Understanding Concierge Medicine: A Practice-Level Overview
Escalating administrative burdens, shrinking reimbursement and limited time with patients have made it increasingly difficult to deliver the kind of care and professional satisfaction that physicians envisioned when deciding to become doctors. Concierge medicine offers an alternative: a structure designed to restore autonomy, deepen patient relationships and create a more sustainable practice. However, transitioning to a membership-based model is not just a clinical decision; it is a business and compliance decision that requires careful planning and navigating regulatory and legal complexities.
Concierge Medicine, also known as “retainer-based medicine,” “boutique medicine,” or “direct care,” is a medical service model where patients pay a membership fee to a doctor or group of doctors for a higher standard of care that allows for prioritization around quality of care and individualized treatment. Concierge medicine began with a primary care focus; but now, a wide range of practice areas—including pediatrics, geriatrics, psychiatry and obstetrics and gynecology—are increasingly adopting concierge model practices. With concierge medicine, physicians often maintain a smaller patient roster, allowing physicians to spend more time during each patient interaction and to provide a comprehensive treatment plan for each patient. Concierge physicians are typically directly available and respond quicker than regular practice providers – often the same day. Some physicians even provide specialized services, such as accompanying patients to specialist visits, making hospital and home visits and providing tests and procedures at the physician’s office.
In 2024, the U.S. concierge medicine market accounted for approximately $ 7.35 billion in annual U.S. healthcare spending. It is projected to grow at over 10% per year, with the concierge medicine market nearly doubling in size by 2030.1 The American College of Private Physicians (ACPP) is a trade group focused on providing support for this type of practice.
1. Pros and Cons of Concierge Medicine
Concierge medicine provides physicians with the opportunity to deliver personalized care. Physicians in these types of practices tend to have extra time to spend with patients due to the physician’s smaller total patient panel. This allows concierge physicians to thoroughly collect information about a patient’s medical history to understand patients better and to provide individualized care. Because of this, concierge physicians can also offer patients a tailored treatment plan for optimum health. Additionally, concierge practices often allow patients to have direct access to their providers for quicker support, advice and assurance. Furthermore, because the patient pool per provider is small, there is less risk of physician burnout and the potential for actual work-life balance.
Although concierge medicine provides significant benefits, both for patients and physicians, there remain some potential drawbacks. Financial barriers may make this type of enhanced care unaffordable for some patients, which would result in patients receiving different levels of care based on their economic status. Additionally, there is an ongoing physician shortage that may be exacerbated if physicians are treating fewer patients at a time.
2. Structural Options
One of the first steps in creating a concierge practice is to determine the preferred structural model of the practice. Options include a hybrid model or a direct care model. Hybrid models allow concierge physicians to charge a membership or retainer fee, while also billing commercial insurance and Medicare for covered services. The fees in this type of practice cover enhanced services like streamlined access to physicians, amenities and administrative services. This type of practice allows physicians to see fewer patients and increase visit length, without completely absolving ties to third-party payers. The fees in this model are not directly associated with a specific scope of medical practice. And hybrid models may maintain administrative burdens because they require compliance with CMS regulations for any services that remain Medicare-participating or Medicare-enrolled.
Direct primary care models, or cash-only concierge models, are when patients pay a periodic fee that covers a defined scope of services—insurance, Medicare, or Medicaid are not billed for clinical services. This model allows for simplicity, as physicians do not need to worry about insurance billing. However, direct primary care models more closely resemble that of a healthcare service plan and without proper considerations and a limited scope of services, physicians may risk being subject to regulatory scrutiny.
3. How to Make It Happen
California is well-known for having one of the strictest Corporate Practice of Medicine doctrines. California Business and Professions Code § 2400 clearly states that “Corporations and other artificial entities shall have no professional rights, privileges, or powers” – a statutory provision meant to “protect the professional independence of physicians and to avoid the divided loyalty inherent in the relationship of a physician employee to a lay employer.”2 As such, only licensed physicians can own and control a medical practice. Concierge practices often take the form of Professional Medical Corporations owned by physicians and may sometimes include an outside Management Services Organization for handling administrative tasks. Because these arrangements are subject to regulatory scrutiny, legal consultation is essential to ensure compliance and mitigate risk.
Notably in concierge practices, the membership or retainer agreement is foundational. Guided by consumer protection statutes with codified obligations, the membership agreement should clearly establish expectations of the concierge practice. First, the agreement needs to clearly detail what is covered by fees and if any services will be billed separately. Second, the agreement must inform the patient that membership is not equivalent to health insurance and that patients should maintain separate health insurance coverage for services not included in the membership. Third, the agreement shall describe conditions under which the agreement may be terminated, advance notice requirements and if any part of the prepaid fee is refundable if the agreement is terminated early. And lastly, the agreement should discuss any specific obligations directed to the patient, such as how fees should be paid and compliance with practice policies.
Aside from corporate technicalities and contractual requirements, other steps to creating and establishing a concierge practice include setting the price for fees and determining patient panel size, appropriately transitioning patients to the concierge practice while avoiding any claims of patient abandonment and appropriately marketing the business – all of which entail regulatory considerations that should be navigated with the help of counsel.
4. Conclusion
As concierge practices continue to evolve, a broader reality is becoming more noticeable — physicians are actively seeking practice environments that better align clinical goals with professional sustainability. Ultimately, a clear understanding of concierge medicine provides physicians with the opportunity to consider a practice that can potentially cultivate more meaningful healthcare.
1Grand View Research, U.S. Concierge Medicine Market Size, Share & Trends Analysis Report, https://www.grandviewresearch.com/industry-analysis/us-concierge-medicine-market-report (last visited Apr. 24, 2026)
2California Medical Ass’n, Inc. v. Regents of University of California (2000) 79 Cal.App.4th 542, 550.
