Inside the practice: Should you switch to concierge medicine?

Many physicians in traditional, fee-for-service practices are having a challenging time. Doctors are burned out and strapped for time with patients. They work long hours, often finishing their charting or talking to patients well into the evening. Some physicians have transitioned their practice to concierge medicine, also sometimes called membership medicine or direct pay.

Inside the Practice® sat down with two internal medicine physicians — Ann Frekko Raffo, M.D., of Gaithersburg, Maryland, and Bradley Adler, M.D., of Armonk, New York — who had switched their practices from traditional to concierge, to learn about the benefits of their new model. The conversation below was edited for length and clarity.

Inside the Practice®: The first thing I want to talk to you about is what your practice was like before you made the switch to concierge medicine.

Ann Frekko Raffo, M.D.:It was in the middle of the (COVID-19) pandemic. Before we switched over, we were a very traditional, volume-based practice. We had several nurse practitioners working in our office as well as a couple of physicians. It was a lot of patients every single day. We had a waiting room that was filled with patients all the time. We were typically running late because many patients didn’t come in very frequently, and when they did they had multiple questions or concerns. And so, while their appointment slot was … only a short period of time, we were always running over. And so, it just led to a lot of stress among our staff and the providers. And patients weren’t satisfied, because they were waiting so long and felt like we were rushed all the time, too. So that was the snapshot picture of what was before.

Bradley Adler, M.D.:My practice was, for about 15 years, a multispecialty group to negotiate with insurance companies to provide multiple types of services. And as we tried to produce good data to show what was for reasonable reimbursements over time, it was just a never-ending battle. In general, our practice was flourishing, but there was just never enough time to see everybody.

Inside the Practice®: Why did you decide to switch to concierge?

Raffo:We had been approached by several different concierge model practice or places that had reached out to us and asked us if we were interested, and we pushed it off for years. Because … you go into medicine wanting to help people. There’s this concern that you’re kind of a sellout if you switch over to a concierge model. But we were feeling like we were getting burned out and we were in practice with my sister and we both sort of thought … we’re getting run-down and we felt like this was not sustainable. And then we thought more seriously about the concierge model of practicing medicine, and the rest was history.

Inside the Practice®: What is your practice like today?

Raffo:The office is much calmer, a lot more smiles. Patients can call and they can get in to see us very quickly, or they can get one of us on the phone. So, there’s not a long … wait to get in to see a provider. Also, our primary goal as being internal medicine primary care physicians is prevention: preventing disease, preventing illnesses. And what was happening before was we were putting Band-Aids on everything and putting out fires all the time. Now we really have the opportunity where every single patient can come in and do their annual physical; we can review everything for their primary prevention and cancer screening and vaccinations. And we can make sure that everything is thoroughly examined … and not feel like we’re rushing through something.

Adler:I wake up every morning, and I’m grateful. I look forward to my day. At the end of the day, I can say to myself, “I really impacted people today” in a way that I felt I couldn’t before. But it’s not about before is bad, and now is good. It’s not about comparing; it’s about being the doctor that you want to be and able to carry out the things that you hope you’re able to do with your patients. A 10-minute conversation with a patient is nowhere near as effective as a 120-minute conversation with a patient. And you realize that when you thoroughly answer a patient’s questions, you put them at ease. It’s a total change in the experience.

Inside the Practice®: How did you approach the change in models with your patients?

Raffo:We would tell patients when they came in, and we also sent out a letter. We also did a video, question and answer, a Zoom-type thing as well, because it was during the pandemic that we switched. … It was tough. I’ve been in practice for almost 20 years. And preceding that I had joined my father’s practice. So many of these patients are generational patients. And a lot of it was hard because some people embraced it right away. And we’re eager to have the ability to not feel so rushed all the time, and they had more time with us. And some … were not interested, for a variety of reasons. So, it was tough.

Inside the Practice®: Dr. Adler, what would you like to add on that topic?

Adler:I needed to really communicate with my patients about this. We created a Zoom video. I recorded it 100 times just trying to make sure that I can convey sincerely what my goals were, why I was doing what I was doing, what I wanted them to understand about it, and that I was an open book to discuss it all with everybody. Once I got that video out and started to hear feedback, I learned that nobody was shocked. A ton of patients were almost expecting this for me. Many were happy. Many were sad. Nobody was angry, or at least they didn’t directly express it to me. They were upset that they were potentially going to lose me. The hardest part for me, of course, was the idea that I was going to somehow not abandon care but stop caring for certain patients. That’s the hardest piece of this.

Inside the Practice®: What advice would you give physicians who are interested or thinking about making a change?

Raffo:If you’re interested, you should look into it. We were approached many times over the years, and I resisted … and we wish we hadn’t, or we could have done this sooner.