Common Misconceptions About Membership-Based Medicine: A Physician’s Perspective
Mythbusting and Level-Setting the Realities of Concierge Practice
As membership-based, concierge models of primary care grow around the country, a growing number of physicians are considering making the switch. As with any venture into the unknown, these doctors often face a number of questions about the nature of practicing medicine in a non-traditional model. On a recent episode of the ROAMD podcast, Dr. Scott Pope sits down with Dr. Jordan Lipton to clarify some of the common misconceptions that he has seen in recruiting physicians over the better part of the last two decades of concierge practice.
As a founding physician & partner at Signature Healthcare in Charlotte, North Carolina, Dr. Lipton has addressed questions, busted myths, and dispelled stereotypes. Signature Healthcare started with two physicians and has grown to a team of seven full time doctors, and they are bringing on their eighth and ninth members later this year.
He shared the single most common question and offers his perspective: “Will patients call at all hours? This might have been true 18 years ago when this was a new concept, however, we’ve found that over the last few years, it may just be that we’ve trained our patients well, but with seven doctors, on an average night on call…I might get one or two phone calls, usually it’s before 7pm, and usually it’s because they went to the pharmacy and their prescription wasn’t there, or they flew to NY and they forgot to bring their prescriptions with them. So, nothing onerous. “
He describes the great work-life balance that has come with a growing team: “Especially now with seven doctors, especially because we’re not all on call for emergencies all the time, and even the people on call are only getting one to two calls a night…I would hazard to guess that our after hours work in the office is far less than what a typical RVU-based or employed physician just to get their documentation done.”
Relationship-Based Medicine: How frequent is communication?
The notion that concierge doctors are dealing with patient requests 24/7 is understandable for those coming from traditional models. However, Dr. Lipton is quick to allay those concerns: “I would say that out of my panel of patients, at least 50% have my cell phone, and at least 75% have my email. But I do let them know, when I’m meeting a patient for the first time…if it’s truly an emergency, don’t rely on a non-emergent form of communication like text and email – call the office, because another physician will speak to them.”
He describes how he’s been able to work seamlessly with other physicians to triage patient requests and coordinate care and patient questions through simple text messages with his colleagues, even while he’s been traveling or on vacation. When asked whether the Covid-19 pandemic has changed that dynamic, he says, “Yes and no – it’s interesting because people are traveling less, we’ve had fewer phone calls after hours…on the other hand we’re getting more questions about covid-testing in particular, about contact tracing and exposures.”
Another common misconception is that concierge practices don’t have adequate documentation practices in place. Dr. Lipton has a unique perspective on this, because Signature Healthcare does accept insurance for some of its patients: “We document what is necessary to provide great care, we don’t document just to meet insurance requirements. If we spend an hour with the patient, we won’t necessarily document…just to be able to bill more. Because just because our patients have insurance, it still ends up coming out of their pocket, as a copay, or in order to meet their deductible. They’re already paying us a membership fee every year, we don’t feel like we need to nickel and dime them for insurance.”
Inappropriate Care and “Demanding Patients”
One of the most common concerns Dr. Lipton has encountered involves patients who overreach their boundaries and make inappropriate requests. “There are exceptions to every rule, but we’ve found that with our patient panel of 1700 patients, our patients are very reasonable. If we say there’s no evidence based medicine to support [requested treatment or prescription], as long as we spend the time to educate them, they’re not going to bother us.”
He clarifies that this still tends to happen “probably once a year,” and in those circumstances, he and his colleagues have told the patients they will refer or introduce them to alternative providers who might be willing to accede to those requests. But more often than not, he insists that communication can help patients, offering the example of having to explain to some patients that there are adverse effects of getting unnecessary CT scans.
The Myth of Elitism: On ‘sacrificing’ philanthropic care
Another common question in concierge care is whether this style of practice will translate to serving only wealthy, privileged patients. Dr. Lipton has a thorough, nuanced perspective on this issue, developed over the course of his 18 years of building a concierge practice. First, he level-sets with the big picture: “It’s better to join a concierge practice and not burn out, than it is to burn out and then all your patients have no doctor.”
He insists that their patient panel is not just comprised of wealthy patients, pointing out that many of their members do use insurance to help afford care. He adds: “We have a policy in our practice: If you have a patient that can’t afford the services, but you feel they would benefit from it, then we’ll take what they can afford…we’ll take them on, either for a discounted rate, or for free.”
Dr. Lipton also points out that with the extra flexibility that comes from a smaller panel, the doctors in his practice are able to volunteer regularly to provide pro-bono care at a local community clinic: “We have always been very philanthropic in terms of our time, and our funds as well. We have seven physicians, and five of us volunteer on a regular basis at a local free clinic. Even though there are about 40-50 physicians who volunteer there, we are the only ones who are there every week. Somebody from Signature Healthcare is always showing up about once a month.”
Dr. Lipton ends the discussion by pointing to some of the global interest in concierge medicine, even though it may go by different names in different countries. He points to a few members residing in Canada and in the UK, and mentions that he has explored the emergence of private, on-demand medical care models through the Middle East, Western Europe, and Japan.
With such growing interest, he says with a laugh that he can’t wait for international travel to open back up again. There’s no doubt that everyone is looking forward to a post-pandemic future, one where traveling with loved ones or for business can be done while staying a quick phone call or text message away from medical care as needed.
To learn more about the realities of operating in a concierge practice, including tips on how to get started, feel free to visit ROAMD online. And make sure to check out our other episodes too.
Dr. Jordan Lipton is a board-certified emergency and ambulatory medicine physician who co-founded Signature Healthcare in 2003. He studied zoology at the University of Toronto before earning his medical degree from McGill University, Montréal, Canada. He completed his residency at Carolinas Medical Center.
Dr. Lipton serves as the Medical Advisory Board director and a volunteer at the HeartBright Foundation, a healthcare charity in Charlotte, North Carolina, and is a member of the Physician’s Advisory Council of ROAMD. In addition to lecturing internationally, he has contributed to numerous medical journals and textbooks.
-02.svg)