Innovative medical screening and assessment tools continue to become available as technology advances at a very fast pace.

At Private Medical, we’ve found it helpful and challenging to stay on top of all the new technological innovations. Our dedicated team of eight physicians and nurses serve on our Innovation Council to diligence each new product/service. If they pass scientific muster and are useful to doctors or patients, we send them to our clinical tools team for workflow integration.

Today, I’ll share some recent and up-and-coming innovations we’ve researched so you can evaluate whether they might be helpful to your patients as well.

How We Use Screening and Assessment Tools

As physicians in the concierge space, part of the value we bring to our patients is the desire and ability to sit and listen to them.

In my practice, rather than having blanket testing for everyone, we consider each individual, along with their goals, concerns, and states of health. Together, we determine the best path forward and which medical screening and assessment tools to prioritize.

People want different things when it comes to the medical tests that make sense for them. Many tests cost extra money, and the value has to be evaluated in the context of preference and personal concern. For example, if a patient has a family history of cancer and is anxious about it, I’ll likely recommend one of the new cancer screening tests at a reassuring frequency — but I’ll steer clear of tests with higher false positive rates.

While we don’t use every test for every patient, having a robust menu to pull from as each situation warrants has been incredibly useful.

What’s Already Available?

To start, it’s worth briefly mentioning some of the newer technologies that are already available and of which you may already be aware.

Cancer Detection

• Full-body scans
• Cell-free DNA testing
• Computerized mole mapping 
• Digital dermatoscopy

One-Time Baseline Tests

• Pulmonary function studies
• Brain function and imaging tests

Cardiovascular Testing

• Carotid intima-media thickness (CIMT) test
• Cardiac CT calcium score (also using AI)

New Screening and Assessment Tools

Now let’s get into the up-and-coming tests that are either still in the development and approval process or are relative newcomers without widespread adoption (as of now). Many of these new screening and assessment tools fall broadly into one of the following categories: blood, breath, urine, apps and wearables.

For full transparency, I want to say that as someone who believes strongly in medical innovation and works to further it, I’m aware of some of these newer tools because companies approach me for advice. That said, I truly believe every tool I mention here holds genuine potential for benefiting physician care and patient health.

Blood Tests

Proteomic Tests

Current protein testing — albumin, creatinine, BUN — typically gauge levels of a handful of proteins, but some 14,000 (or more) proteins make up the human proteome.

In the relatively new field of proteomic testing, blood tests can now detect thousands of proteins. While analyzing these thousands of proteins would be difficult for humans, proteomic tests use AI to reference existing bio-banking studies and detect known patterns and biomarkers in the bloodstream.

For example, if a patient has liver disease, their protein makeup looks a certain way. And their protein analysis looks completely different from a patient with heart disease. Proteomics can detect disease in its early stages and illuminate the body’s response to treatments and medications.

Proteomic tests are still emerging, but even in their fledgling stages, they can evaluate cardiovascular risk, VO₂ max, bone density, fatty liver, and visceral fat. Proteomic tests are, in essence, potentially capable of replacing DEXA scans, calcium scores, and VO₂ max tests, among others — all with a simple blood draw.

As technology continues to improve, it’s expected that proteomic tests will be able to assess the internal organs in even greater detail.

Metabolomic Tests

Metabolomic tests measure the body’s metabolites — the “exhaust fumes” of the body — to reverse-engineer what’s going on inside internally. Helpful for gauging what I like to call epigenetic velocity, metabolomic tests can give patients an understanding of their general inflammation and metabolic markers, or in other words, of how fast their various parts and systems are aging.

Because low-grade inflammation is a key driver in aging, metabolomic testing could open up a whole new world of information we as physicians can use to improve patient health and longevity.

Pharmacogenomic Tests

Since they measure how fast a patient metabolizes medications, pharmacogenomic testing can help our understanding of drug efficacy and interactions and influence how we prescribe medications.

These tests are at a stage I’d describe as “good but getting better.” In their current state, pharmacogenomic testing can help us choose the best blood thinner for a given patient or inform how we prescribe SSRIs for depression and anxiety.

Worth keeping an eye on; these tests are only getting more interesting with time.

Breath Tests

Owlstone Medical, a UK-based research company, studies the breath. Their device — a sort of medical breathalyzer — measures 70,000 different volatile organic compounds in the breath with the aim of early detection and precision medicine.

Similar to metabolomic tests, these breath biopsies can reverse engineer various conditions and states of health in the body. In particular, they can measure liver and gut health, and the hope is to proceed to early cancer detection, treatment response prediction, and hazardous exposure monitoring.

Urine Tests

Urine tests could become easier and more accessible for patients. Though not widespread yet, various smart toilet seats can measure the components in a person’s urine, detecting hormonal fluctuations, ketones, vitamin balance, and more. This kind of at-home testing can be especially helpful for patients with mobility issues.

Some of these technological toilet accessories aren’t yet available in the U.S., though at least one has received FDA approval.

Wearables and Apps

Several exciting wearables are already on the market, and others are coming our way.

Aktiia

This watchband-like wearable measures blood pressure whenever the wearer is still. Aktiia is already approved and being used in Europe but is not yet commercially available in the U.S. However, it is available for investigational use.

Oura

Oura has been around for about a decade, but its sleep-monitoring ring continues to improve. The ring, with its app, provides a daily sleep analysis, heart rate monitor, and health recommendations. Though not new to the market, how we interact with the product is changing.

I’m hopeful Oura will develop a physician dashboard to improve doctors’ visibility into their patient’s health data. If you’re a ROAMD physician interested in helping with this project, please get in touch via the network.

Sparta Science

Sparta Science has developed a device that measures thousands of musculoskeletal strength and health data points. The device is a force plate that people jump on and measures vital signs associated with movements, such as balance and force.

It’s also proving useful in mild traumatic brain injury measurement.

Eye-Sync

NeuroSync developed the Eye-Sync, a virtual reality wearable that measures a patient’s eye movements. It then compares the movements to the unique movement patterns associated with conditions such as concussion, sleep deprivation, ADHD, and neurodegenerative disorders. It is now FDA-cleared in the U.S. and takes about a minute to provide results.

TimeShifter

A number of apps for managing jet lag and shift work exist, but we think TimeShifter stands out from the bunch. Though not a diagnostic tool, it’s a useful health aid you might suggest to patients struggling with unusual work schedules or frequent travel.

Mixed Reality and Advanced Visualization Tools

Our patients may also receive benefits from advanced visualization tools. BrainKey, started by two Stanford scientists, offers a 3D graphic visualization of a patient’s brain based on MRI results. These can illuminate brain structure, blood vessel health, aneurysms, cysts, or anything that shouldn’t be present.

This personalized map of the brain allows physicians to see different structures and areas of patients’ brains and gives an overall sense of brain age and health. This establishes an excellent baseline of brain health and can result in patients changing their habits. Because patients have a more concrete idea of their current brain health and trends, BrainKey visualizations can improve their behaviors.

Final Thoughts on New Screening and Assessment Tools

As new and emerging blood, breath, urine, and wearable tests hit the ground, I predict we’ll discover as yet unimaginable insights into body functions and trends. Such tests can be especially effective in the concierge medicine space, where we’re positioned to listen to our patient’s needs and fully advise them with individualized care.

Because we strongly believe in staying up to date with medical innovations, my practice, Private Medical, created an Internal Innovation Council. We apply a formal process to carefully research and vet new medical screening and assessment tools and companies.

If you’ve found an innovative screening or assessment tool you’d like our team to review, I invite you to contact us via ROAMD.

• Subscribe to the Private Medical newsletter
• Contact ROAMD

When considering hiring for concierge practices, our minds often jump to medical roles: physicians, nurse practitioners, and other medical personnel. But, as you know, there’s more to membership-based practices than just their medical expertise.

One of the significant advantages of concierge medicine is the less harried, more pleasant overall experience for patients. And that experience begins long before they enter the exam room.

By the time patients see their physician, they’ve already interacted with other staff members — an experience that sets the tone for their entire visit and perhaps beyond. This is why getting the right people in those front-facing roles is in everyone’s best interest: the patient, the physician, the practice, and even the front office employee, too.

Today, we’ll discuss some oft-overlooked but valuable skills to watch for when filling this critically important position and where to find the best prospective employees to represent your practice.

The Pivotal Importance of Front Office Staff

A front desk person, or receptionist, fills a vitally important role. We all know first impressions can be profound and long-lasting, and it’s helpful to apply that principle in medical offices.

The front office person, or team of people, is the “face” of your business to anyone who walks in. They’re the first up to bat; the first to greet potential patients, new patients, and returning patients. While the quality of patient care in appointments is, of course, of vital importance, front office interactions have the power to elevate the experience into something beyond the typical.

Front office personnel set the stage for the patient’s entire interaction with your office. To a large degree, their people skills, or lack thereof, determine your office’s atmosphere.

Best Practices for Hiring Front Office Personnel

We frequently find front office positions filled by people with a more profound interest in healthcare than the role satisfies, such as a receptionist who is also an aspiring medical student. While hiring someone on a healthcare trajectory may seem logical because of their baseline medical knowledge, they may lack the necessary skills to be successful in a front-facing, non-medical role.

Numerous “soft skills” enhance the interactions between front office personnel and patients. Soft skills differ significantly from measurable, technical “hard” skills. The medical paper “Soft Skills Are Hard Skills” describes soft skills as “generic skills, essential skills, key competencies, employability skills, emotional quotient skills, and life skills… which enable individuals to deal effectively with the demands and challenges of everyday life.”

There’s an entire population of experienced, intelligent people who dedicate their professional lives to guest-facing roles. They enjoy it, and they cultivate the soft skills intrinsic to the profession. You just have to find them.

Hospitality as a Candidate Resource

Though it may seem counterintuitive, one of the best places to look for skilled front office staff is outside of healthcare, especially in hospitality.

The hospitality industry requires a great deal of its professionals from the get-go, and the application of those skills reaches far beyond hotels and restaurants. Hospitality hones skills that make excellent front office staff in concierge medical practices: perceiving psychological nuance, reading the room, picking up on demeanor or intonation, assessing when to joke and when to give space, and knowing how to respond to each of those subtleties appropriately.

If it looks like a lot, that’s because it is, yet it all falls under the seemingly small label of “soft skills.” And a front office employee who doesn’t speak the language of soft skills isn’t going to pick up on the cues your patients are sending.

Think about a particularly fantastic experience you’ve had at a restaurant. Remember the server’s ability to resonate with your mood, to steer you through the menu, to keep up the kind of banter you like, to deeply listen, to anticipate your table’s needs, and to deliver the product in a way that felt natural, and to maintain a level of enviable efficiency. Many elements are at play in hospitality, and the same is true in your medical practice.

Why Front Office Staff Don’t Need a Medical Background

One of the most significant objections to hiring from outside the medical industry is that front office staff need a baseline understanding of medical topics. And in most cases, that’s absolutely true! But it doesn’t preclude outside hiring as much as you might think.

While front office staff often need medical knowledge, that doesn’t mean it’s a prerequisite. In reality, it’s usually easier to teach medical information to someone from a hospitality background than it is to teach hospitality skills to an aspiring medical practitioner.

Many people with clinical, scientific, and mathematical inclinations are drawn to healthcare, and many with specific innate soft skills are drawn to hospitality.

Why does this matter? These differing baseline inclinations lend to expertise in certain areas. So while an analytical bent might serve a clinician exceptionally well, it doesn’t mean they’d make an outstanding receptionist and vice versa. However, a receptionist doesn’t need the same level of medical knowledge as a doctor or even a nurse — just enough to do the front office job well.

Even if this generalization doesn’t hold true in all cases, it makes sense to attract professionals who want the specific job you’re hiring for, rather than people who want it as a stepping stone to other aspects of medicine.

Where to Find Excellent Front Office Candidates

So, where exactly can you look for promising front office staff? Your imagination is the limit, but we’ve found universities, hotels, and restaurants to be fruitful areas for exploration.

• Universities. Students studying certain subjects are more likely to have the innate soft skills you need, and you’ll likely have the advantage of being the only medical practitioner speaking with them. Students are, of course, coming in at an entry level, which includes advantages like being able to train in good habits from the start.
  • Specific majors:
    • Hospitality Management
    • Learning and Development
    • Human Resources
  • Campus job fairs
  • Alumni resource groups
• Hotels. Hotels vary wildly in size, type, and expectation, thus providing a wide range of experience for employees. People with this background will likely have volumes of real-world experience with highly relevant, transferable skills:
  • Front desk staff
  • Concierge
  • Valet
  • Bellhop
  • Pool staff
• Restaurants. Restaurants also vary, but the work is service-oriented and people-focused. It’s also often physically demanding and can come with hard hours. Many excellent employees might be ready to switch industries for better hours (no overnights or double shifts, plus the ability to eat meals at regular mealtimes).
  • Maitre d’
  • Host
  • Waitstaff
  • Manager
  • Barista

Not Just Nice, but Skilled

While personality is essential, one caution: General niceness doesn’t necessarily indicate a strongly developed soft skill set. A person can be nice, friendly, and likeable and still fall short when it comes to other necessary abilities.

Let’s return again to a memory of a meal, except now recall a time when a nice, well-intentioned, likable server was terrible at the actual job of serving. Unfortunately, niceness did not equal skilled.

To differentiate between simple likeability and strong soft skills, remain observant when you visit any of the above venues, and try to notice when someone creates an instant connection with you or others. Do they communicate warmth and make you feel cared for? Do they deliver on the promise of wherever you find yourself — whether that’s a fantastic meal well executed, a cozy stay at a bed and breakfast, or a perfectly crafted coffee handed off over pleasant conversation?

A person who can connect and manage guest experience details provides a crucial service for your practice. And they can learn what medical knowledge they need just as they can learn the details of a menu or the nuances of delivering a world-class experience.

If you came upon this article hoping it would tell you exactly how much to pay a new physician, let me apologize in advance. I can’t tell you how much to pay your doctors.

That fact is, there’s no simple, straightforward formula to determine a new concierge doctor’s salary. There’s no “conventional fee plus 10%” equation I can give you.

What I can give you, however, is an exercise in what to contemplate to help you get to a number that makes sense for your situation.

Why It’s Harder to Set a Concierge Doctor’s Salary

As you’re well aware, setting a new concierge doctor’s salary is much more complicated than paying someone to work a cash register for a set number of hours each day. It’s almost laughable to compare the two.

It’s also more complicated than searching for salary recommendations on hiring platforms like Glassdoor, Indeed, Doximity, or MGMA. Those places can provide you with compensation data and maybe a range of salaries, but it’s unlikely they’ll have much, if anything, on concierge practices.

Their focus will be on pay for physicians employed in fee-for-service practices that manage insurance-based patient panels of 2,000 to 3,000. All the details will be very black and white, like two weeks paid time off, set on-call schedules, and which weekends the doc has to cover. But that’s not the job you’re hiring people to do.

Even if I know nothing about your specific practice, I know it’s unique. There’s no set model across the board for concierge practices. So even if the range of salaries the aforementioned websites offer was based on concierge data, it wouldn’t be enough. Your practice is unique — the services you offer, your staffing model, your pricing model — and your compensation will be, too.

What to Consider When Setting a Concierge Doctor’s Salary

The uniqueness of each concierge medical practice makes a set number or formula impossible. But, while their responses will differ, every practice will have similar questions they need to consider before setting a new physician’s salary.

The following are four principles to contemplate as you prepare to hire a new concierge doctor and set their salary.

1. Equity Structure

When it comes to compensation, there’s a big difference between someone who comes in as an employee and someone you bring in as a partner and fellow entrepreneur. The key here is to know which type of position you’re looking to fill.

Employees

A concierge doctor coming in as an employee expects a base salary and a good day’s work. Yes, they’re willing to go above and beyond as a concierge physician, but they don’t want to get involved in the long-term strategy of building the business.

It’s the difference between someone who comes in to be “fed” and someone who comes in to “hunt.”

There’s absolutely nothing wrong with hiring doctors in this capacity if that’s what you need. They can be a huge asset. But these are not the physicians to offer equity to.

Partners and Peers

For physicians who want to be part of the fabric of your practice’s growth infrastructure, there should be upside in the way of equity. They’re coming in as partners and peers, and they should be able to invest into that.

Knowing from the start which role you’re looking to hire for makes an enormous difference here. If you want an employee but you’re giving away equity, you’re giving away equity too cheaply. If you’re looking for a partner and don’t roll equity into the conversation, you’ll find it challenging to hire the right people.

Analyzing what you actually want up front is essential to knowing what that equity consideration will look like.

Succession Planning

Then, you have further equity questions to contemplate. Let’s say you determine you’re looking for a partner. How do they fit into your growth plans? What potential future do they have with your practice?

For example, would they be willing to operate another location under your brand? Would they be interested in taking over your practice when you’re ready to transition into another role or retire? How will they fit into your succession plans?

All of this will play into how much equity your new concierge doctor earns and how quickly. And, of course, you can stay flexible. Maybe you hire a peer simply to work side by side with you in the practice, but after three years you realize they could be your successor. You can revisit the equity conversation at that point. Either way, starting with the end in mind is paramount for equity considerations.

2. Physician Characteristics

Experience

Some practices won’t consider new candidates until they’ve been practicing on their own for five or more years. Others welcome doctors straight out of residency.

Again, neither is right or wrong. What matters is that you take into account the particulars of your practice and the individual you’re considering.

Would you be willing to take someone right out of residency or someone with three years of experience if they seemed like the right fit? If so, you might not want to set a five-year experience requirement in the job description.

A concierge doctor who’s been running their own private practice for 10 years will have higher expectations for salary and overall compensation, but they’ll bring a lot of experience to the table. Those with less experience will probably accept a lower salary, but they will surely need more hand-holding fresh out of residency.

An important and perhaps counterintuitive point here is to not tie your new concierge doctor’s salary to pricing that’s specific to them. In other words, don’t charge X to see you or another experienced physician and set your new physician’s price at X minus 20%. If you do, by perception alone you instantly devalue the care your new physician provides.

What’s more, if you want to reduce your panel size down the road, this sort of structure makes it impossible to maintain your financial metrics. For these reasons, it’s best to decouple the amount you charge for new concierge doctors’ services from their salaries.

It’s possible that a less experienced, employee-level doctor may see that you’re paying them X while charging patients X plus some percentage for their services, and wonder why they’re not earning more. Be prepared to have conversations with them about two things: 1) your tangible costs they can measure, and 2) the risks you take as an entrepreneur that cannot be quantified.

Tangible costs are things like your expenses for overhead, marketing, building costs, finding patients to fill their panel, and more. The risks? The risks are virtually impossible to measure in full.

Over time, what you pay a physician and what you charge for their services should grow closer together. It’s not because of how much you charge for their services, but because some of the expenses on your side will decrease as their experience and patient panel grow.

Panel

Is the person you’re hiring someone you’ll be feeding, or will they be feeding themselves?

In other words, is the physician you’re hiring bringing patients with them, or will you need to fill up their panel? If you need to fill it, do you have an existing waitlist to pull from, or will you need to go out and find those patients?

Think back to how much time and how many marketing dollars it took to fill up your own panel, or that of another one of your doctors. This will give you a good idea of the expense and time involved in bringing on a physician without an existing panel, and how that will affect compensation.

Relocation

If you’re recruiting a physician from outside your immediate market, you’ll likely want to offer to cover their relocation expenses. But an extra $25K to move someone across the country is a major outlay, and you’ll need to factor it into their compensation.

Perhaps (internally) view their first year of salary as prorated to compensate for those moving costs, and then provide a bonus in year two that bumps them back up to the salary target.

3. Benefit Structure

It’s helpful to think about a new concierge doctor’s salary in light of their full compensation package. You incur expenses on all the benefits that come alongside salary, whether they’re traditional retirement offerings or more modern perks.

Are you offering a 401k? Are you matching the 401k? What about insurance? Will you contribute to a match HSA? Do you offer dependent care? PTO? What about perks like time and funds dedicated for CME? We’ve even heard of employers offering laundry services. There are so many opportunities to wrap benefits into your total compensation package to make your practice feel concierge, even to your employees.

Bonuses are another major consideration. You might structure your compensation to include cash bonuses for holidays, performance, and/or employment anniversaries. Or, if your new physician will be buying equity, you might offer an option for them to contribute toward equity purchases over time with a reduced salary.

4. Legal Matters

Finally, consider what legal matters you’ll become involved in for a new physician.

Does your practice plan to pay their malpractice premiums? Or will your new hire pay their own? Do you have a vendor that provides reduced payments for concierge practices?

As you grow and add physicians to your practice, you may need to consider key person insurance. If you become incapable of working tomorrow, how will your practice and all your employees be affected? Will any of your new physicians evolve to be of similar importance to your practice?

Non-compete clauses are another legal matter you may run into. Do you plan to include one in a new concierge doctor’s contract? Then their salary may need to be a bit higher to compensate for it.

Or, does your potential new hire have a non-compete with a former practice or hospital? There are often ways around that, but it should still be taken into consideration. If their non-compete already makes the candidate feel queasy about leaving, they’ll be even less likely to do so for a low salary.

Get All Your Stakeholders on the Same Page

The list above is in no way comprehensive, but it should provide some good starting points to help you think through compensation in the context of your practice’s specifics.

I encourage you to sit down and think through each item. If you have other stakeholders involved in the compensation question, whether they weigh in on your new concierge doctor’s salary, benefits, or equity, bring them into this conversation. You can even share this article with your partners, your CFO, and your legal team to get everyone on the same page.