Concierge Medicine

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
alphaholic06

alphaholic06

Doctor, Who? Me?
Verified Member
Physician
15+ Year Member
Joined
Jan 14, 2004
Messages
962
Reaction score
126
Points
4,746
  1. Attending Physician
Advertisement - Members don't see this ad
Anyone doing this or have info on it? I got approached by a group about being their medical director. Business model sounds interesting, but I'm trying to think through compensation, etc. Any help would be greatly appreciated.
 
That doesn't make sense, a little bit, for me. If it is concierge, why would they need a medical director? The only thing I could think of is if the provider wasn't a doctor. And, if I was paying concierge prices, I CERTAINLY would not want a PA or NP. But, paying another doc to be med dir, while there's a doc seeing pts, seems redundant.
 
RustedFox said:
I don't think this is really in our skill set.
Click to expand...

Providing point-of-care on-demand urgent-careish type services with an overarching theme of client/customer/patient satisfaction?

Not in our skillset?

Which country do you practice in again? Because as far as I'm concerned that's probably 90% of my practice these days.
 
Similar to fox above...What will you be managing or directing for concierge medicine -- as an expert in emergency medicine?

Urgent care concierge makes sense.

Concierge functioning as a PCP? Not likely a good fit.
 
Yeah; I was unclear.
When I hear the phrase "concierge medicine", I think: "People will call me for every primary-care related request, as well as advice regarding nonsensical things like "detox-es" and "cleanses" and other white magic that makes the muggles go [ooooh!]."
 
Even with that interpretation it sure sounds like a great option for a burned-out ER doc

"Would you like a side of Toradol with your banana bag?
 
Hey, I have a concierge medicine practice.
For the most part, people get whatever they want. I also have a full time social worker and a 24-hour nurse hotline.
You just have to have a life expectancy of 6 months or less.

Oh, wait...
 
alphaholic06 said:
Anyone doing this or have info on it? I got approached by a group about being their medical director. Business model sounds interesting, but I'm trying to think through compensation, etc. Any help would be greatly appreciated.
Click to expand...
If you can pull off concierge medicine and be successful with a business model that prioritizes cash-pay and takes insurance companies out of the loop, I think it's a great thing as long as its done legally, effectively and provides good Medicine. Unfortunately I don't have direct experience with this to help you with, but more power to you, if you can make it work. I'd look into it, if I were you.
 
Advertisement - Members don't see this ad
It's an urgent care model, not primary care. I would have to supervise midlevels, which we do anyway. Definitely a cash model, no insurance company middlemen.
 
alphaholic06 said:
It's an urgent care model, not primary care. I would have to supervise midlevels, which we do anyway. Definitely a cash model, no insurance company middlemen.
Click to expand...

Midlevels + cash-only concierge patients?

You're about to deplete the world supply of Z-Paks and steroids.
 
I genuinely curious if anyone knows. For patients who do concierge medicine they still must have to have regular insurance for imaging, tests, specialists, hospital stays and meds right?
 
Mushdoc said:
I genuinely curious if anyone knows. For patients who do concierge medicine they still must have to have regular insurance for imaging, tests, specialists, hospital stays and meds right?
Click to expand...
Not exactly, I'll go into more detail at lunch
 
Mushdoc said:
I genuinely curious if anyone knows. For patients who do concierge medicine they still must have to have regular insurance for imaging, tests, specialists, hospital stays and meds right?
Click to expand...
OK so first we have to roughly define our terms. There's no official definition, but colloquially Concierge practices still bill insurance they just charge a fee on top of that for things like text/e-mail access, longer appointments, stuff like that. Direct Care is when you don't bill insurance for any of the services you provide.

In the latter case, most people who do that work out networks of imaging centers/labs/specialists/whatever and negotiate prices. For instance, when I was doing that there was an imaging center down the hall from me that offered special cash-only prices to my patients. X-rays were $25, CTs w/o were $250, w/ $500, MRIs w/o were $500. US varied from $70 for AAA screening to $200 for complete abdominal. Read included in those rates.

Labs were done through an agreement with Quest. CBC $5, A1c/lipid/CMP $7 each, PSA $15, Testosterone $20, you get the idea.

49 states allow physician dispensing - basically an in-office pharmacy for your patients only. Doing that, generic medication is surprisingly cheap. I had lots of meds in house that cost less than $1 per month. A z-pack was $4, 30d of flomax was around $8, stuff like that.

Insurance of course had major value for hospitalizations/surgery, but I had specialist that would charge a new patient a flat $125 for the first appointment. Like optometrist would do a diabetic eye exam for $70.
 
VA Hopeful Dr said:
OK so first we have to roughly define our terms. There's no official definition, but colloquially Concierge practices still bill insurance they just charge a fee on top of that for things like text/e-mail access, longer appointments, stuff like that. Direct Care is when you don't bill insurance for any of the services you provide.

In the latter case, most people who do that work out networks of imaging centers/labs/specialists/whatever and negotiate prices. For instance, when I was doing that there was an imaging center down the hall from me that offered special cash-only prices to my patients. X-rays were $25, CTs w/o were $250, w/ $500, MRIs w/o were $500. US varied from $70 for AAA screening to $200 for complete abdominal. Read included in those rates.

Labs were done through an agreement with Quest. CBC $5, A1c/lipid/CMP $7 each, PSA $15, Testosterone $20, you get the idea.

49 states allow physician dispensing - basically an in-office pharmacy for your patients only. Doing that, generic medication is surprisingly cheap. I had lots of meds in house that cost less than $1 per month. A z-pack was $4, 30d of flomax was around $8, stuff like that.

Insurance of course had major value for hospitalizations/surgery, but I had specialist that would charge a new patient a flat $125 for the first appointment. Like optometrist would do a diabetic eye exam for $70.
Click to expand...
Thanks for the reply. Do you think we can chat offline?
 
alphaholic06 said:
Thanks for the reply. Do you think we can chat offline?
Click to expand...
I'm not really the guy for anything beyond generalities as I've been out of direct care for almost 5 years now. There's great resources for it though. Most are geared towards primary care, but urgent care is usually just acute primary care.

I'd suggest starting here: DPC Alliance

You can also find direct primary care people in your area and reach out to them - 99% are excited to help others get out of the insurance game: Mapper — Direct Primary Care Frontier
 
RustedFox said:
Yeah; I was unclear.
When I hear the phrase "concierge medicine", I think: "People will call me for every primary-care related request, as well as advice regarding nonsensical things like "detox-es" and "cleanses" and other white magic that makes the muggles go [ooooh!]."
Click to expand...

There are two pretty darn comprehensive courses out there. There is direct primary care (tm) which will train you for an insane fee how to design your entire buisiness model for concierge medicine and will also make sure you're qualified being *at least* good enough to do things "by the book" even if they leave you hanging as far as how to handle outliers. Also (iirc) AAFP provides an extremely thorough long-ish term course specifically designed to turn IM and EM into appropriate FM doctors by teaching those with a good grasp of 'primary care' medicine already what they ACTUALLY need to do, per AAFP recommendations, including lots of focus on peds, outpatient low level psych, and obgyn for the IM people. The fee is also less insane, largely because of the amount of education given.

with that said I would NOT feel comfortable running primary care without one of those under my belt.
 
Last edited:
Advertisement - Members don't see this ad
RustedFox said:
This is a picture of what I think Concierge Medicine would be like:


Also: someone please teach me how to embed gif files ?
Click to expand...

download the gif as a file. then hit attach file at the bottom of the post. once it uploads you can click it and click to embed as full image.

Slightly fewer steps, but it wont always work, is to find the website for the gif like you did. then click the little landscape button at the top of this window (between link button and emoji button) and past the webpage for the .gif. Doesnt always work because its not always easy to get a dedicated .gif address and if the gif is particularly long or high quality sometimes SDN refuses to host it - and you get this really strange thing where its only visible when editing or when quoting but not when you post it the first time.
 
Concierge medicine sounds horrible to me. I thought part of the appeal in EM to most of us was the fact that we could leave work at work and essentially go off the grid once we leave the hospital? Being on call 24/7 sounds like a nightmare. I'd have to have the potential to make well over 30% of my current income to even remotely be tempted. Probably closer to 40%
 
Groove said:
Concierge medicine sounds horrible to me. I thought part of the appeal in EM to most of us was the fact that we could leave work at work and essentially go off the grid once we leave the hospital? Being on call 24/7 sounds like a nightmare. I'd have to have the potential to make well over 30% of my current income to even remotely be tempted. Probably closer to 40%
Click to expand...
For us FM peasants, we can make about the same money seeing roughly 1/3rd the volume.
 
DocEspana said:
There are two pretty darn comprehensive courses out there. There is direct primary care (tm) which will train you for an insane fee how to design your entire buisiness model for concierge medicine and will also make sure you're qualified being *at least* good enough to do things "by the book" even if they leave you hanging as far as how to handle outliers. Also (iirc) AAFP provides an extremely thorough long-ish term course specifically designed to turn IM and EM into appropriate FM doctors by teaching those with a good grasp of 'primary care' medicine already what they ACTUALLY need to do, per AAFP recommendations, including lots of focus on peds, outpatient low level psych, and obgyn for the IM people. The fee is also less insane, largely because of the amount of education given.

with that said I would NOT feel comfortable running primary care without one of those under my belt.
Click to expand...
Which AAFP course is this? Just curious.
 
Fox800 said:
Which AAFP course is this? Just curious.
Click to expand...

oh god. I think I first heard about it from either @VA Hopeful Dr here or my buddy from travel medicine who does direct primary care now. And since there is a 50% chance its VAHD, lets tag him. I read about this like 8-9 months ago so I cant recall a ton of specifics.
 
So the AAFP has a couple things.

www.aafp.org

Direct Primary Care

Learn about the direct primary care (DPC) model, which provides a meaningful alternative to fee-for-service insurance billing.
www.aafp.org www.aafp.org

There's also a virtual DPC summit in July (usually a live meeting...), No link yet for that one.

There's also this: DPC Mastermind Weekends — DPC Alliance
 
As far as a course teaching you to become primary care physicians we don't really have one of those to the best of my knowledge.

We do have an intensive one week board review class that travels around the country that would probably do the job.
 
Groove said:
Concierge medicine sounds horrible to me. I thought part of the appeal in EM to most of us was the fact that we could leave work at work and essentially go off the grid once we leave the hospital? Being on call 24/7 sounds like a nightmare. I'd have to have the potential to make well over 30% of my current income to even remotely be tempted. Probably closer to 40%
Click to expand...

I don't know. Dealing exclusively with people who find my opinion worth paying for and being able to fire people from my practice both sound pretty sweet some days...
 
VA Hopeful Dr said:
OK so first we have to roughly define our terms. There's no official definition, but colloquially Concierge practices still bill insurance they just charge a fee on top of that for things like text/e-mail access, longer appointments, stuff like that. Direct Care is when you don't bill insurance for any of the services you provide.
Click to expand...

Out of curiosity, don’t most PCPs in large integrated systems in 2021 (and many smaller ones) already provide portal/email access for questions?

My pcp isn’t concierge (large university system) but will answer an email to him directly usually within 24 hours and I can get a phone or video visit with him fairly fast.

What other benefits do concierge PCP practices provide?
 
doctalaughs said:
Out of curiosity, don’t most PCPs in large integrated systems in 2021 (and many smaller ones) already provide portal/email access for questions?

My pcp isn’t concierge (large university system) but will answer an email to him directly usually within 24 hours and I can get a phone or video visit with him fairly fast.

What other benefits do concierge PCP practices provide?
Click to expand...
Sure, but if it's a new problem they have to come in for an office visit.

When I was doing DPC (which is not concierge), for minor stuff I would not. For example, patients would text me a picture of a rash and nine times out of 10 I could diagnose it from that picture and maybe a question or two saving them an office visit. Similar thing with URIs and UTIs. I also answered emails and texts after hours and over the weekend which I absolutely do not these days. If you'd like me to go into a full spiel about the advantages, I will happily do so but it'll have to wait until I have time to do it justice.
 
Advertisement - Members don't see this ad
VA Hopeful Dr said:
Sure, but if it's a new problem they have to come in for an office visit.

When I was doing DPC (which is not concierge), for minor stuff I would not. For example, patients would text me a picture of a rash and nine times out of 10 I could diagnose it from that picture and maybe a question or two saving them an office visit. Similar thing with URIs and UTIs. I also answered emails and texts after hours and over the weekend which I absolutely do not these days. If you'd like me to go into a full spiel about the advantages, I will happily do so but it'll have to wait until I have time to do it justice.
Click to expand...

Why did you leave that model of medicine and stop? What are you doing now?
 
cyanide12345678 said:
Why did you leave that model of medicine and stop? What are you doing now?
Click to expand...
Primarily because I had the chance to move back to my hometown. We had just had our twins and living in my wife's hometown was not working out because her parents would see the girls maybe once every six weeks. so we move back to the same neighborhood as my mother (who takes care of the girls two and a half days per week) both of her brothers, and one of dad's sisters. The other sister lives two neighborhoods over. Just a huge family support system.

But, I also learned that I absolutely detest running a business. I'm much happier being a cog (currently hospital employed) than an owner.
 
doctalaughs said:
Out of curiosity, don’t most PCPs in large integrated systems in 2021 (and many smaller ones) already provide portal/email access for questions?

My pcp isn’t concierge (large university system) but will answer an email to him directly usually within 24 hours and I can get a phone or video visit with him fairly fast.

What other benefits do concierge PCP practices provide?
Click to expand...

In concierge it seems doctors advertise almost 24/7 access to patients. That’s generally not the norm in regular practices. I can’t text my doc at 8pm and expect a response. Also more likely to treat over the phone/internet, especially because they have no financial incentive to bring people in for an office visit.

UTIs are things I’ll treat over the phone, but for many new onset concerns I just find it easier to do a televisit or have patients come in to the office. Not just for a more proper eval, but I have a million things going on during the day that it just makes it easier to schedule a dedicated appt for a patient.
 
AMEHigh said:
In concierge it seems doctors advertise almost 24/7 access to patients. That’s generally not the norm in regular practices. I can’t text my doc at 8pm and expect a response. Also more likely to treat over the phone/internet, especially because they have no financial incentive to bring people in for an office visit.

UTIs are things I’ll treat over the phone, but for many new onset concerns I just find it easier to do a televisit or have patients come in to the office. Not just for a more proper eval, but I have a million things going on during the day that it just makes it easier to schedule a dedicated appt for a patient.
Click to expand...

Yep, I had a very uppity couple one night at 1a.m. where the husband was getting admitted and they both demanded that I call their "concierge" doctor immediately. I was very surprised but he was readily available and he came immediately to the hospital to do the admission orders and examine them.
 
Groove said:
Our local FM guys are anything but peasants. They clean 400K annually but they do see up to 28-30 pts/day.
Click to expand...
That's more or less where I'm sitting as well (it was the stereotype joke I was going for).

I'd also wager if you worked the same number of hours/month that I do you'd make way more. That's not a criticism as your work is much more stressful than mine.
 
Groove said:
Yep, I had a very uppity couple one night at 1a.m. where the husband was getting admitted and they both demanded that I call their "concierge" doctor immediately. I was very surprised but he was readily available and he came immediately to the hospital to do the admission orders and examine them.
Click to expand...
Yep, we had a well known concierge doctor at my hospital in residency that worked in the community. I guess before I was there he would do his own orders and manage the patients, but he was super old and I guess he was doing crazy things, so he got his privileges revoked. I think he is one of those FM docs that you EM people complain about, like he'd send in someone for a hgb of 10 with a list of demands for the work up. But after his privileges were revoked he'd still do courtesy visits for his patients that were admitted, which was still a nightmare cause he and the patients thought he was being helpful, but he'd actually just confuse the picture!
 
Two of my private group partners tried this. One came back to EM and the other stayed in concierge private practice. All in all they both said the money wasn't as good as they expected but it was a slower pace, and clients were generally well off really grateful older people. We live in a more suburban area, some of the outlying areas bordering on rural and there is a PMD shortage so you don't have to be board certified IM with geriatrics fellowship to get business. It does take some dedicated reading and attention to detail to catch up on HTN management etc. Not my thing though.

Payment for them was usually an annual fee divided in monthly installments plus the insurance fees for house calls etc.
 
AMEHigh said:
Yep, we had a well known concierge doctor at my hospital in residency that worked in the community. I guess before I was there he would do his own orders and manage the patients, but he was super old and I guess he was doing crazy things, so he got his privileges revoked. I think he is one of those FM docs that you EM people complain about, like he'd send in someone for a hgb of 10 with a list of demands for the work up. But after his privileges were revoked he'd still do courtesy visits for his patients that were admitted, which was still a nightmare cause he and the patients thought he was being helpful, but he'd actually just confuse the picture!
Click to expand...
I had someone like this in my community. They once requested a pulmonology consult to decide if a patient needed to be intubated.
 
thrivedirectcare.com

Thrive Direct Care

Thrive Direct Care is a Physician-0wned and operated practice providing direct access to a board certified emergency physician without the hassles and headaches of insurance. The assurance of an emergency physician - without the emergency department bill.
thrivedirectcare.com thrivedirectcare.com

Ask him, see what his experience has been
 
Advertisement - Members don't see this ad
Thanks
VA Hopeful Dr said:
I'm not really the guy for anything beyond generalities as I've been out of direct care for almost 5 years now. There's great resources for it though. Most are geared towards primary care, but urgent care is usually just acute primary care.

I'd suggest starting here: DPC Alliance

You can also find direct primary care people in your area and reach out to them - 99% are excited to help others get out of the insurance game: Mapper — Direct Primary Care Frontier
Click to expand...
 
You must log in or register to reply here.

Similar threads

YeeHawWooHoo
Emergency Medicine Schedule
2
Replies
67
Views
7K
Major
Major
H
VA emergency medicine
Replies
10
Views
4K
Old_Mil
Old_Mil
WildWing
FAQ - Emergency Medicine
Replies
15
Views
4K
The Knife & Gun Club
The Knife & Gun Club
cyanide12345678
Occupational medicine
Replies
18
Views
4K
namethatsmell
namethatsmell
E
Advice for EM residencies
2
Replies
61
Views
9K
EctopicFetus
EctopicFetus
Top Bottom