“The interest level from patients is incredible,” Dan Cunningham wrote to me in an e-mail, commenting on my recent blog post about concierge medicine. Dan is the manager of a concierge medical practice that he and his wife, an internist, opened earlier this year.
Concierge medicine is an alternative approach to providing primary care. Patients or their employers pay a fee to an internist or primary care physician who provides all of 
their primary care. Many concierge doctors do not accept insurance: the cost of providing primary care is covered by the fee that the patients pay, and there are no co-pays. Concierge medical practices typically offer patients 24-hour direct access to their doctors, short or no waits for appointments, and longer appointments with one-on-one time with their doctors,
not physicians’ assistants and nurse practitioners. To provide this level of care, the physicians limit the number of patients in their practice. You still need insurance or pay out of pocket for other providers and specialists, lab tests, prescriptions, hospitalizations, surgery, emergency care, special procedures, and other non-primary care.
My initial reaction to this type of practice was what Dan calls an “entrenched strain of thought that this is elitist and for the wealthy.” Dan explained that concierge medicine is now a middleclass service. He said that the incomes of the patients coming to his and his wife’s practice are spread over a range; their patients are not just the wealthy.
People are driven to concierge medical practices when they want to have a close relationship with their doctor, just as medicine was practiced before health insurance and politicians became the middle men, dictating a patient’s care. They come because they want to have more than 10 or 15 minutes with their doctor, giving the doctor time to evaluate more than just the obvious symptoms.
How do people afford this? A little research told me that it comes down to choices. People are making the choice to spend their money on the concierge medical services instead of other items such as luxury cars or vacations. They are also electing high deductible medical insurance plans and using the savings to pay for the concierge medicine. Some concierge practices accept a limited number of lower income people.
Dan said that concierge medical programs have been proven to save patients money. How is this possible? Medical practices save time and money when they don’t have to bill
insurance. This savings can be passed on to patients. More importantly, huge savings can be had when a patient receives good primary care before problems escalate into serious and expensive medical issues requiring emergency rooms and specialists. Contrast this to a conventional medical practice where a physician has to see many people each day in order to receive enough in insurance reimbursements to cover his or her costs. This results in ten-minute appointments which may not be sufficient time to diagnose a patient’s problem.
The doctor then refers the client to a specialist. From there costs can escalate.
Concierge medicine is criticized for contributing to the shortage of primary care physicians throughout the country. The demand for doctors is expected to increase when the Affordable Care Act takes full effect next year. As doctors retire or leave conventional practices and reduce their number of patients, many people are left without primary care physicians. Dan said that some of this shortage results from newly graduated doctors not wanting to specialize in primary care because of the undesirable work conditions: bureaucracy, paperwork, and huge patient loads that prevent them from providing quality care.
Dan is hopeful that concierge medicine can create a primary care profession that doctors want to join. He and his wife will be “very active working with medical students over
time, showing them that they can go into this (area of medicine) and take care of people, and they won’t just be stuck in a 15-minute treadmill-triage system.”
