Physicians of Concierge Medicine: Bradford S. Pontz, MD, of Specialdocs

BRADFORD S. PONTZ, MD
Fairfax, Virginia

What my practice was like before concierge

We were successful and a very busy practice, I had worked for the group for about 14 years. We had been completely independent. And although that offers some advantages, of course, it was very challenging in terms of our ability to work with commercial insurance payers and get reimbursement for the care we were giving to the patients in any type of reasonable fashion. About five years before the concierge transition, we joined a medical group that was new and forming in our area. The medical group did offer some advantages financially — we were able to, through them, negotiate better reimbursement with some of our commercial payers. And we did do better overall financially with that group. The challenge was that a lot of the newer contracts we were able to take advantage of through that group involved performance types of reimbursement models, with a need for lots of documentation of quality measures and participation in programs such as a patient-centered medical home. And it really did introduce a lot of burdens in terms of not only doing the best thing to take care of our patients, which we already were doing, but being very careful about documenting it in the [electronic health record] to make sure the payers had evidence that we were doing these things. We were very busy with patient care before we entered that model, and we only got busier, to the point where it almost felt like I was not able to deliver the medical care that I was comfortable with for my patients. That’s when we began to look at a different way of doing things.

Why I decided to explore concierge medicine

I had been familiar with concierge medicine for a number of years before we actually made the decision. I knew several physicians who had made the transition, including two who left the group that I worked with to establish their own solo concierge practices. At the time that those physicians did it, I felt they had been in practice in the area a bit longer than I had; they were older than I was. There was another physician in our group who was closer to my tenure, and I felt that he and I were just not quite ready to make the move. But as time went on, and I saw the various challenges with the models I’ve described, it became clear to me that the concierge model really offered the best combination of advantages.

The benefits I’ve experienced from transitioning to concierge medicine

The benefits from the concierge transition are numerous. We have significantly fewer patients than we used to in the practice. I have about 25% to 30% of the patients that I used to have. So with a change of that magnitude, we are really able to spend a lot more time with our patients and just deliver a lot more for them. We can spend about twice as much time for each patient’s visit. It means we can be a lot more thorough with our care, we can address all the patient’s questions or complaints when they come in for a visit. And the pace of the visit is more relaxed; it allows both the physician and the patient to just enjoy the interaction more.

Outside of the visit, we have more time to be available in other ways. The patients all have my email address, and they also have my personal cell phone number. They can contact me if there’s something urgent that comes up after hours. And I do get a number of emails every day, but I have time to respond to them, and the patients appreciate that level of contact.

Also, my staff is less busy than they used to be. And so they have more time to provide service for the patients. Some of the patients have really begun to develop a relationship. And that’s been nice to see. Our days are fulfilling, and we’re able to feel proud of the care we’re delivering.

The biggest challenge I faced during my practice transition

The biggest challenge was wrestling with the fact that, by definition, there were some patients of mine who were going to be forced to move to another physician. And these were often patients who had been long-time patients of mine that I had enjoyed working with; we had a good relationship. And they would have been happy to stay with me except for this transition. And so I did have to really sort of wrestle with that a bit and make sure that I was comfortable with it.

But we took a lot of steps to mitigate any adverse effects. We worked with a large number of other practices in the area who were doing what we would call traditional practice. And we made sure that there were practices we knew and respected in the area that could absorb these patients. I spoke to those practices directly myself, and we created a list of best practices for the patients. We did have the ability to enroll a small number of patients on what we call scholarship basis, which means the patients do not need to pay the annual membership fee. And we did that for a few particularly elderly or complicated patients where it would be a real unfortunate event if they would need to transition to another physician. The vast majority of the patients who chose not to move with us and enter the concierge model said, “I understand why you’re doing this and I wish you well.”

Interestingly, in the 2 1/2 years since our enrollment period, we have had a number of those patients who came back to the practice.

If I could do the practice transition again, what would I do differently?

We were a bit short staffed during the transition period. It is a busy time, because you’re still trying to do all the medical topics of a visit, while also having a brief conversation about your concierge transition during each visit. If I had to do that over again, I probably would have just hired some temporary help for the transition, because it was a stressful period for the physicians

and the support staff.

How concierge has affected my feelings of burnout, work-life balance and career satisfaction

I think it’s had only a positive effect. In the traditional model, I still enjoyed what I was doing. I love being a physician, I love taking care of patients and knowing them over a period of time as their primary care doctor. It was just the high volume nature of the patient load and the need for chart documentation that was really taking time away from my personal life. I’m spending less time after hours doing chart work. Because I used to be so busy seeing a large number of complicated patients each day, that I wouldn’t get a chance to do all my charting during the day. So I would do that in the evenings and on the weekends. And it was really starting to create a personal life that was untenable. So I’m happy to have a bit more time for my family on evenings and weekends.

Why I chose my concierge vendor

I did a fairly thorough analysis of about six different concierge consulting companies about three years ago as we were preparing to make our transition. We chose Specialdocs Consultants, and, for us, they’ve been a great fit. They have a lot of experience in the field. They offer a lot of flexibility and seem to understand that every practice is different. And there is not a need for every practice’s transition period to be exactly the same and a certain protocol. Nor does every practice need to look and operate exactly the same on the far side of the transition. They are a small enough group that we’ve really had the opportunity to get to know all the people that we have worked with. Overall, we’ve been very happy with the experience.

My advice for physicians considering concierge

Don’t be afraid of considering the transition. I think there are a number of physicians out there who are understandably put off by the some of the risks associated with it. But the rewards really are there. One does need to do some type of analysis of the practice and make sure that you can support it economically. But I would encourage everyone to have confidence in their own practice and in their own relationship with their patients. There may be more interest among their patients than they initially realize. Other concierge physicians have said what I’m about to say: One of my few regrets is that I didn’t make the transition earlier. I’m glad I’ve made it now.

Editor's note: This transcript has been edited for length and clarity.