STARTUP: The Concierge Journey: Tips for Successful Transition

By Erik Goldman

startup guide to concierge medicine direct primary careThe concierge model is a great option for physicians seeking more control over their time, their professional lives, and their ability to care for patients. But it is by no means a financial cure-all, says Marcela Dominguez, MD, a family physician in Mission Viejo, CA, who started a concierge component in her practice earlier this year.

“My life is so much better now. It’s a big improvement. I’m enjoying the benefit of more time for my family and my kids, more time to do administrative stuff during the workday rather than after-hours. But it’s not like my financial woes suddenly disappeared, especially during this first year.”

Dr. Dominguez, who will share her lessons-learned at HPC’s upcoming Heal Thy Practice conference, says the shift to concierge requires careful preparation. “There are a lot of transitional stages, and you have to be ready form them.”

Careful Assessment

From the outset, she knew she wanted a hybrid practice in which non-member patients could still come to Complete Care Family Medicine, and use their insurance. But rather than seeing Dr. Dominguez regularly, they would get one yearly visit with her, and all subsequent care from her NP or her physician-partner.


She chose to work with SignatureMD,  a consultancy that enables doctors to create hybrid models that best fit their preferences and their patient populations.

“I had about 3,000 active patients in my database. SignatureMD did a phone survey to estimate how many would consider joining a concierge. They asked all kinds of questions: Would you like quicker access to your doctor? Does having email and cell phone access have value for you? Are you willing to pay extra for that level of service? If your doctor were to switch to a membership model, would you join?”

Dr. Dominguez got data from about 1,200 of patients, roughly 300 of whom said they would join a concierge style practice. “These were patients who gave a definite “Yes.” Maybe’s didn’t count. Based on these numbers, we thought my practice had a good chance of succeeding.”

Always Underestimate

When assessing whether the concierge model is right for you, Dr. Dominguez strongly recommends underestimating the expected membership. “Look at the low end, and consider if it still makes sense economically. Though the survey said 300 people—roughly one-tenth of my total volume–were likely to join, my low-end estimate was 125 patients. If it could work with that, I knew it would be OK if there were more.”

In actuality, the practice fell short of its initial goal of 100 members in the first 3 months. Beginning in January, all of Dr. Dominguez’ patients were informed that the practice was offering a concierge option, and that those who did not join would have limited access to Dr. Dominguez. By April, only 50 had joined. The number increased to 75 in the ensuing months, but that’s still short of the goal.

Reasons for the shortfall? Dr. Dominguez thinks the nature of her hybrid model makes it easy for some patients to watch and wait.



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