I am 3.5 years into DPC and am here to say that the critics might be right, DPC and Concierge is the same.
Author: Sarah Zaheer, MD
It is safe to say that many DPC docs are noticeably clear that they are not concierge physicians. While there is no standard definition of concierge medicine, the general perception seem to be:
· Concierge physicians are expensive
· Concierge physicians often also bill insurance
· Concierge physicians do not serve the masses
· Concierge physicians are not solving the healthcare crisis
· Concierge physicians are for the wealthy.
· Concierge physicians cater to patients whims and demands
· Concierge physicians are available 24/7 for patients
Direct Primary Care on the other hand is affordable, reaches people of all socioeconomic groups and does not work with insurance at all. The model is about providing primary care in a way that makes sense for patients and doctors alike and the antidote for our broken healthcare system.
From my personal experience, for many patients, concierge medicine seems to be a term applied to any physician who charges more than just their insurance. If there is an out-of-pocket payment (never mind that the amount is lower than their co-pay and total visit costs) it is concierge medicine. They do not see it as revolutionary, and don’t right away get that the model reduces overall costs. They may see it as elitist, but they certainly recognize it as a solution for their individual needs. They seek this type of care often out of desperation, because their needs are not being met elsewhere.
When I started my practice, I excitedly talked about the revolutionary direct primary care model any chance I got. Many would quickly respond with, “Oh, you mean a concierge practice.” So much so, that I reaLized that even patients who enrolled in my practice also considered it to be concierge practice. I have been very transparent about what I offer and what I do not, what my boundaries are and have received no push back, despite being labeled concierge. This kept on happening and I realized that if everyone wants to label what I considered common sense primary care as concierge, I needed to rethink my definition of concierge medicine.
Once, while working with a marketing expert and fine tuning my brand strategy, I explained how I am different from concierge medicine. I explained my frustration with the concierge medicine label and desire for the direct primary care terminology to stick. She was familiar with concierge medicine but quickly got my point and hopped on the DPC hype bandwagon. She went on to say that the first thing that came to her mind with the term concierge was a hotel concierge, and for a doctor that term did not make sense. This gave me hope that I was on the right track.
Several years later, the term concierge physician continues to stick with me. Despite the fact that I have never identified as being so, or even dared to say I am “concierge-like” as is common in the DPC community. I visibly cringe when anyone refers to my micropractice as a concierge practice and rush to explain why that term does not fit. Still, in my community, I am considered to be a concierge doctor. Direct Primary Care and Concierge primary care are synonymous here.
Over the years, I have also realized that not everyone has the negative, elitist connotations with this term that exist in my mind. And for those who do have those ideas, I can explain the affordability of DPC till I am blue- they will not see how the differences between Direct Primary care and Concierge Medicine are meaningful. Important to note, a lot of well meaning doctors fall into this category. They worry that deserving patients will be left behind and only wealthy will get quality care, as the Direct Primary Care movement continues to gain traction with patients and physicians.
I can acknowledge the similarities they see between the two. Direct Primary Care improves access for a fee, just like concierge medicine. You have a better relationship with your doctor, just like in concierge. I get it. The term concierge medicine has existed for longer and is familiar. We have had several well respected concierge primary care doctors in our community who have been practicing for 20+ years. Interestingly, they also do not call themselves concierge, instead will use the label “retainer- based.” A few of them even show up on the DPC Mapper. I was surprised to learn that some of them are not available for common after-hours urgent concerns. Some of these doctors choose to not offer text or portal message services. Many do not even keep electronic charts but are still considered concierge.
What is even more telling, is that patients who consider me a concierge physician do not have any unrealistic expectations. They are the nicest, very mindful of my time type of folks I have ever met. They truly understand how it works. I have wonderful conversations with them before deciding on a treatment plan. I feel “less” pressure to prescribe because we can talk things through, continuity is guaranteed and there is no rush. They respect business hours and my expertise, and I get to practice comprehensive primary care. All of this sounds and feels like DPC.
All of this leads me to think that the concierge medicine label is here to stay, I cannot shake it off. Secondly, instead of rebranding or promoting DPC to come across as “concierge-like” to gain momentum, concierge medicine needs rebranding. We need to rethink our ideas of what is elitist and what is a basic right. Being treated as a whole person, with dignity and respect is a basic right of every patient and is not elitist. As doctors, we treat all patients with all our expertise based on medical necessity, not financial status. If we are considered concierge physicians, we are still following the same ethical and moral codes that medicine demands of us. If some of us have higher prices, which reflect the cost of living in that area, or the number of maximum patients we aim to care for- it does not mean that we are offering a luxury brand version of primary care. Primary care is still Primary care and the guidelines that we follow are the same. I recommend the same screenings to everyone and advise everyone against the same wellness scams. Rather than restricting certain services for those who have disposable income, I work on getting the same services at lower costs to make them accessible to all. Not working with insurance frees me to show up for patients in a more effective way but it is still the same medicine that I practice. This model allows me to follow the standard of care and all that is expected of primary care so much better. They are no tiers to good primary care. They may be tiers to certain services, but we are not going to treat medical conditions differently just because of the label “concierge”.
I know many do not agree with me. In all fairness, I am still working hard on controlling my facial expressions when anyone refers to me as concierge. I have stopped correcting folks in the moment, but my face still gives it all away. My views on this are still evolving but I want to emphasize that some of the things that are considered “concierge” such as seeing a patient the same day (when they are in need) vs making them wait three or four long painful weeks, is not a luxury version- it is basic primary care. That is the whole point of primary care. Spending time to listen to the patient’s concern in an empathetic manner is basic primary care, is not a “concierge” level of health care. Working with patients on taking charge of their lifestyle and focusing on preventative healthcare is not concierge medicine- that is basic primary care. Perhaps what is considered standard primary care and not concierge, needs to be re-labeled and called out more for what it is – Dysfunctional Care. I do not want to put down the amazing doctors who practice primary care in insurance based setups, but I know all of them are realizing that they are in a “the math ain’t mathing” type of set up. You cannot do what primary care demands of you in 15 minute appointments, with no guaranteed continuity and no established rapport with the patient. We know this and so do patients. Let’s face it, insisting that this bare bones version is real primary care might be further eroding patient’s trust in the healthcare system. And then we wonder, why patients are getting healthcare advice from wellness influencers, and not their trusted expert PCP who would know them well. The reality is that they never get to see their non concierge PCP, who despite their best efforts does not inspire trust compared to a wellness influencer who gets more air time.
A lot more can be said on this, but let me conclude this with:
To, the well meaning doctors in traditional set ups who are opposing DPC on the grounds that it is concierge care in disguise, I say even if that is so, let’s admit that it is still a more ethical and compassionate version of primary care. It is real primary care. Patients can see that and that is reflected by the continued growth of the DPC model nationwide. To DPC docs like myself, who do not accept DPC and concierge to be the same thing I say, it’s time to stop demonizing the label concierge physician and continue focusing on common sense, comprehensive primary care that our community needs.
Ahhhh….. Do what you have to do to survive with your sanity. Did a 5.5 year residency in a roundabout fashion and did geriatrics because old folks liked me after I got out to practice in a rural area. It was in an area close to my wife’s mother and I and my parents were fine with that. Not too far to travel to visit my folks back in the day. Had a nice family life with my lovely wife. I didn’t expect to live so long and all my close family members including my younger wife, excepting my younger sister have died off. I reflect back with nice memories. One never knows what to expect out of life but I had a good one.
Great article-well written and thought out!
Thank you!
interesting.
two things:
if concierge and direct primary care are the same, then why are concierge doctors rebranding themselves as direct primary care? they recognize the difference and want to adapt the definition to fit their practices. we should not let them. just because the lay person doesnt understand doesnt mean we stop educating them. very much like we educate that there is a difference between a doctor who is a physician, and a doctor who is not.
thing 2, there will be a day i believe when there will be so many docs doing direct primary care that we will no longer have to call it direct primary care. it will just be how primary care is done. someone will say they are going to their primary care doc and everyone will know that they are going to a direct primary care doctor, because that’s just what it is.
It’s back to the future
I agree with what your are saying, espectially the second point. I am coming to the realization that from a patient perspective the terms don’t matter as much. Also, my experience is limited to my community only and a lot of the doctors who are considered “concierge” are
actualy direct care and are doing it for the same reasons anyone is doing DPC- to be able to pratice primary care the way it is intended. Knowing that helps me understand why my practice is considered concierge in my comunity.
I love this article. I have often had many of the same thoughts since I started my DPC practice. Just today I was telling an undergrad student shadower that primary care simply cannot be delivered well in 15 minutes. It just can’t.
I also do not feel pressure to cave to every patient’s whim. I have found that having the time to explain my stance (for or against) the request makes all the difference.
I don’t have any answer to the “concierge” vs. “DPC” naming problem. I find it to be very funny though that one of my patients who has been with me for more than 2 years still refers to me as their “concierge doctor.” I just roll with it now 🙂
Concierge vs. DPC? If there is not enough potential patients in a geographical area a doc wants to locate to that can afford it, best to located elsewhere. I don’t think there’s much difference between the two except, “concierge” might demand to be paid more and if they can get it, good for them! It’s a naming difference that’s irrelevant in my book. Although it might mean if I was a “concierge” doc, a patient could roust me out of bed to their home on a moments notice for care, in my book they’d have to pay me royally for that privilege. (I’m retired so doesn’t meany anything for me.)