Cash-Only Practices: 8 Issues to Consider

Neil Chesanow


May 15, 2014

In This Article

Can Any Doctor Do This?

Starting a concierge or direct patient care practice is tougher than it may seem. One concierge marketing consultant told Medscape that her firm rejects two thirds of the doctors who seek help with a transition. Why? Their traditional practices are not sufficiently established to make a move that's likely to be successful.

This consultant asks doctors 2 key questions: How long have you been in practice in your current location, and how many patients have you seen in the past 2 years? Doctors who have been in practice in the same community for a minimum of 8 years, but preferably 10 years or longer, are good risks. If the doctor is a primary care physician, seeing about 1600 patients over a 2-year period is also desirable.

A doctor's interpersonal skills are also crucial to success.

"The doctors whom I've seen who have done poorly didn't have the 'love factor' with their patients," says Matthew Priddy. "Their patients wouldn't drive across town to see them. With primary care, so much of what you're selling is that relationship with the patient -- that comfort they have in knowing you. In my experience in hiring physicians for my practice, in cases where it hasn't worked out, it wasn't because they were bad doctors. It was because their personalities just didn't jibe well with patients."

A concierge marketing consultant described a traditional physician who was planning to convert to a concierge practice but hadn't yet informed his patients. Patients who had seen him only a few days before were baffled to receive a flyer in the mail making the announcement. "Why didn't Dr. Smith tell me about this when I was in the office?" they wanted to know. They were miffed.

Are Concierge Patients Extra-Demanding?

Most concierge and some direct primary care practices promise patients 24/7 cell phone access to their physicians. Is it tantamount to being on call 24/7 as a lifestyle?

"The question I'm most often asked in regard to patients is: Does private medicine attract the type of needy patients who feel like they're paying money so they can boss you around?" says Matthew Priddy. "Will they call me in the middle of the night because they have a hangnail? Do they demand that you do unreasonable things, like get them an MRI in 5 minutes?"

The answer, he says, is generally no.

In fact, this was Priddy's biggest fear before he made the transition: that patients who paid a fee to be a member of the practice would act like prima donnas. "I didn't want to be someone's butler," he says. "I was worried that there would be a sense of entitlement among our patients -- that we're paying you X amount of money a year, and if I want that antibiotic, you're going to give it to me. And if I want those pain meds, you're going to write those scripts for me. Or I'll quit.

"We absolutely have people who sign up with that attitude, and we tell them they can quit," he says. "I'm not going to write you a script for Vicodin® just because you write me a check. That's not how it works."

But demanding patients have been the exception, not the rule. "Ninety-five percent of our patients are fantastic," Priddy says. "Five percent aren't. That's just life."


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