The model, well established in primary care, is attracting increasing numbers of specialists seeking a more sustainable practice life

By Bonnie Darves, a freelance health care writer

A decade ago, the concierge medicine model, in which patients pay a fee or retainer in exchange for enhanced, accessible care, guaranteed physician availability, and unhurried visits, had become common in primary care but was relatively rare in the medical specialties. That’s changing. Today, the model is showing up in an increasingly broad range of specialties, from cardiology to endocrinology to gastroenterology, oncology, dermatology, gynecology, and, of late, emergency medicine.

In tandem, some physician practices are expanding their clinical scope to incorporate the rapidly growing realm of functional or integrative medicine as either adjunctive services or a mainstay. That model, typically a concierge-style, cash-pay structure, combines traditional treatment and alternative or complementary modalities in pursuit of providing a holistic care model focused on addressing root causes of illness.

The drivers for the proliferation of concierge care are two-fold. Physicians are seeking a way to exit what many perceive as “treadmill medicine” — rushed visits and unmanageable productivity expectations that, in turn, can result in suboptimal care. Patients, especially those with chronic or medically challenging conditions, are looking for more personalized care and access to resources to better manage their disease and improve their overall health.

Because concierge medicine is fast evolving, it’s hard to get a sense of the extent to which physicians in either primary care or the specialties are moving into the model. Concierge Medicine Today, the industry’s leading trade journal, reports that between 7,000 and 22,000 US physicians are practicing some form of concierge medicine — either in a standalone model or a hybrid format that involves a mix of subscription-based and traditional patients.

The journal’s editor-in-chief, Michael Tetreault, whose publication has tracked the field for nearly two decades and whose company hosts the annual Concierge Medicine Forum, describes the uptick in specialty concierge practice as more mindset than business model. “I’m seeing more and more specialties entering this [concierge] space,” Mr. Tetreault said, because it enables physicians to establish “a more sustainable pace in their practice model.”

Specialists take the plunge

That promise of a more sustainable pace led Denise Armellini, MD, to establish The Endocrine Center in Fairfax, Virginia, six years ago. “I was seeing 30 patients a day and often working until 11 p.m. It was my kids who pushed me,” she said. “I was about to leave for a speaking engagement when one of my children said, ‘I think you prefer your patients to us.’”

Dr. Armellini cancelled the engagement and began moving forward in earnest on her concierge practice, working with Specialdocs Consultants, which helps specialists establish concierge practices. The company assumes responsibility for the marketing and back-end functions such as the website, patient communications, member billing, and other operational activities.

Dr. Armellini, like many physicians who move into concierge medicine, was concerned about leaving behind a large number of her patients. She was genuinely surprised, however, by her patients’ positive response to her announcement letter. She still felt a little guilty, even though she assured patients that other endocrinologists would take over their care.

“Most of my patients were happy for me, and only a few were upset,” she said. Dr. Armellini quickly amassed a sufficient patient panel — she contends that most concierge physicians can establish a financially viable practice with roughly 10 percent of their previous patient panel. The Endocrine Center even managed to grow quickly during the pandemic, to 400 patients, and Dr. Armellini has since brought in another endocrinologist to help expand the practice.

The practice’s success has increased Dr. Armellini’s professional satisfaction and given her the personal time she had been missing.

“This model gives you the ability to not be rushed, to educate patients, and to allow more frequent visits — I’m able to practice the preventive medicine I’ve always wanted.”

— Denise Armellini, MD, The Endocrine Center

The feeling that she was pushing a rock up a steep hill drove rheumatologist Molly Magnano, MD, to establish Pacific Rheumatology Associates in San Francisco after 20 years in her field. She had tried employed medicine and private practice, and regardless of the setting, she found that she had too many patients and not enough time to take care of them. “For me, practice had become transactional and volume-based,” she said, “and I was increasingly frustrated.”

Since making the transition about a year ago, Dr. Magnano has evolved the practice into a model that works well for her and her patients. “Rheumatology is an ideal fit for the concierge model, I think, because many of our patients have chronic, long-term illnesses,” she said, and need closer, more frequent follow-up.

“What felt different, almost immediately, is that I had 45 minutes to an hour to spend with my patients — and the ability to make house calls if needed. All of a sudden, I loved medicine again.”

— Molly Magnano, MD, Pacific Rheumatology Associates

Dr. Magnano was initially concerned about leaving patients behind and her ability to make the concierge model work financially. Before starting the practice, she sent a survey to her patients to gauge their reaction. Patients were far more interested than she expected in following her to the concierge practice. “Saying good-bye to some of the 2,500 patients I had before the transition was difficult,” Dr. Magnano said. Those feelings were offset eventually by the fact that both she and her staff were happier, and the patients were better cared for.

To retain some previous patients, Dr. Magnano structured the practice as a three-physician hybrid model. Some patients are strictly concierge, and the others are cared for in a traditional fee-for-service arrangement by one of the rheumatologists. The concierge fees allow more time not just for patient visits — a combination of in-person and video — but also for coordinating care and managing time-intensive prior authorization. Specialdocs Consultants helped set up the concierge side and manages the communications and back-office and membership billing functions.

While some of Dr. Magnano’s physician colleagues in the community initially expressed skepticism about her move, she said many came around “once I explained my motivation.” Dr. Armellini had a similar experience, and today, she frequently hears from rheumatologists who want to explore making the transition.

In Mr. Tetreault’s view, based on his reporting, concierge practice is a good fit for specialties that aren’t defined primarily by procedures but rather by relationships. “Concierge practices work anywhere patients need time, clarity, and ongoing management,” he said. The obvious candidates are internal medicine specialties, such as cardiology, endocrinology, gastroenterology, rheumatology, and oncology, Mr. Tetreault observed, but the model is also showing up, of late, in pediatrics and women’s health.

Large-scale concierge models address growing demand for personalized care

Lisa Larkin, MD, has channeled her personal interest in women’s health, and especially the under-addressed sector of menopause and midlife health, into a growing concierge network called Ms. Medicine. She formed the company in 2016, and today, affiliated endocrinologists and primary care physicians focused on women’s health treat more than 6,000 concierge patients. Recently, gynecologists have approached Dr. Larkin to discuss coming on board.

“Menopause is finally having a moment,” Dr. Larkin said, and women are looking for more personalized care that “addresses the health care gap for midlife women.” Using a licensing agreement, she helps practices structure services in a direct-pay model that is rapidly gaining traction. Ms. Medicine hires and trains staff and helps practices launch, staying on board for five years to assist with the transition.

In the Ms. Medicine model, physicians see 14 to 16 patients a day and offer personalized 24/7 care — via in-person and video visits and text exchanges — to address both urgent needs and ongoing health concerns. The clinical scope covers a broad range, from menopause and sexual health to breast cancer risk assessment, heart health, bone health, and pelvic-floor conditions. The model includes direct access to specialists as needed.

“This model isn’t perfect, but it grew out of the failure of traditional models to address women’s health issues,” Dr. Larkin said. She notes that Ms. Medicine also operates a nonprofit organization called HERmedicine dedicated to expanding education on women’s health.

Even emergency physicians have answered the concierge call. Erick Eiting, MD, MPH, a former Mount Sinai emergency physician and residency director, joined Sollis Health in New York in 2024. The concierge practice offers what it calls “immediate care” in New York, Florida, and California, in a clinic-based model supported by 24/7 access through email, text, its portal, and house calls.

Sollis members, who first undergo a baseline health evaluation on joining, seek care for chest pain, wound care, orthopedic care, injuries, and other issues requiring immediate medical attention. The clinics offer full imaging and lab services onsite, and Sollis collaborates with patients’ primary care physicians and maintains an extensive fast-track referral network for specialty care. The organization recently added pediatric immediate care to its concierge services.

The rationale for the Sollis model, Dr. Eiting said, is to enable members to seek care from veteran emergency physicians without waiting hours at a hospital and, in about 20 percent of cases, being released rather than admitted. “Sollis gives me the opportunity to practice medicine the way it should be practiced — with time to talk to patients and get a sense of what’s going on,” said Dr. Eiting, who is Sollis’ New York regional medical director. “I spent my career trying to build models to improve care, and I was often frustrated. This opportunity was the universe telling me what my next adventure would be.”

Physicians at Sollis, whose practice experience ranges from five years to two decades, work three- to eight-hour shifts, and they have broad discretion and sufficient time to deliver needed immediate care and coordinate follow-up care. “Basically, we find the best place or person for whatever care patients need. For them, it’s like having a doctor in the family,” Dr. Eiting said.

At the very sophisticated, comprehensive, and expensive end of the specialty concierge spectrum, integrative models such as Atria Health Institute are emerging to provide the Holy Grail of medical care: personalized and proactive preventive health. The company, which also operates a research institute, focuses on disease intervention and prevention, using a multidisciplinary model that includes physicians in 18 specialties. Atria provides members access to the most recent developments in medical science, technology, and health.

David Dodick, MD, Atria’s chief science and medical officer, describes the model as an antithesis to the “reactive” care that dominates health care today. “It’s precision, preventive medicine, and I think the future of health care will be focused on that,” said Dr. Dodick, who spent 32 years at Mayo Clinic and still teaches and mentors there. Physicians who practice at Atria — its 65 specialists and primary care doctors are recruited for their expertise — has campuses in New York, South Florida, and Northern and Southern California.

The appeal for Atria physicians is the ability to practice unhurried, collaborative medicine with immediate access to cutting-edge research, testing, specialty colleagues, and technological resources. Internists’ patient panels, for example, top out at 150. “Physicians not only have the time they need to care for members but also the resources,” Dr. Dodick said.

The organization sets a high bar for physician recruits, who go through eight to 10 interviews and extensive evaluation of their patient interactions. “We’re looking not just for expertise but also for soft skills — patient rapport, compassion, and the ability to interact with patients’ families,” Dr. Dodick said.

“We’re looking for physicians who understand that preventive health care is the future and who want to be involved in an integrated practice that permits constant collaboration.”

— David Dodick, MD, Atria Health Institute

Prerequisites for moving into concierge medicine

It is no small leap to move from traditional medical practice to a concierge model, especially for physicians who have never operated a practice before and have mostly worked in employed positions. But it’s doable, with certain prerequisites: expert advising, robust support, and an entrepreneurial mindset.

The key prerequisites, all sources agreed, are a solid professional reputation, a clean malpractice profile, and sufficient practice experience. Opinions differ on what that number is, but the commonly cited range is eight to 10 years of practice experience, with five as a minimum.

When recruiting, Dr. Eiting at Sollis Health looks for at least three to five years of emergency medicine practice in a busy facility. He also seeks soft skills that he deems crucial in concierge care. “I’m looking for emotional intelligence and situational awareness, in addition to solid experience,” he said.

Business skills, or a willingness to obtain them, are also a must because concierge medicine is an entrepreneurial endeavor. “To succeed in concierge medicine, you must have the ability to take risks because getting established may involve taking out a business loan,” Dr. Larkin said. “You also need to have ‘street cred’ and gumption — the ability to build a presence in your community.”

Dr. Magnano cautions specialists considering concierge practice to prepare for a dip in income while they make the transition. Because she had been in private practice before and had a well-established reputation in the community, Dr. Magnano weathered the conversion readily. In her view, a minimum of 10 years practice is ideal for specialists who plan to convert to concierge practice.

Greg Grant, chief operating officer of Specialdocs, reported that while the company has worked with physicians at all stages of their careers, the “sweet spot” for making a transition appears to be mid-career, especially for female physicians. “Physicians who are in their forties to early fifties have built their patient panels, know their specialty, and are confident in their practice. But we’ve also seen physicians in their thirties make the transition successfully,” Mr. Grant said.

He acknowledges that converting from employed practice to concierge medicine, without prior business experience, typically requires significant pre-planning and a longer ramp-up time. Specialdocs considers 500 patients an optimal patient panel and 150 the basic minimum, from a financial standpoint.

Craig Fowler, who heads the recruiting firm Athenic Group and is a former National Association of Physician Recruiters president, observed that while most specialty concierge practices are private entities, solo or multi-physician, the model is being adopted by some hospital systems and health care organizations seeking to meet a growing demand for customized care. “Some of these systems have established a concierge arm, including Atrium Health, Texas A&M, and Cleveland Clinic, to name a few, and that means that employed positions are available and increasing,” Mr. Fowler said. “I think we’ll see concierge medicine grow in the years ahead because it’s actually a patient-driven model.”