Cash-Only Practices: 8 Issues to Consider

Neil Chesanow


May 15, 2014

In This Article

An Increasingly Growing Movement?

It's easy to get the impression that many doctors, fed up with traditional medicine, are about to switch to concierge medicine and direct primary care.

For example, a 2012 survey of some 14,000 physicians by Merritt Hawkins found that nearly 7% of practice owners planned to switch to a concierge practice in the next 1-3 years.[1]

According to the Association of American Medical Colleges, there were 817,850 active physicians in the United States in 2012, the latest year for which statistics are available.[2] How many of these doctors are in concierge or direct primary care practices?

"We believe -- and this is after years of verifying doctors, talking with actual doctors, talking with business leaders, and talking with physicians who are influencers -- that there are slightly less than 4000 physicians who are verifiably, actively practicing concierge medicine or direct primary care across the United States, with probably another 8000 practicing under the radar," Michael Tetreault estimates.

Matthew Priddy, whose organization includes physicians in both groups, figures that there are about 5000 concierge and direct primary care physicians nationwide. But he also believes that a sizable number of concierge and direct primary care physicians don't want to draw attention to themselves and keep a low profile.

Right now, far more traditional doctors are telling surveyors that they plan to switch than actually appear to be doing it.

How Hard Is the Transition From Your Regular Practice?

"I'm getting ready to transition to cash only," one family doctor comments. "It's not that difficult. The insurance companies want us to think it is, so that they can make all the money and we stay broke."

This is a common theme among doctors who have made the switch and then write motivational essays for other doctors on how to succeed: Transitioning to and running a concierge or direct primary care practice is not that difficult, they insist, particularly if you stop taking insurance,

"That's BS," counters Matthew Priddy, whose 5-doctor primary care practice doesn't take insurance. "We've been open for 12 years and have been very successful in Indianapolis. It's not easy."

Priddy's wife, an ob/gyn, is a hospital employee. When she's not on call, her evenings and weekends are her own. "But when you own a business, even when you're not on call, you have business meetings," Priddy points out. "There's a whole other aspect to it that I personally think is great, but if it's not your bag, it can be a bit of a drag for folks."

"Some doctors would say this is easy, especially the successful ones," he reflects. "But there are also doctors who failed, gave up, and went back and worked for hospitals. Those folks are out there too, and they would probably tell you that it's impossible. It can be a little bit of a selection bias when you talk to the doctors who are oft-quoted in the media or who are involved in national organizations. But that is more the exception than the norm."


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