Frustration over too much time lost to paperwork and satisfaction in the ability to devote quality time with patients are recurring refrains for doctors switching to concierge medicine.
Fear and guilt are significant but mentioned less. The fear involves wondering whether the new business model will work, said Terry Bauer, CEO of Specialdocs Consultants, which for 20 years has helped doctors convert and handle logistics afterward. The guilt involves wondering what will happen to the hundreds of patients that they now can’t handle and are forced to seek a new doctor.
Dr. Uday Jani, a Specialdocs client, is downstate Delaware’s first concierge doctor.
“There was a big fear,” he said of his decision a decade ago. “A very emotional time. Will this model float?”
It has. Jani retained his staff of two full-time employees and a part-timer when he went from 3,000 patients to 525, with 70 now on a waiting list.
“And I can be a doctor again,” he said, referring to how he enjoys the time to be with patients without running to the next responsibility.
Concierge medicine involves patients paying an annual fee for better access to their doctors and more time with them. A variation called direct primary care includes the annual fee and excludes dealing with insurance, with the doctor negotiating rates for specialty services.
There’s no official list of concierge doctors, so there’s no accurate measure of how fast the trend is growing since it began in 1996, according to Concierge Medicine Today. The trade publication estimates there are 10,000 to 25,000 “physicians or subscription-based programs across the U.S. and abroad,” a fraction of the 1 million doctors in the U.S. Delaware has at least 25 concierge doctors, and the Federation of State Medical Boards counted 5,795 licensed physicians in Delaware in 2018.
A traditional pay-for-service practice averages about 2,500 patients, Bauer said, and the average concierge practice has 375 patients, averaging $2,250 in annual fees.
Those fees ($843,750 in Bauer’s average) are divided between the doctor and a management company like Specialdocs. Specialdocs charges a 20% management fee for the first four years, then dropping to as low as 6% in out years. Other management companies have fees as high as 35%, he said.
When asked what Specialdocs does for its share, Bauer said “it’s easier to tell you what we don’t. We don’t employ the staff. We don’t pay the physician. We don’t pay the bills for the doctor. But we do manage membership, patient enrollment, patient management, patient billing and patient collections. We assist and guide the doctor on regulatory matters, marketing, practice operations, recruiting staff and looking strategically. We are really their concierge business adviser.”
Of course, doctors can make the switch on their own, and Jani has fielded many calls for advice.
He charges patients $1,500 or $1,750 annually, based on age. That sliding scale is common, considering how older people typically see doctors more. He also has some “scholarship” patients who cannot afford the annual fee and don’t pay it.
When Jani was switching, Specialdocs wondered if the concept would work in Delaware.
“We weren’t sure if there was a concentration of people and enough people with the disposable income to make that investment,” Bauer said.
But since then, citing the wealthier people retiring, summering in or just lured to the Sussex County beaches, Delaware has become “a good market” for concierge practices.
Concierge medicine is so new that Bauer knows of no studies on patient health, but economics studies have shown that “patients who are part of a concierge practice had significantly fewer visits to the emergency room, visits to specialists and readmissions to hospitals, and as a result better compliance with treatment plans and lower costs to the system.”
As for patients considering concierge practices, Mark Thompson, executive director of the Medical Society of Delaware, had this advice: “You should look for whatever meets your needs.”
