Concierge Medicine in A Changing Medical Landscape

Joseph R. Anticaglia MD
Medical Advisory Board

Often, after checking into a hotel, people look for the concierge desk. The concierge is a hotel employee whose job it is to make your stay in the hotel as pleasant meaningful, and memorable as possible by improving the services the hotel offers. They arrange tours, make restaurant reservations and are helpful in obtaining tickets to the theater or sports events. People enjoy the personalized attention.

Concierge Medicine (CM) is a doctor-patient relationship in which doctors offer their patients personalized, improved services in exchange for an annual fee. The concierge model first appeared in 1996. It was founded by Dr. Howard Maron and Dr. Scott Hall who named their practice MD2, pronounced “MD Squared.” Other names for such medical care include personalized medicine, retention medicine and direct primary care (DPC) providers.

Costs of concierge medicine vary widely. Initially, only the wealthy could afford the annual fee. Today, the cost is more affordable, and patients often pay their retainer fee monthly. CM’s business model is a variation of retention fees, subscription fees, or more recently, membership fees to certain internet companies.

CM Doctors

Concierge doctors offer improved services by limiting the number of patients in their practice. Patients have direct access to their doctor 24/7 and can walk in to see their physician about a problem without an appointment. They do everything your internist or family doctor does in treating patients — physical examinations, ordering lab tests or X-rays, writing prescriptions and so forth.


Michelle has been a patient of Dr. Arlington for the past 27 years. The doctor has treated her heart irregularities, hypertension, and elevated cholesterol over the years. In addition, he has prescribed medications for her asthma, upper respiratory and urinary tract infections, and other complaints.

She was surprised to receive a letter from her internist which in part said: “I appreciate the privilege of being your doctor over the past many years. You’ve been an ideal patient, and I want to continue to provide you with the personal care and quality time you deserve.

However, because of the high number of patients presently in my practice, I haven’t had the time to deliver the excellent care to which I am accustomed. To remedy this, I plan to limit my practice to a certain number of patients and become a Concierge Doctor.

This means, for an annual membership fee in my practice, you will have access to me where and whenever you need to 24/7 (i. e., phone, email, telemedicine). If you have an unscheduled visit to

the office, you can be seen on a walk in basis. Your health insurance covers the traditional health services and that will not change.

This arrangement will allow me to dedicate as much time as needed to your physical and emotional needs. Please call our office so we may answer any questions you may have.

Pros and Cons of CM

Why is CM up ticking across the United States?

  • The advantages of Concierge Medicine membership include round-the-clock availability of your physician to care for medical needs, the option of seeing your doctor without an appointment, and in some instances, the availability of virtual consultations (telemedicine). Doctors benefit by having personal, quality time with their patients, reducing overhead costs, spending less time hassling with insurance companies, and having the option of adjusting their fees according to patient needs.
  • The disadvantages of CM for patients include: membership fees may be prohibitive, underutilization of medical services makes membership not cost effective and some out of pocket expenses may be incurred in spite of insurance overage Doctors lose a significant number of patients when they transitioned to concierge medicine .Doctors may not satisfy patient’s expectations of “personalized” medical care with subsequent termination by patients in the CM program.


Relative Value Units many instances, determine physician reimbursements. It is a standard set by Medicare to determine the amount to pay doctors depending on their productivity. Doctors are expected to diagnose and treat a certain number of patients per year (productivity — volume of work) to reach their reimbursement target. A physician’s time, effort and resources are taken into consideration when Medicare determines its payment.

Both doctors and patients are dissatisfied with RVU’s. Doctors complain that RVU arrangements make them practice “assembly line medicine.” The hassle with Medicare and other insurance companies takes time away from patient care. Patients complain about being treated by physicians as an item on the assembly line. Concierge medicine is offered as an alternative assembly-line medicine

Changing Medical Landscape

The landscape for delivering medical care is changing rapidly. Into the mix is Telemedicine, which offers medical care for non-emergency conditions 24//7. Whether it’s traditional medicine, concierge medicine, telemedicine, P. A. (physician assistant) medicine or other plans, it’s necessary to find the medical coverage that best suits your needs.


  1. Michelle Konstantinovsky; Many Doctors are Switching oy Concierge Medicine, Exacerbating Physician Shortages; Scientific American, October19, 2021
  2. Dedication Health; Concierge Medicine Has Beem Around for Decades
  3. WebMD Editorial Contributors; What is a Concierge Doctor? WebMD, June 29,2021
  4. Joseph R. Anticaglia, MD; Alcohol Use Disorder Identification Test — AUDIT; 2021

This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.