You may have noticed or not that several family physicians (PCPs) have left the medical practice you rely on. More than a few in the greater Portland area have left in the last few years. As a physical therapist, when I send my patient evaluation to their PCP, I often discover that their doctor is no longer at the practice. Some have retired, particularly since Covid, but many have moved to other medical practices in greater Portland. Often the move has to do with salary and benefits. PCP salaries are low in comparison to the cost of educating a doctor, which can be more than $400,000 just for medical school education. We also know there is pressure on every provider in our healthcare system to see as many patients as possible, leading to a high rate of burn-out among PCPs and other providers.

Other PCP doctors have moved into concierge service, where there are two main players: Direct Primary Care (DPC) and MDVIP. Both of these national organizations have been around for 25 years and are growing in popularity. They act as the business support for a practice. Both require a patient to pay a subscription to the doctor. It can be either a monthly or yearly fee. The cost can be $100 to $120 per month depending on age and demographics. The patient still needs to carry insurance coverage in case of significant testing, procedures and treatment.

PCPs appreciate this model as it gives them more autonomy within their practice and more time with their patients. Outside concierge services, a PCP in the larger medical systems in this area can have between 1200 and 1400 patients under their care, too many to be easily managed and the reason why a patient may see a PA or nurse practitioner as the first step in their care. Patients often object to the lack of continuity of care this model provides.
On the other hand, a DPC or MDVIP doctor needs only about 400 patients to sustain their practice and make a good wage on the monthly fees. Even though some of the money goes to the business entity for support and overhead, the doctor still makes a better salary.

Unfortunately, there is a dearth of PCP doctors both regionally and nationally, which makes access to healthcare challenging, particularly in rural areas.
We cannot begrudge a medical doctor for making a better living with less stress. The issue is that access becomes more difficult for the individual who cannot afford the better access to a medical provider. The concierge model continues to perpetuate the reality that money buys you better healthcare.

I have talked with several docs and their reason for choosing the concierge model makes perfect sense. They want to provide better care to their patients and spend more time evaluating the patients and make more money while continuing to do what they love to do. Many have explained that they feel that they can provide approximately 90% of what their patients need on a yearly basis, including proper bloodwork and medications, and they are on call for the consumer.

Healthcare is expensive and there are many factors contributing to the costs, especially the battle between insurance companies and the large medical establishments. When patients want to discuss their frustration with healthcare, my response is often, “Don’t forget that healthcare is a business,” and consumers are sometimes caught in the middle.
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