Physicians of Concierge Medicine: John Verheul, MD, MPH, of SignatureMD

JOHN VERHEUL, M.D., M.P.H.
Midlothian, Virginia

What my practice was like before concierge

I had been in practice for almost 25 years. So I had a fairly big practice and about 2,500 patients, plus two nurse practitioners. So that would add on maybe another 700 patients, so very, very busy. I was in hospital making rounds. We were doing about 1,200 occupational physicals a year. So our workday started at 6:30 in the morning, and oftentimes, I wasn’t home until 8, 9, or 10 o’clock at night.

Why I decided to explore concierge medicine

I think the biggest thing was burnout — I was tired of it — and the total work-life balance that I had. I struggled to be home with my wife and kids and do what I wanted to do. It just wasn’t working anymore for me. I got very frustrated with the [electronic health record]. I was very frustrated with lots of other insurance issues that were going on. I had no time to study or to read. I have a master’s degree in public health and I really enjoyed teaching, and there was no way I could teach. I couldn’t do what I wanted to do.

So I was [considering] considered retirement; I was thinking “I don’t need this anymore. I’m done with this.” Then I heard about concierge medicine, and I decided to check this out. Our area was fairly new to concierge at the time. And so I wanted to give it an opportunity and see what maybe I could do because I really wasn’t ready to retire. I didn’t want to retire but I was feeling pushed to do that.

The benefits I’ve experienced from transitioning to concierge medicine

I am so glad I did this. It changed the nature of my practice. Being in the concierge program, I have more time to be with my patients; I was able to go ahead and teach. People were motivated; they sign up for this program because they’re motivated to take care of themselves. I was able to enjoy my time at home more. And, of course, financially, it was an incredibly good decision for me.

In traditional medicine, 20 to 25 patients per day was not unusual at all. Now I have a limit of about 10 patients a day to complete physicals, which each lasts about an hour. And then I’ll spend anywhere from 20 minutes to 45 minutes, depending on the problem, with a particular patient and get things taken care of.

The biggest challenge I faced during my practice transition

The terrifying thought that I might not have anybody join me — that was the worst problem. I was very concerned about losing my base of patients. I mean, I could always go back and do something else and practice a different kind of medicine if I wanted to. But I think the scariest part was saying, “Are people going to be willing to make this plunge with you?” Don’t forget, 10 years ago, concierge medicine was a lot more scary in terms of getting into the program than I think it is now, because people have accepted it as being a good quality program as medicine has fragmented even more. The need for a good quarterback, a primary care physician, somebody who’s going to have your interest is more important than it ever has been. So I think the greatest fear was: Will I have enough patients?

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

I would have done it sooner! I don’t think there’s anything different I would have done. The program that I was in was extremely good. Three months beforehand, they told all my patients about the program. We had a great opportunity to explain to patients why I was doing what I was doing; I think I had a great groundswell of support from the majority of my patients. And the attrition rate that I was so terrified was going to happen was much milder than I expected. So, no, I don’t think I would have done anything differently. Other than have been less anxious about the transition.

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

It’s been dramatic. Over the years, I can tell you that my satisfaction level has gone up dramatically, I’ve been able to change my practice to a more holistic practice — that is what I wanted to do for years. I have a chiropractor in my office, we offer physical therapy, I have a naturopath, we have trainers, we have counselors. I’ve been able to gradually assimilate them because I have the time to do this, which is the important thing. And it has been so wonderful.

With regards to financial remuneration, I have no financial concerns, nothing to worry about from that standpoint. And the beautiful part is the ability to teach and take time with my patients, I now have a minimum of 20 to 30 minutes, sometimes 45 minutes. I have several slots for that. I do home visits on Fridays, because I can and it’s not financially driven that much anymore, because I have that support.

Why I chose my concierge vendor

I interviewed a number of concierge programs. I ultimately selected SignatureMD, which is the company that I’m with now. And the reason I did it with them is because they allowed me to keep my nurse practitioners. The biggest problem I had was I didn’t want to let go of my patients. I didn’t want to select 200 people and to the rest say, “Well, sorry.” With my nurse practitioners, I was able to still see my patients through them. They would come to me and say, “Hey, I have a problem.” So I never felt I lost contact with those people; that was the biggest thing for me.

My advice for physicians considering concierge

You need to vet the concierge program very carefully, because each one is a little bit different. They have different reimbursement models and programs and how you do things. That’s very important. Secondly, you have to have confidence in yourself, I think you have to feel, “My patients and I have a very good relationship, and patients want to come with me into this new journey.” So the confidence aspect is important. Just say to yourself, “Look, I’m going to have fun, I’m going to have more time and I’m going to take better care of my patients. I want to go and do other things. And that’s why I want to take this big step because [what I have now is] not working for me.”

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