"It is predicted that private medical practice will
disappear by 2025 because of the continuing and
increasing efforts of our government healthcare
business takeover priorities. That objective can be
prevented by the one offensive activity that will
guarantee survival of private medical practice
businesses. To do that, physicians must eliminate
the universal medical practice management weakness
caused by the lack of business knowledge of
physicians in our profession."
(Part 1 of this article revealed the promising attributes to patients and physicians of concierge medical practice and the rising benefits, needs, and reasons for physicians to consider that method of private medical practice.)
1. Hybrid Model of Concierge Medical Practice
With respect to the sensibilities of your patients, the hybrid model doesn’t disenfranchise your patients or contribute to physician shortage, contrary to the propagated image of “cash
only” medical practice.
The commonly used transition method is to recruit from 10 to 20 of your patients who elect to join the concierge practice model for an annual fee. Other patients who are not interested, continue with their primary care physician as usual. The downside for physicians is that they have to juggle between patient categories among a continuing large number of regular medical patients.
It’s reasonable to assume that by the time the patients who have not joined the concierge group become so disturbed about the increasing co-pays, eight-minute office visits, longer waiting periods to be seen, that they will see the benefits of joining the concierge model willingly. The old “capitation model” of practice in the 1980’s was similar but never really caught on.
Once a physician is comfortable with the model, understands the value of such a model to himself, his practice time, and his lifestyle improvement, recognizes that by converting his practice completely over to the concierge model, will he have to see and care for less than 500 patients to earn the same amount of money he earned before with 3000 patients.
But, it also will assuredly provide better medical care because of having time to read more medical journals, go to more medical education meetings, able to afford and take more time to increase his or her skills and training, and, most of all, have more time with family. Can you imagine that?
2. Innovation Model Concierge Medical Practice
Without a doubt, beginning your new medical practice business using this concierge model avoids having to accumulate a large herd of patients and then converting to a “direct primary care practice” later on. The big disadvantage is that the startup of medical practice requires money, usually a fairly good size bundle.
Just picture the lender’s face when you explain to him that you have no job and that you have a left-over debt of $165,000 from your education--and are asking for another $50,000 to get started in medical practice on top of the other debt. Thank God you have a rich uncle to help you financially.
Of course, you’ll have that same problem with the bank no matter how you begin your practice. You could join an HMO, gather the money up, then start your private medical practice. Maybe there’s a group medical practice you can join first already employing a “retainer-based” method of practice, and go from there.
3. Transformational Model Concierge Medical Practice
So, you’ve been in practice 15 years already. It must be disturbing for you to see the decrease in income earned by physicians (8% decrease average over the past 10 years according to the AMA studies, among others). Then you wise-up and ask yourself if you know for sure whether your practice is growing… you know, the number of patients joining minus the number leaving, monthly. Or, haven’t you done that? Or… maybe start right now?
Most physicians see what’s happening now in the world of medical practice—and it definitely is not good. Choices for medical practice careers haven’t changed, really. But, the consequences of those choices now are very different, and are important to know about for medical practice
business management and practice marketing reasons.
Transforming you practice is not easy. Some follow the hybrid model to transition and some just set a date to stop their regular practice and begin your concierge practice. We’ll talk about the issues related to that move in another article.
4. Private Practice Group Model
Luckily, there are a good number of medical group practices who have come together in a concierge practice in this country which you might choose to join. In addition, with the gradual dissatisfaction with the health care system and the gradual increase in numbers of patients looking for alternatives, the concierge practitioners, already solo or in a group, will be looking for physicians of a like mind to join them.
Practice overhead will be reduced by adding a new doctor to the group's staff. Retiring physicians leave openings for new physicians. When you join such a group, it is very common to be obligated to pay additional amounts to the owners of the building... often to one or two of the
other physicians.
Solo primary practice physicians in private medical practice, especially in rural areas, are disappearing. But if they join together in group practice, the physician attrition would be
far less common.
5. Commercial Model Concierge Medical Practice
Concierge Choice Physicians (CCP), a medical practice consulting company, is one of the several groups who offer a turnkey solution to physicians who sign up for their assistance and joint venture. This company splits the annual patient concierge subscription fee with the physician and also provides all the marketing services paid for by the subscription fee arrangement. CCP has special interest in working with the Hybrid Model.
Other physicians have created joint ventures with large businesses which refer large numbers of their employee medical patients to the concierge physician practice in return for providing office space, equipment, supplies, and other necessities. The employees pay the annual subscription fee to the physician and the company has saved thousands of dollars spent on large health insurance plans which are much more costly and administratively complex.
Be creative and create your own special joint ventures.
The where and how elements of concierge medical practice...
The most common reason that a concierge practice fails is lack of income. You know that the lack of income to sustain the practice comes when a concierge practice is not able to recruit enough patients. Success requires about 300 patients, per physician, enrolled, at least. As with any regular medical practice, you don’t make money or earn an income without patients. But, you already know this. The topic brings us back to what is critically important and what most physicians neglect before starting a medical practice—Demographics.
Considerations to face head-on if you want a successful concierge practice...
- Big enough population to attract enough patients--I haven’t seen any studies concerning this issue, but, my belief is that you should have no serious problem launching a practice in any urban area of one million population... where you will be the only concierge physician for
that population.
This criteria has to be modified by the affluence of the area, local industries and businesses, availability of educational and recreational facilities, and the average income of the population, among others.
Because of the scarcity in the present day (2022) of numbers of concierge physicians, the competition for patients should not be an issue in this population for the next decade.
- Professional Competition-- Contacting various resources available on the Internet which provide such information is easy to find. For example, in February 2010 an informal one year summary of findings related to the concierge medicine marketplace was released.
- Over 66% of current U.S. concierge physicians in practice are internal medicine specialists.
- Second in rank are family physicians.
- Since early 2009, there has been a steep rise in numbers of concierge dental and pediatric practices—understandable, because they are primarily office-based practices with large volumes of patients.
Demographics is an important aspect of deciding where to practice. For example, it has been proven that for a solo private medical practice startup, the success for that physician requires population statistics.
It is recommended that a physician should not attempt to create a concierge medical practice in any location below a population of at least one million.
When there is a population at least 10,000 and there is OVER ONE medical doctor of that physician's specialty per 10,000 population practice, success is limited. Practicing in a population where your specialty is only one doctor per 10,000 population, success of the practice is usual.
One shouldn’t leave out the increasing numbers of plastic surgeons using this same game plan. As the antagonism between physicians and government interference in health care increases, the high probability of physicians opting out of commercial health insurance programs and government Medicare and Medicaid will happen.
It’s reported now that over 30% of physicians have already stopped seeing Medicare/Medicaid patients.
Affluence counts-- Go where the money is! At least you should practice very close to those areas of your city. Patients with money are the ones you most likely want to cater to in your practice. Whether you admit it or not, you do cater to them as well. By marketing your concierge practice to the affluent, you will build your practice more rapidly than otherwise.
The affluent seek special attention, the best quality of medical care, the convenience of services, and are willing to pay for it. Any patient or family with an income over $200,000 will be looking for a concierge medical practice, and often don’t know it, don’t know how to find one, or where to look. You have to tell them.
What you must understand about business and practice success at it’s best...
- You are in control of your life and professional career. All those who criticize you for being an elitist, a violator of your medical oath, or leaving the poor people to be treated by someone else don’t give a damn about you or whether you succeed or fail.
- You can’t do anything without money. You have every right as a professional to attract and grow your income to the level you need, and no one objects to that as long as it is done ethically and professionally.
- You never signed a contract to be poor, to treat all the underprivileged, to sacrifice your children’s education, to give up on your lifestyle dreams, to go without just for the sake of what some call social justice.
It doesn’t mean you shouldn’t treat such patients, as we all have done one time or another, but, it does mean you don’t have to feel obligated to destroy your practice and life by doing so. It’s what some mentally handicapped people who support social justice imply.
- Your medical practice income comes from providing good healthcare to all your patients, no matter how you derive that good income within professional bounds. The wealthiest physicians that I know are the greatest contributors to charity organizations and organizations that support health care.
If it were all said and done, I believe that their contributions during their life in medical practice lead to more healthcare for the poor around the world than all the years in medical practice that one might do catering to poor patients. You can’t do that when your medical practice can barely support itself.
- You don’t have to be liked—just respected.
Self-esteem counts--You can’t go into a concierge practice feeling guilty. You were taught how to be a good doctor. No one dictates who you treat, at least not as of today. One of the greatest gifts a physician has is the God-given talents and skills to practice medicine freely.
My view of the future of concierge medical practice...
The middle class of our society is slowly being squeezed out by the economics of our country, the lack of a work ethic, entitlements, and the descent from holy ground. Division of our society into the poor and rich not only is inevitable but also creates a divided mindset about medical practice as a profession.
I expect the medical profession will become more fragmented in terms of sub-sub-sub-specialties clearing the road for all mid-level providers to take over the majority of healthcare. In essence, the opportunities for physicians to remain in direct contact with patients to any significant degree will be fulfilled by concierge medical practice.
Back in my middle years of OB-Gyn practice at the beginning of the managed care tsunami (1970’s) as a means of reducing medical care costs was the first time I ever heard of a “cash only” medical practice. I never thought any physician in their right mind would have the guts to try it.
But, changes, influenced by circumstances, continue to lead us around to places we don’t choose. Concierge medical practice may very well be a good place to be in the future. If I had the chance to start medical practice over again in my 20’s, I would go the concierge route for many reasons. And… care a hell of a lot less about what our government chooses to do with control of healthcare. First, the government has to eliminate private medical practice completely.
It seems obvious that most physicians know very little about concierge medicine other than through short articles about it in medical journals. Most patients know nothing about concierge medical care, except those in the inner circle of healthcare.
A smart physician who is now looking at medical practice business management strategies for their practice, career change, and business focus for their practice should read Michael Gerber’s book, "The E-Myth: Physician." Believe me, choices such as this are part of your medical practice business and marketing plans whether you know it or not.
(I am receiving no compensation for this article from any entity whatsoever. I have no agreements, contracts, special arrangements with any individual or organization having to do with any aspect of concierge medical practice anywhere. My intention is to make physicians aware of possible medical practice methods that they may choose to establish for their financial stability.)
----Professional Probe----
"We are often fooled by names and labels--
"Concierge" does not signify a
spa or bath house."
"Once our government gains complete control of healthcare, concierge medical practice likely will not be possible because of the domination of the laws pertaining to medical practice that will become pro government biased--meaning that any form of private medical practice will be outlawed." We know that our government will not tolerate any competition."
Articles©2013-2022/CGG INVESTMENTS LLC. All rights reserved. #12, 3-16-22
