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One Doctor’s Journey into Concierge Medicine (continued)

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Fall 2002

Rick opened his doors on September 1, 2002. Business was slow, and he had to adjust to the new pace of a concierge physician. By mid-October, Rick had 175 patients signed up, and he was seeing just a few patients each day. He would answer about four or five e-mails and perhaps 10 phone calls. It was certainly a far cry from his traditional solo practice, but Rick was delighted with the change. He notes, “I don’t feel like I am on roller skates going from room to room. There is no question that I am having better interactions with patients.”

Rick tells the story of one of the first patients he treated as a concierge physician:

“I had an 85-year-old woman who called me at 7:30 pm on my cell phone. She had never had heart problems, but I didn’t like what I heard. In my former practice, she would likely have gotten one of the four covering physicians. I called her son and he took her to the emergency room. Sure enough, she was having an inferior myocardial infarction. I took care of her all night, and she had angioplasty. Because I didn’t have a conventional morning with 30 patients booked, I was able to stay in the hospital with her and see her frequently over the course of her three-day hospitalization.”

Although in the fall of 2002, Rick still had a lot of angst about how things would go in the future (Would his practice fill? Would concierge medicine really work for him and for his patients? Would his lifestyle really be dramatically different?), he was optimistic and happy to finally begin this new journey.

Winter 2003

In the beginning of 2003, Rick had 180 patients signed on and he was seeing eight to nine patients a day. He returned an average of six phone calls and four or five e-mails. His schedule was open, with flexibility to go to the hospital or nursing home when the need arose. Rick was keeping an eye out for a like-minded doctor who would be interested in joining his practice. At the same time, he was starting to market his practice more aggressively and was initiating a direct mail campaign that targeted new patients in surrounding towns. He was also mailing information to CEOs of companies, lawyers, venture capitalists, accountants and others to whom this type of service would appeal. He followed up his direct mailings with phone calls that either his office manager or he would make if “we have identified someone as a good prospect.”

During the winter of 2003, Rick was convinced that he had made the right move. He said, “I love coming to work. I am so much happier. It is fun being a doctor again.” Still, he knew there would be plenty of work ahead in order to keep his new practice afloat. He confided, “I think that the biggest challenges are to grow the patient base and to assimilate a new doctor into the practice.”

Spring 2003

By April of 2003, Rick’s practice was half full—he had 200 patients signed on. His practice was mentioned in the Boston Globe and in several local newspapers. He had launched a business-to-business mail campaign where he sent letters to 100 small businesses in his area. Part of his marketing campaign focused on the fact that it is not cost-effective for a busy executive to sit in a doctor’s office for an hour or two in order to obtain an antibiotic for a mild upper respiratory infection. Rick believes that it is perfectly reasonable to treat people over the phone in some instances—particularly when the patient is well known to the physician.

Financially, Rick says, “I incurred a lot of start up costs.” Nevertheless, he says that he is doing at least as well as he was when he had a traditional medical practice and he comments, “I clearly will be in a better situation financially than I was before.”

Wayne Lipton says that doctors should not go into concierge medicine with the idea that they will have incredible financial gains. Lipton notes, “This is not about huge windfall millionaire primary care doctors.” Instead he reports that for most doctors who want to go into concierge medicine, it is a quality-of-life issue. The most important thing to these doctors is that they want to spend more time with their families—away from medicine. However, Lipton is quick to report that there certainly are financial benefits. He says, “For some doctors, concierge medicine stabilizes their income and improves their lifestyle. For others, it can double their current revenue.”

In the spring of 2003, Rick was so happy with his decision to go into concierge medicine that he began to work on starting a business that would help other physicians transition from their traditional practices. Rick says, “There is a need out there for doctors to get advice. There is no manual [on how to start a concierge practice]. I can help people who want to do this learn from my experience.” Rick also wants to change the name “concierge medicine” to “personalized retainer practices” because he says, “Concierge kind of trivializes what we do.”

Summer 2003

In the summer of 2003, Rick’s practice was still half full. But he wasn’t worried, “Things are moving along, and this is exactly where I want to be.” Rick had gone back to teaching residents at the local community hospital (a favorite volunteer activity that he had given up when his traditional medical practice became unwieldy). On a personal level, he was spending more time with his wife and daughters, and he was making up for lost time. He attended his 16-year-old daughter’s high school field hockey and lacrosse games, and he saw his 13-year-old daughter play in every one of her soccer games. When asked whether he was glad he went into concierge medicine, Rick replies, “I think it is wonderful. I look in the mirror every morning, and I am so happy I did this.” n

Julie K. Silver, MD is an assistant professor at Harvard Medical School in the Department of Physical Medicine and Rehabilitation. She is the author/editor of several books including Post-Polio Syndrome: A Guide for Polio Survivors and their Families (Yale University Press, 2001).

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