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Medical Practice Business And Marketing Articles

Article #12 - Jun. 2010

“Medical Practice Business Transformation—
Concierge Practice” 
(Part 2 of 2)

It is predicted that private practice will disappear
by 2013-2015. What are your options?

(Find out if it comes into your crosshairs, doctor.)

(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 practice.)

Hybrid Model 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, 8 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, also will assuredly provide better medical care because of having time to read more journals, go to more medical education meetings, able to take more time to increase his skills and training, and, most of all, have more time with his family. Can you imagine that?

Innovation Model Concierge Medical Practice

Without a doubt, beginning your new medical practice using the 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 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 $150,000 from your education---and are asking for another $50,000 to get started 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 practice.  Maybe there’s a group practice you can join first already employing a “retainer-based” method of practice, and go from there.

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 now?

Most physicians see what’s happening now in the world of medical practice—and it ain’t 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 reasons. 

Transforming you practice is not easy.  Some follow the hybrid model to transition and some flat set a date to stop your regular practice and begin your concierge practice.  We’ll talk about the issues related to that
move in another.

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 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 doctors.

Solo primary practice physicians in private practice, especially in rural areas, are disappearing. But if they join together in group practice, this attrition would be far less common. 

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 doctor 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 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 doctor 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. 

I know! ... I’m getting to that next.

The where and how elements of concierge medical practice

The most common reason that a concierge practice fails is lack of income.  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...

  1. 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 populations... 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 (2010) of numbers of concierge physicians, the competition for patients should not be an issue in this population for the next decade.

  2. 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.

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, best quality of medical care, 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 doctors 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 leads
    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 are 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 midlevel 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.

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 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 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.) 

The author, Curt Graham, is a highly experienced business and marketing expert, copywriter, and entrepreneur who has been published in various media over 50 years while in medical practice and after.
Discover what it takes for you to reach the optimal limits of your potential in medical practice, and how to do it: Click Link NOW!

© 2004-2011, Curt Graham M.D., All rights reserved.

handwritten signature of Dr. Graham

Article #12A


photo Dan kenney riding on a bull

Why People Fail

A series of No B.S. articles from Dan Kennedy


"Watch The News. Make News."

I happen to be a politics junkie and, therefore, a news junkie. I even write political columns, so I have to pay attention daily. But I learned years ago that it is the news media’s job to make every problem a crisis, every item of earth-shaking, life-altering importance. Few news events actually are. As a matter of fact, most things wind up being about as important as you permit them to be. 

Few people think of themselves as news-makers.  

All the world’s a stage, and on it there are players, but there are countless more spectators. It never dawns on people how much of their time is spent as a spectator, how little spent actually playing a game over which they exercise control. Millions watch football on any given Sunday.

Only a small cadre of coaches scheme to win their games on Sunday, a small number of players work hard all week to be mentally and physically prepared to win the games in which they compete. It’s significant that the spectators rarely make news – the winning players and coaches do. And the spectators never get million dollar contracts to watch. They must pay for that privilege. 

There is that old cliché, about three kinds of people: those who make things happen; those who watch things happen; those who wonder what the heck happened, why, and why they were left out!  There’s a lot of truth to the cliché. Most people act as if they are in a little boat set adrift in a vast ocean of circumstances beyond their control, rowing fast and frantically, looking about endlessly for someone to come to their rescue. Few are captains.  

It’s my observation that exceptionally successful people are very deliberative and purposeful about three things, in this regard. First, they act as captains. Every day – yes, every day – they set out on a charted course of their choosing; they never meander about aimlessly.

Two, they are “makers”, creators, doers. They make things happen, make things move forward, get things done, sometimes through sheer force of will and refusal to accept or excuse less. In doing so, they are even, from time to time, news-makers, to their clientele, in their industry, in their community.

Third, they seek association with people of this ilk, and abbreviate as best they can the time spent with or on people not so self-determining, self-motivating. They recognize just how powerful association is.

My friend, the late Jim Rohn said that given the bank balances of the five people you hang out with the most, he could “guess” your bank balance with great accuracy. He also noted that rich people have big libraries, poor people prefer big TV’s – a way of asking you what sort of ideas you associate with most. A lot of people with 52” plasma’s and TV’s in three or four rooms of the house say they have no time to read.

Most accomplishment or lack thereof is result of investment – not accident. Those who are endlessly, constantly disappointed with their incomes, businesses, lives, prefer believing in accident, luck, randomness as a comforting religion, but that’s delusional.

Examination of most success reveals controllable causes, notably that person’s investments of his time, energy, money, in association with productive and provocative ideas, and people who are in the game, not in the bleachers.

The WHY PEOPLE FAIL articles are provided by Dan S. Kennedy, serial entrepreneur, from-scratch multi-millionaire,
      speaker, consultant, coach, author of over 13 books including the No B.S. series (, and editor of The
      No B.S. Marketing Letter. WE HAVE AR
      Free Membership in Glazer-Kennedy Insider’s Circle, newsletters, audio CD’s and more: for information and to register, visit:

 Articles © 2010/Glazer-Kennedy Insider’s Circle LLC. All rights reserved.



masonic emblembright colored American flag  Curt Graham, M.D.
   2404 Mason Ave.  Las Vegas, NV 89102
    E-mail = cgmdrx(at)
     © 2004 - 2015 Curtis Graham, M.D.,  All Rights Reserved.