An Insider’s Perspective on Running a Membership Medical Practice

When it comes to starting a new business, there’s no teacher better than experience. But in the highly complex field of medicine, there’s not much room for error. So how does a physician get started with a membership medical practice?

Dr. Vivek Sinha offers his expert perspective in a recent episode of the ROAMD podcast. Speaking with Dr. Scott Pope, Dr. Sinha shares his thoughts on tactical decisions such as pricing schema, as well as strategic considerations, such as where to seek help and research your business model before launching your own membership-based medical practice.

Dr. Sinha, founder and medical director of Belleview Medical Partners in Alexandria, Virginia, is a board-certified family medicine practitioner. He has been practicing in this membership-based model for the last seven years. Originally trained in Chicago, he and his wife, who is also a physician, moved to Virginia and joined a large provider system. About five years in, he started realizing that seeing 25 patients a day wasn’t the kind of medicine he wanted to practice. 

Speaking about his transition into the world of DPC and membership medical practices, he says, “I kind of backed into this style of medicine. I thought, ‘What would my ideal patient encounter be like?’…and then I backed into it. I said, ‘How do I replicate it, How do I make it sustainable, and then how do I make it scalable?’ And through that journey, I came upon concierge and DPC medicine, which lead me to ROAMD, and I haven’t looked back since.”

Dr. Sinha explains that the style of the patient visit was the largest consideration for him. He describes how he didn’t want to worry about being reimbursed when it came to spending time talking to patients on the phone or conducting a house visit. But, he doesn’t fault doctors who choose to stay in an FFS practice; he points instead to the broader systemic issues.

“It’s the system. I am an optimistic glass-half-full guy. I like to believe that the majority of us are there because we’re truly altruistic and want to help people…that’s what gets us out of bed in the morning. The problem is that the system is difficult, and you have to actively navigate it to do right by your patient. And after some time, that can get fairly exhausting. That’s why a lot of physicians are looking for alternate means to provide the care they want to provide.” Membership medical practices provide this alternative.

On Becoming an Entrepreneur

Dr. Sinha offers an enthusiastic, candid round of advice for anyone who might be thinking about embarking upon their own journey into membership-based medicine. “One of the reasons I left my practice is because I had patients saying ‘Listen, we like you, but we don’t like everything that surrounds you.’…and that’s when I realized that if I want to provide good care in the room, I have to start providing care outside of the room. The biggest paradigm shift I had was valuing what we do, and frankly, putting a dollar value on it, a number on it. You can be the most helpful fantastic physician, but you can’t keep the lights on and pay the rent, not only are you going to suffer, your patients are going to suffer as well.”

He says the shift to becoming an entrepreneur and business owner was difficult and took some getting used to. Once he started reframing his work, for example, telling a patient to take cholesterol medication, as sales – selling the value of taking that medicine – he began to see his work and the value he was providing in a broader lens. 

“I think physicians tend to undervalue the service we provide. When I went to med school and did residency, there wasn’t a tremendous amount of practice management. There was some billing courses that we took, but your goal really is on what happens after that examination room door closes, and that’s what you focus on. You don’t focus on what their copay is, how you’re reimbursed for your time, you’re focusing on what the patient needs, and that’s what you’re there for. It’s a very big paradigm shift when you are responsible for everything behind the door [as well as] everything outside of it.”

On Arriving at a Pricing Model

With so many options for pricing a DPC or concierge membership model of medical care, where should a new entrant get started with their practice? Dr. Sinha is clear that the process for him was one of trial and error: “I’d love to show you the secret sauce and say ‘This is the mathematical formula I came up with.’  I researched concierge medicine for about three years before I pulled the trigger. During those three years, I called every single doctor across the country that I could find…I asked them about their price point, the one thing I realized was that the price point was very different, just like the cost of living is very different, depending on where you are.”

“That’s the first step: Being self-aware of where your practice is set up. Number two – is figuring out what is your suite of services…There are a lot of different ways to price your membership structure. They’re all okay, but you have to find what works for you…We chose two tiers: One is office-based medicine, and the other is house call-based medicine. His first year these were the same price, which he realized was a mistake early on, and course-corrected the next year. Some levels of tiers are important.”

One physician he spoke with urged him to keep his ‘elevator pitch’ simple, succinct, and logical. Dr. Sinha adds that transparency is important – in his case, in the form of open information on his membership medical practice’s website. Ultimately, he chose his pricing menu based on the style of medicine that was most important to him, and the type of patient visits that he enjoyed – for example, a focus on the pediatric end of family medicine, more so than eldercare. 

Mentorship, Advice, and Expert Help

When it comes to getting ready to launch a membership medical practice, Dr. Sinha is unequivocal in his advocacy to seek counsel from those who have done it before. “ROAMD is a fantastic resource. When I speak to any physician in the ROAMD network, I know that they’ve gone through and are struggling with the same things that I’ve gone through and am struggling with. That camaraderie is excellent. Having said that, people are different levels of the path – which is what makes it so good.”

In addition to other doctors, he describes that one of his key business partners was his best friend growing up, who happens to be an attorney. This provided someone to help set up a corporate structure, as well as bounce new business ideas off of. Dr. Sinha also points out that his wife has served as an invaluable thought partner, both as a fellow physician and as a business leader at the clinic where she works. 

Beyond that, he mentions there were a “tremendous amount of experts that we did talk to.” This includes contracting with a law firm for help with regulatory strategy, as well as a marketing firm for help launching the brand in the clinic’s early days. Ultimately, he advises others to speak to a wide array of experts, and make your own decisions based on what will work best for your own membership-based medical practice. “If you can’t be authentic, if you are doing something an expert is telling you to do, but it’s not in an authentic manner, people will see through that, especially in a field as critical as healthcare.”

In closing, he underscores that his business and his patients are a very important part of his life and that he makes sure that his family, including his wife and children, know about it, and talk about it. He encourages other physicians to keep communication open with their family members, colleagues, and mentors. “I would say, if you’re happy doing what you’re doing, that’s great. If you’re interested in making a change, then the regret of not making that change, I imagine that would be very, very high…I would encourage anybody to reach out, talk to as many people as you can, and talk to ROAMD.”

Interested in getting in touch? Visit us online for more information about the ROAMD network. And make sure to check out other episodes of our podcast to plug into other conversations with physicians who have set out on their own journey to building a membership-based medical practice.