Putting the ethical issues aside (seeing only patients who can afford to see you), how realistic is it to start a practice like this for primary care? When I was interviewing for a job last year, one of the medical directors I met in a group practice was doing this on the side. Because his concierge practice had picked up so many patients, he decided he just wanted to do part time and eventually leave and hence they needed to hire a new physician. Well, he told me that he had 250 patients in his concierge practice and each patient pays $200/mo. So that was $50K per month-CASH. He didn't deal with insurance at all and his patients had access to him 24 hrs per day. Because his patients were all "white collar" managerial, high exective type, he wasn't worried about people calling him at night, unless it was an emergency, because his patients all "had a life." His patient population was mainly 40-65. And once they have Medicare, he no longer sees them. There are also Integrative Medicine Services that I came across that basically charges a fee for service and are also quite successful. They absolutely do not do any primary care and again, they don't deal with insurance companies. Initial visits would be $350/hr and any follow ups would be $250/hr-CASH. And quite a few of them have a waiting list of about 2-3 mo because they can only see a limited number of people per day. So my question is, are these types of successful practices hard to establish in today's practice environment? There is a lot of money that can be made if it is designed properly... Any ideas? What are some of the obstacles or difficulties?