Defining and Understanding “Boutique Medicine”

What it is – How it Works


By Dr. David Edward Marcinko MBA

According to colleague Robert James Cimasi of Health Capital Consultants LLC in St. Louis MO, concierge or boutique medical practices began in the mid-1970s, and are now in many major metropolitan areas. Concierge medicine is described as a “return to old-fashioned medicine,” where physicians limit their client base and devote more time to each patient. Patients can usually get in to see their physician within a day, and most have 24-hour access to their physician by beeper or cell phone.

The Doctor’s Perspective

Physicians who turn to concierge medicine are typically tired of not having enough time with their patients and dealing with overbooked caseloads, and are looking for a way of balancing their lives while still providing quality care for their patients. Patients who have physicians in this type of practice appreciate the “perks” they get for paying a yearly fee — similar to “annual membership dues.” These fees can range anywhere from $1,000 per year to $10,000 per year depending on the patient’s age, benefits received, area of the country, and practice.

Patient Amenities

Amenities vary by practice, but some include longer physician office visits, increased access to physicians, e-mailed “newsletters” or condition-specific information, physicians accompanying patients on visits to specialists, and house calls. In order to provide more attentive care and amenities to patients, physicians often decrease their patient load to approximately 10-25% of their managed care load. Thus, most of their patients must find other physicians, leading to potential increases in the patient load of managed care physicians.

Elitist Patients

Although concierge medicine may provide many benefits for patients (including more, and in some cases, nearly unlimited access to their physicians), it has been met with some scrutiny. Some say that this type of medicine is elitist, that it is available only to wealthy patients who can pay the annual fees. Medicare beneficiaries who are members of a concierge practice have received political attention, because many politicians have said that the annual fees patients pay is a lot more than the Medicare rate and thus is illegal billing.



Critics also emphasize that healthcare needs to be first-rate for everyone, something that the current managed care system prevents. The implication that managed care means second-class medicine has also been a fear cited by critics.


However, concierge physicians portray their clients as mostly middle-income people who are willing to pay more for this kind of care. Concierge medicine is not a substitute for health insurance. Patients typically keep their traditional insurance to pay for any tests or scans ordered by the physician.




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7 Responses

  1. Transfusion LLC – is another company in the business of converting practices to concierge medicine. Hopefully they realize that MD-VIP’s $500 per patient per year “franchise fee” is, to put it nicely, not really worth it. What do all ME-P readers, think?



  2. Here is an interesting link on concierge medicine and the current recession.


    Kevin Pho; MD


  3. The tremendous increase in the number of physicians opting for the CM model – 5,000 doctors by some estimates – is a testament to the decreasing satisfaction these doctors have with the current healthcare system.

    A concierge doctor regains the ability to practice medicine at a pace comfortable for both the patient and the doctor, to spend extra time emphasizing wellness and preventive care, and to take managed care and government intrusion out of the decision-making process.

    In my experience, the main factor driving this decision for most physicians is not increased compensation, but the hope of regaining control of their medical practice.

    Brian J. Knabe; MD CFP CMP


  4. The Micro Concierge Medical Practice

    Dr. Tomas X. Lee, an MBA from Stanford University, approached venture capitalists from the firm Benchmark Capital who invested several million dollars in a new type of concierge medical practice for the masses.

    Called One Medical Group, it represents a new model for primary care that aims to set a nationwide example. With 31 physicians in San Francisco and New York, it offers most of the same services provided by personalized “concierge” medical practices, but at a much lower price: $150 to $200 a year.

    One Medical Group doctors see at most 16 patients a day; the nationwide average for primary-care physicians is 25. They welcome e-mail communication with patients, for no extra charge. Same-day appointments are routine.

    And unlike most concierge practices, One Medical accepts a variety of insurance plans, including Medicare.

    Your thoughts are appreciated.

    Dr. David Edward Marcinko MBA


  5. Why concierge and direct pay medicine is not unethical?

    Dr. David Edward Marcinko MBA


  6. “Monthly Retainer” Practices Growing

    Family physician Steven Butdorf of Eugene, Ore., was tired of rushing patients through appointments, tired of insurers denying procedures, and tired of paperwork.

    So, according to this article, on Feb. 1st, Butdorf opened Exceptional Health Care, which lets patients pay a set monthly fee in return for specific health care services – leaving out insurance companies altogether.



  7. Concierge Medicine for Everyone Else

    Move over concierge medicine; here comes “direct primary care.”

    The idea is that routine, mundane primary care should not require expensive insurance and can be cheaper without it. Direct primary care practices charge $50 to $60 a month for adults, with lower fees for children.

    Depending on the practice, the monthly fee also may cover certain lab tests, basic X-rays and stitches for cuts.



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