Making the Transition to Concierge Care

CHARLOTTE, NC — “Twenty months ago I was in a situation just like many of you, working in a large practice with a heavy patient load, working long hours, filling out forms, chronically running 30-45 minutes behind schedule,” said Dr. William Lee, a Raleigh, NC area family physician who recently left insurance based practice in favor of MDVIP’s concierge practice model.

Speaking at Holistic Primary Care’s second annual Heal Thy Practice: Transforming Primary Care conference, Dr. Lee described the transition process and underscored the positive effect his decision has had on his own life, and that of is patients.

Prior to the change, Dr. Lee practiced with 4 other MD’s and 5 PA’s. He worked 12-14 hour days, seeing 24-30 patients. Much of his time was spent in lab reviews, returning phone calls, and filling out endless streams of paperwork. Though he was approaching retirement age, he still had years to go, and did not want to spend them in misery.

He told Heal Thy Practice attendees that he became interested in the MDVIP model of concierge-based care ( after hearing a presentation by a doctor who had converted his practice. Making the transition was, he said, “a decision that has changed my life, and hopefully extended my career.”

Fears & Concerns

Understandably, Dr. Lee had many concerns. “What would patients think about me? How would I be able to separate from patients I had known for over 20 years? What would other doctors in the community think? Would I be able to recruit enough patients? What would 24/7 call be like? What would it be like to run my own small business?” But the prospect of being able to provide better care and have a better quality of life was compelling.

The transition took roughly 10 months. MDVIP begins with an in-depth practice evaluation, at no charge. They look at your current patient population, demographics, median income, current practice management capacity, and other variables. “In the worst case, you get a free analysis of your practice, what you’re doing right and what you’re doing wrong and how to run it better.”

MDVIP uses the information to model out the likelihood of success in a membership model. “They are able to predict, with about 99% accuracy, whether someone can open with a number that would be economically feasible.”

The next step is to schedule “town hall” meetings to explain to patients the rationale for the practice transition. MDVIP insists that no patient be left without a doctor, and requires affiliated physicians to recruit other doctors to take over any patients who do not sign up as members. The company provides patient care representatives, who visit the office for 6 months prior to the start date to facilitate recruitment and to help those who do not join to find other doctors.

Dr. Lee said he found “a great deal of acceptance,” among his patients, even those that did not join. “People understood why I was making the change.” MDVIP allows 10% of total patient volume to be “scholarship” patients. “I’ve taken full advantage of that. Those patients that I knew couldn’t afford to join, I invited to come in under scholarship.”

The transition also involves a lengthy process of educating and re-training staff. In some cases, it means parting ways with employees such as insurance billing staff, whose services won’t be needed. In Dr. Lee’s case it meant leaving a group practice, finding a new office, purchasing all necessary equipment an EMR system, transferring his malpractice coverage, and moving out on his own.

I ♥ Medicine…Again!

Rounding out his first year in the new model, Dr. Lee said his experience has been uniformly positive. He sees just 8-12 patients per day. His patient care hours are 9-4 on Mondays to Thursdays, and 9-12 on Fridays. He spends about an hour each day after seeing patients on lab/x ray reviews and phone calls.

Many doctors understandably fear the prospect of being on call 24/7, which is part of the deal in nearly all retainer-based systems. The reality is nothing like one’s imagination, said Dr. Lee.

“I actually get fewer calls now than I did before, when I was not officially on call. I’ve only had one midnight call (since starting with MDVIP) and it was from a lady who took the wrong pill and wanted to know if she’d be okay until morning.” If you’re able to take thorough care of patients in the office and give them the time and attention they need, they have much less need to call you after hours.

Dr. Lee said that stepping off the insurance treadmill cut his practice overhead in half, to around 30-35% of total gross income. Though the transition from group to solo practice was a little scary, it suits him well. “It is tremendous fun to be able to take control. I love practicing medicine again!”

To find out more about the concierge practice model, read  Despite Recession, Concierge Practices Show Brisk Growth, Excellent Outcomes.

To purchase a recording of Dr. Lee’s presentation, or any of the other excellent talks from HPC’s 2010 Heal Thy Practice conference, click here.

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