What Is Concierge Medicine? A Physician's Perspective
I have run a concierge medical practice in San Francisco since 2008. Before medical school, I trained as an electrical engineer at Stanford, which turned out to shape how I think about medicine more than I expected. Engineers think systematically. When a system consistently produces bad outcomes, you look at the design, not the people inside it. American primary care is a system that, by design, produces rushed visits, fragmented care, and burned-out physicians. Concierge medicine is a redesign.
The basic model
Concierge medicine is straightforward: patients pay an annual membership fee, and in return their physician maintains a much smaller panel of patients. That is the whole mechanism. Everything else follows from it.
In a typical primary care practice, a physician manages 2,000 to 3,000 patients. This is not because anyone thinks it is a good idea. It is a consequence of insurance reimbursement math. When each office visit pays $80 to $150, a practice needs the doctor to see 20 to 30 patients a day just to keep the lights on, and since hospital systems live on downstream revenue, the more patients a doctor touches, the more profitable they are to the institution. The result is 7-minute appointments, where your doctor is simultaneously listening to you, documenting your visit, thinking about the patient in the next room, and carefully avoiding asking open-ended questions.
A concierge practice flips the economics. Membership fees replace volume-driven billing, which makes a panel of a couple hundred patients sustainable. That single change produces a cascade of downstream effects: appointments that last 30 to 60 minutes, longer if needed, same-day availability, a physician who actually knows your medical history and your life, and perhaps most importantly, a physician who has the time to think carefully about your problems rather than reach for the quickest answer.
How it differs from related models
The terminology in this space is confusing, so let me clarify.
Direct primary care (DPC) is a related model where patients pay a low monthly fee, usually $50 to $200, and the practice does not bill insurance at all. DPC practices tend to serve a broader patient population at a lower price point, but they may not offer the same attention to detail, depth of specialist coordination or the same level of physician availability outside business hours. DPC is doing important work expanding access to relationship-based care, and I am glad it exists.
Boutique medicine is a marketing term. It has no clinical definition. Some excellent practices use it; some mediocre ones do too.
The variable that actually matters across all of these models is panel size: how many patients each physician serves. A practice that calls itself "concierge" but has a panel of 1,000 per physician is a fundamentally different product than one with 200. If you are evaluating practices, ask the question directly. The answer tells you more than anything on the website. One caveat: too small a panel and a physician's skills get stale, so under 100 patients per physician is probably too few.
What the relationship actually looks like
The part of concierge medicine that is hardest to explain to someone who has not experienced it is how much the continuity changes the care itself.
When I have seen a patient through a back injury, a cancer scare, a medication change that caused unexpected side effects, and a period of heavy work stress, I am not starting from scratch at each visit. I know what their baseline looks like. I know how they describe pain (some people say "it's fine" when it clearly isn't). I know which specialists they have worked with and what those specialists found. I know what they are worried about, even when they have not said it yet.
That accumulated knowledge is not a luxury. It is diagnostic information. A physician who knows you well will catch things that a physician meeting you for the first time cannot, no matter how smart or well-trained they are. The relationship itself is a clinical tool.
The other piece that gets overlooked is care coordination. In conventional primary care, when you need a specialist, you are often handed a list and wished good luck. In our practice, we make the referral, we communicate directly with the specialist before and after, and we make sure the overall plan stays coherent. For patients managing multiple conditions or seeing several specialists, this coordination is often the most valuable thing we do.
There is also a technology dimension that rarely gets discussed. Physicians inside large health systems are locked into whatever software and infrastructure the institution chose, often years ago, often for reasons that had nothing to do with patient care. An independent concierge practice can build its own technology stack from scratch, optimized for how the physicians actually work and how patients actually want to communicate. In our case, that means secure messaging that gets answered the same day, telemedicine visits for patients who are traveling or who simply do not need to come in, integration with wearable and tracking data when it is clinically useful, and AI tools that handle administrative work so the clinical team can focus on clinical thinking. Technology should make the doctor-patient relationship closer, not insert itself between you and your physician. That is easier to get right when you control the system.
Common misconceptions
"It is just paying more for the same thing." The care is structurally different, not cosmetically different. A 45-minute visit with a physician who knows your history is not the same product as a 7-minute visit with a physician who is reading your chart for the first time.
"It replaces emergency care." Your concierge physician is your primary care doctor, not your emergency room. A genuine emergency still warrants 911. What changes is that your doctor responds immediately, can talk directly with the emergency department team, coordinates your care during a hospitalization, and makes sure nothing falls through the cracks during transitions.
Who tends to get the most out of it
Over the years, I have noticed a few patterns in the patients who find concierge care most valuable.
People managing complex medical situations, multiple specialists, overlapping medications, or a diagnosis that does not fit neatly into one specialty, often find the biggest benefit. They need someone whose job is to see the whole picture, not just one organ system.
Busy professionals who cannot afford to spend half a day navigating a phone tree for a 7-minute visit tend to value the efficiency and direct communication.
People who think of their health proactively, who want a physician they can bring questions to about prevention, exercise, nutrition, sleep, or emerging research, while still having an expert team at the ready when a new medical situation does emerge.
And some patients simply value privacy and discretion. A small, physician-owned practice handles sensitive information differently than a large institutional system with hundreds of employees and rotating staff.
What to look for when evaluating a practice
If you are considering this model, a few questions will tell you most of what you need to know:
How many patients does each physician serve? This is the single most important question. The number should be in the low hundreds, not the thousands.
Is the practice physician-owned or corporate-owned? An independent practice makes clinical decisions without institutional pressure on referral patterns. When we recommend a specialist, we are choosing the best person for the problem, not someone who happens to work for the same health system.
What happens when you need a specialist? Does the practice coordinate the referral and communicate directly with the specialist? Or do they hand you a name and leave you to sort it out?
What is the after-hours model? Speaking directly with your physician is meaningfully different from reaching a call center.
Does the practice engage with your health between visits? Some practices are reactive, waiting for you to schedule. Others monitor lab trends, follow up on medication changes, and reach out proactively. The difference matters, especially for patients managing ongoing conditions.
Does the practice have hospital relationships? This is uncommon but provides important continuity. We maintain clinical relationships across UCSF, Stanford, and Sutter/CPMC, so when a patient is hospitalized, we can stay involved in their care regardless of where they are admitted.
Why independence matters
One factor that deserves more attention: whether a practice is independent or affiliated with a hospital system. This is not just a business structure question. It directly affects clinical decision-making.
An independent practice has no institutional obligation to refer within a particular network. We can send a patient to the best cardiologist for their specific problem, whether that person is at UCSF, Stanford, in private practice, or at the Mayo Clinic. A practice owned by or affiliated with a health system faces pressure, sometimes subtle and sometimes not, to keep referrals within their own institution, even if that's not necessarily optimal for the patient.
We are physician-owned and fully independent. That independence is not incidental to how we practice concierge medicine in San Francisco. It is the foundation of it. When you pay your physician directly, your physician works for you. That is a simpler and more honest arrangement than the one most of American healthcare operates under.
Paul Abramson, MD is the founder of My Doctor Medical Group, a concierge medical practice in San Francisco. He trained as an engineer at Stanford before completing medical school at UCSF. More at mydoctorsf.com.
