2020 was the turning point for concierge medicine

It’s almost unfathomable how much has changed in the course of just 10 months as the pandemic upended how we conducted business, interacted with family and friends, dined out, celebrated life passages and mourned endings, and in particular, received healthcare.

Last year at this time I penned a column confidently titled “Why 2020 will be a banner year for concierge medicine” describing it as a time of enormous opportunity and expansion for this beneficial practice model. While our prognostications ultimately turned out to be resoundingly true, no one could have foreseen the direction the healthcare industry was headed – ‘unprecedented’ might well be the word that describes 2020 for decades to come.

But in reviewing the basis for my prediction, what stands out clearly is how the cornerstones of a Specialdocs affiliated concierge medicine practice were designed to counter the challenges of a traditional, fee-for-service healthcare system and these practices’ steady performance during the pandemic provided plentiful evidence.

Built for sustainability, the Specialdocs membership model thrived with minimal dependence on insurance reimbursement and a growing coterie of patients grateful to have found doctors dedicated to personally guiding and caring for them throughout the crisis. Our physician clients, who have always valued the autonomy of our practice model, continued to make individual decisions about office safety protocols, telemedicine, openings and re-openings, COVID-19 testing and patient outreach, with guidance and support from our team of experts. To borrow a phrase from real estate: “if the bones are good, the house won’t fall.”

Unfortunately, the structures supporting traditional practices were exposed as flimsy, unable to weather storms like COVID-19. The continual onslaught of decreasing reimbursement, rising regulatory burdens, escalating overhead costs and changing patient expectations were already battering the system, and COVID-19 further exposed its flaws. The loss of 16,000 practices that permanently closed their doors in 2020 as a result of plummeting patient visits and associated revenues, and another 8,000 expected to shutter in the next 12 months, is of great concern to everyone involved in healthcare.

Where do we go from here? To answer that question, let’s take a look back at the top predicted and actual reasons 2020 became a milestone year for concierge medicine.

We said physician burnout, or as JAMA labeled it, moral injury, presenting as emotional exhaustion, depersonalization and a sense of loss of professional efficacy, was so prevalent that only a bold plan for systemic change would resolve the issue. In January 2020, surveys showed almost 73% of doctors had considered quitting medicine due to burnout. There’s no question that the spread of COVID-19 only exacerbated the problem. The shift to survival mode with empty waiting rooms, and a full roster of barely profitable telemedicine visits pushed many independent physicians to close their practices, accept employment at a hospital or health system or retire early.

For the Specialdocs network of practitioners, the patient-focused, physician-empowered model of concierge medicine brought a renewed sense of purpose and satisfaction. I heard this clearly and emphatically from the physicians in our network at the bi-weekly clinical conferences we held throughout the pandemic. They candidly discussed the stress caused by the constantly changing nature of COVID-19’s trajectory. But along with that was a frequently expressed sense of gratitude for having the time and resources to be available to vulnerable, anxious patients. One moment in particular crystallizes that for me. At the end of a somewhat frustrated dialogue on COVID-19 testing availability, the tenor completely changed as one of our Special Docs asserted: “There’s never been a better time to be a doctor. We can, and are, making a real difference in our patients’ lives.” The swift embrace of his statement by every one of the Specialdocs physicians was profoundly moving, as was the discussion that followed, focused on how we can further enhance our services for their patients. Far from being overwhelmed by the challenges posed by COVID-19, our network of concierge doctors were instead thankful to be inspired by their original calling to the healing arts.

Although we thought artificial intelligence (AI) might have proved a more useful, forward-looking tool for concierge doctors, in 2020 its focus understandably turned toward COVID-19 tracking, treatments and vaccine development. The real technology story for concierge doctors this year was the truly remarkable explosion in telemedicine. Obstacles previously thought insurmountable, chief among them tech-resistant older patients, were swiftly overcome as a result of the pandemic. For the Specialdocs affiliated concierge practices, without the reimbursement dependencies of traditional fee-for-service models, telemedicine has become an in-demand offering, viewed as a value-add rather than a critical revenue stream.

In our network, doctors were up and running within 48 hours on doxy.me, which we found to be an exceptionally user-friendly platform. A recent survey of Specialdocs physicians showed just how embedded telemedicine has become: 94% of our clients indicated they would continue to offer it in some form even after fully re-opening their offices. They view it as a complement to care and plan to use it in a number of ways: ongoing prescription refills; regular check-ins for chronic illness, diabetes and weight management; mental health discussions; vitals checks for congestive heart failure monitoring; wellness and nutrition coaching; and as a welcome alternative for elderly patients who may have transportation issues.

• We also believed that concierge physicians would become a more inclusive group, and saw this trend evolve more quickly than we imagined back in January 2020. In this tumultuous year, the face of a concierge doctor continued to evolve from primarily older males to encompass physicians who were younger, of color and diverse ethnicities. Female physicians remained a rising force in concierge medicine; at Specialdocs, the number of female doctors in our network grew by 17% in 2020, a percentage that has increased each year for the past five years. The median age of new concierge physicians continued to edge steadily downward as doctors in mid-career clearly recognized the model’s resilience and sustainability during COVID-19.

• Likewise, our forecast for younger, more diverse patient panels is becoming more of a reality, fueled by the drive to adopt healthier lifestyles and enhance immunity in the face of COVID-19. The realization of how fragile good health can be if not diligently maintained drove thousands of new patients to establish a strong, long-term connection with a doctor by becoming a member of a concierge practice. Older patients with multiple chronic conditions were especially appreciative of the personalized attention they received from their concierge physician in a year filled with uncertainty. And they were increasingly joined by Millennials and Gen Xers drawn to personalized care, health and wellness in addition to the technology-driven convenience of telemedicine, online appointments, and the ability to text and call a physician on their personal cell phone. A small but growing number of younger patients have become members of Specialdocs’ physician practices in 2020, pointing to the increased cross-generational appeal of care available whenever and wherever needed.

• The types of specialties suitable for a concierge model expanded beyond internal and family medicine as a result of its broader patient reach, with OB-GYNs, cardiologists, pediatricians, endocrinologists, rheumatologists, pulmonologists, lifestyle and integrative medicine physicians realizing the rewards of personalized care for themselves and their patients in 2020. Empowering patients with tailored strategies for managing or preventing type 2 diabetes, heart disease and obesity was especially compelling in a time of heightened awareness of underlying conditions that complicate recovery from COVID-19.

What does this mean for 2021? As COVID-19 vaccines are rolled out all over the country, we expect to gradually and thankfully resume our typical activities. We’re grateful for the positive impact this will have on health in the U.S. and worldwide. However, it’s clear that the pandemic has made a permanent imprint on traditional primary care practices, and there will be no easy return to a flawed system that proved woefully inadequate for both physicians and patients. The same weak spots remain in place, limiting opportunities for growth and meaningful change. My advice last January has taken on new urgency as we move forward into a post-pandemic world: if you are considering a transition to the concierge model, the time is now.

Terry Bauer is CEO of Specialdocs, a pioneering concierge practice consulting company established in 2002 that has helped physicians nationwide transform their practices with the industry’s most customized and sustainable concierge model.