Call of Concierge: Still a Niche in Cardiology, But Growing

Concierge cardiologists report high job satisfaction along with more stable practice revenue, but experts caution specialists to learn about the differences in practice models.   

Response to stresses

Concierge medicine has its roots in dissatisfaction. Driven by both physicians and patients who long for more face time and relationship-building than the standard 15-minute appointment supports, concierge practices started popping up in the late-1990s, after a Seattle physician got attention for launching a membership-model practice. Patients paid a monthly fee directly to the physician in exchange for 24/7 access, same-day appointments and no time limits on visits. 

For clinicians, the lure hasn’t changed much. Many want to step away from the grind of seeing six patients an hour and the associated fear of making mistakes. Approximately one in five U.S. physicians report intending to reduce their clinical work hours in the next year (Mayo Clin Proc 2017;92[11]:1625-35).

Just as burnout is more prevalent among primary care physicians, so, too, are concierge practices. Numbers are hard to come by, says Concierge Choice Physicians (CCP) Founder and Managing Partner Wayne Lipton, but he estimates 5,000 concierge practices are operating nationwide, including about 7,500 physicians, most of them in primary care.

Calculating concierge medicine’s penetration in specific specialties is even more difficult, says Michael Tetreault, editor of the trade magazine Concierge Medicine Today. In 2015, his research suggested that specialists comprised less than 10 percent of concierge physicians and there were only about 25 physicians who self-identified as concierge cardiologists. Specialists haven’t embraced concierge medicine like primary care has, although Tetreault’s polls suggest interest is growing “moderately” among specialties (see figure below).

Phillip Miller, vice president of the physician recruiting model Merritt Hawkins, also has seen hints of emerging interest in concierge practice among cardiologists. “I polled our recruiters, and we have heard reports that more cardiologists are switching to concierge using either [a] retainer or hourly billing model, but we haven’t recruited for one,” he says. 

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More models to choose from 

Considering the reasons that concierge practices appeal to clinicians and patients alike, it’s not surprising that a variety of models have emerged, ranging from all-in to blended approaches. The ability to customize is what makes concierge medicine viable for specialists, says Lipton. The model also impacts how physicians are paid for their services, with all model types including at least some fees patients pay themselves and variation in whether payers will cover appointments and services. In most cases, patients may file claims for customary (i.e., non-membership) fees.

The range of models makes it possible for concierge physicians serving various patient demographics, says Lipton. “There is a myth about concierge … this model is not just for primary care doctors in the most expensive neighborhoods,” he stresses. “It works well for a broad range of demographics and for a wide range of specialists, especially those that often provide core medical services for their patients.”  

Lipton points to the hybrid model as the better choice for cardiologists, who typically maintain their traditional practice while offering the concierge option for patients who want extra time and service. Approximately 5 to 10 percent of the patient panel typically opt for the concierge option, at a monthly cost of $150-$200, resulting in a significant revenue boost for the practice. In most hybrids, physicians continue to accept Medicare and insurance payments for customary services, according to Lipton. 

In this model, physicians need to set aside specific blocks of time to see only their concierge patients, and they need to adjust how they think about cultivating referrals. In concierge models, the main source of new referrals is word of mouth from existing patients. 

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While concierge practice is not without risks, physicians who make the shift report finding joy in the change. Dan Wohlgelernter, MD, a cardiologist at Cardiology Consultants of Santa Monica, in California, says that since adopting a concierge approach in 2014 his practice load is one-third that of the traditional practice he ran for 30 years. 

And he’s enjoying being a doctor again. “I can now practice medicine in the way I thought best while maintaining a profitable practice with less financial worries due to ongoing cuts in reimbursement,” he says. “I don’t feel forced to see more and more patients. I have a more enjoyable pace with time to work closely with patients.”   

Tiffany Sizemore, DO, a concierge cardiologist with Cardiac Care at Choice Physicians in Ft. Lauderdale, Fla., opted for concierge right out of training and believes heart failure patients “derive the most benefit from [concierge] service.” 

She points to reduced overhead costs and the potential for more practice as income as benefits for concierge physicians, but what she really likes is “being able to spend quality time with my patients, educating them on their disease state, helping them through the process and getting to know them.”