronic illness management and more timely disease diagnoses [1].

Concierge medicine has its drawbacks. Concierge physicians tend to care for fewer African-American, Hispanic, and Medicaid patients, as well as fewer patients with diabetes and other chronic health diseases [7]. These populations are already underserved and at risk for worse health outcomes; retainer practices may therefore contribute to disparities within healthcare. Additionally, concierge practices are concentrated in urban and affluent areas, neglecting rural populations and shrinking the available physician pool [5]. This contributes to a tiered healthcare system, where wealthy patients have access to skilled physicians and advanced healthcare services [3]. These “worried well” may also overuse healthcare services.

To address this, concierge physicians should strive to care for underserved populations and honor their duty to provide nondiscriminatory care. Some have already reported providing charity care and continuing to see patients who cannot afford retainer fees [7]. Additionally, a potential solution to the shrinking physician pool could lie in retraining licensed doctors from other specialties or those shifting toward retirement as primary care physicians, and increasing the use of nurse practitioners and physician assistants in newer models of primary care [5, 2]. Physicians who downsize their patient roster in transition from a traditional healthcare model to a concierge model also risk patient abandonment [7]. These physicians should consider their patients’ ability to access care from other community sources and help them find other physicians if they choose not to stay in the practice [8]. 

Ultimately, concierge medicine benefits physicians and patients, but questions of accessibility must be prioritized to avoid reinforcing systemic healthcare inequities. 

References:

1. Rylands, K. S., Collins, C. M., & Collins, D. R. (2025). Maximizing the Value of Concierge Medicine: A Systematic Review of Cost, Access, and Outcomes. The American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2025.03.016 

2. Dalen, J. E., & Alpert, J. S. (2017). Concierge Medicine Is Here and Growing!! The American Journal of Medicine, 130(8), 880–881. https://doi.org/10.1016/j.amjmed.2017.03.031

3. Alhawshani, S., & Khan, S. (2024). A literature review on the impact of concierge medicine services on individual healthcare. Journal of Family Medicine and Primary Care, 13(6), 2183–2186. National Library of Medicine. https://doi.org/10.4103/jfmpc.jfmpc_1685_23

4. Dwilson, S. D. (2016, September 13). Understanding Concierge Medicine: Is the Service Right for Your Practice? Dignity Health. https://www.dignityhealth.org/articles/understanding-concierge-medicine-is-the-service-right-for-your-practice

5. Concierge Medicine is Widening the Primary Care Gap — Retrained Physicians Can Help Fill it. (2025, April 22). Physician Retraining & Reentry. https://prrprogram.com/concierge-medicine-is-widening-the-primary-care-gap-retrained-physicians-can-help-fill-it/

6. Uscher-Pines, L., Pines, J., Kellermann, A., Gillen, E., & Mehrotra, A. (2013). Deciding to Visit the Emergency Department for Non-Urgent Conditions: A Systematic Review of the Literature. The American Journal of Managed Care, 19(1), 47–59. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC4156292/

7. Caleb Alexander, G., Kurlander, J., & Wynia, M. K. (2005). Physicians in Retainer (“Concierge”) Practice. Journal of General Internal Medicine, 20(12), 1079–1083. National Library of Medicine. https://doi.org/10.1111/j.1525-1497.2005.0233.x

8. Doherty, R. (2015). Assessing the Patient Care Implications of “Concierge” and Other Direct Patient Contracting Practices: A Policy Position Paper From the American College of Physicians. Annals of Internal Medicine, 163(12), 949. ACP Journals. https://doi.org/10.7326/m15-0366