A direct, thoughtful response to the most persistent criticisms of membership medicine — from someone who has been reading, reporting, and sitting in waiting rooms for nearly two decades.

By the Editor-in-Chief, Concierge Medicine Today

I’ll be direct about something upfront: I have opinions on this topic, and some of them may be wrong. The older I get, the faster I am to acknowledge that. But I have also spent nearly two decades reading everything written about concierge medicine — the careful analysis, the lazy op-eds, the patient letters that sparked a cycle of confirmation-seeking journalism. I have talked to physicians in every corner of this landscape and sat across from patients in practices at every price point. Bear in mind, I’m not a Physician. I’m simply a patient. The perspective that provides (below) I one who knows what it is like to sit on the other side of the exam room, service window and subscription billing from you and your practice.

What I have observed over the past three to five years, especially since the pandemic: the critics have largely stopped updating their arguments. The same five objections cycle through healthcare media with predictable regularity — physician shortage, elitism, equity, altruism, and fairness — often written by people who work inside a system that has its own substantial fairness problems and who have a reasonable financial interest in the status quo not being disrupted.

That said, the good news: there is more accurate, positive, and honest reporting about membership medicine today than ever before. You won’t always find it online. You’ll often find it sitting across from a patient or physician in one of these practices, hearing what it actually feels like to get medicine right.

RELATED PHYSICIAN WRITTEN OP/ED | MARCH 2026
We’re Asking the Wrong Questions About Membership Medicine

Here is my honest response to the five myths I encounter most often.

Myth 1: Concierge Medicine Worsens the Physician Shortage

This argument sounds compelling until you examine the numbers. According to industry sources at Concierge Medicine Today, there are an estimated 3,000 to 4,000 physicians currently practicing in some version of a subscription-based or membership healthcare delivery model in the United States — a conservative estimate that includes specialty practices, which likely represent more than 25% of that total (Concierge Medicine Today, April 2025).

For context: the Kaiser Family Foundation reported approximately 1,101,735 total active licensed physicians in the U.S. as of January 2025. That means membership medicine physicians represent approximately 0.36% of the total physician workforce. For primary care specifically, the same KFF data identifies approximately 535,012 licensed primary care physicians in the U.S. Even if all 3,000 membership medicine primary care practices were counted, that is 0.56% of the primary care physician pool.¹

This is not a rounding error in the shortage conversation. It is statistically invisible within it.

More importantly, the framing of the argument is backwards. Bodenheimer and Smith (2013) in Health Affairs articulated what many in primary care already understood: the physician shortage is more accurately described as a gap between patient demand and the capacity of primary care, as currently delivered, to meet it. Training more physicians alone will not close that gap.² The real question is not how many physicians we have, but how many are still practicing, and under what conditions.

A physician who transitions to a membership model and serves 400 patients with genuine depth and continuity is still practicing medicine. A physician who burns out and leaves the field at 52 is not. Physicians with burnout are at least twice as likely to report making major medical errors, and five times more likely to leave medicine altogether, according to research cited by the National Academies of Sciences, Engineering, and Medicine.³ If membership models reduce burnout and extend careers — and the evidence suggests they do — the shortage math looks different than critics imply.

A physician colleague in Connecticut, practicing in a membership model for many years, put it clearly: “To minimize harm in medical practice, we must reduce the number of patients each doctor sees daily. This allows them sufficient time to properly address patient needs, think critically about each case, and coordinate care with other practitioners when necessary. Building trusting relationships with patients is central to what these doctors strive to achieve every day.”

Also worth noting: Medscape data from 2020 found that only 17% of clinicians used cash-only, concierge, or direct-pay primary care models at that time, with 10% of primary care practices implementing a flat monthly fee for unlimited services. The narrative of a mass exodus is not supported by the data.

Myth 2: The Critics Have the Moral High Ground on Altruism

Of all the arguments leveled at membership medicine, the altruism critique is the one I find most genuinely worth engaging — and the most misapplied.

In July 2020, Dr. Jillian Bailey, a family physician in Ontario, published a letter to the Canadian Medical Association Journal that has stayed with me since. She wrote:

“I fear that the call to altruism may lead to worsening compassion fatigue and burnout among my colleagues. I would like to suggest that we encourage each other in the pursuit of meaning in our careers. Altruism and meaning are quite different concepts.”´

She continued: “Altruism is not the solution. I suggest that we encourage ourselves to reconnect with meaning — our ‘why’ that we are in medicine.”

This is not an argument against caring for patients. It is an argument against using the language of selfless sacrifice to justify conditions that are genuinely unsustainable — and then using that same language to criticize physicians who found a way to practice medicine that is both meaningful and sustainable.

The bias I observe today does not primarily come from patients. It comes from within the healthcare profession itself — from physicians who feel the same fatigue their colleagues do, yet direct their frustration at peers who chose a different path rather than at the system creating the fatigue. That dynamic does not serve anyone.

I have met hundreds of physicians in membership medicine practices over the years. They are not people who abandoned their calling. They are people who found a way to honor it.

Myth 3: Membership Medicine Is Fundamentally Unfair

The fairness argument deserves a direct response, so here it is: the current fee-for-service system is also unfair. It is just unfair in ways we have normalized.

A patient today can visit three different primary care offices for the same condition and receive five separate bills containing eleven different codes — three of which might overlap. Those bills will be confusing, delayed, and often contested. The administrative complexity of the current system imposes a tax on every patient interaction that has nothing to do with the quality of care delivered. That is not equitable. It is the existing standard.

RELATED STORY | TIMELINE OF INDUSTRY
History of Cash Only Healthcare Programs in America (1900s-Present Day)

Membership medicine, in its contemporary forms, offers something the traditional system rarely does: price transparency. Patients know what they pay, what they receive, and who they will see. That is not a privilege — it is what every patient in every income bracket deserves and rarely gets from their insurer.

Why are there so few young physicians choosing primary care or family medicine each year? We know the answer. The current system rewards volume over relationship and documentation over diagnosis. Membership medicine is one response to that structural failure — not the cause of it.

Consider the analogy plainly: we do not hold a Yeti cooler to a standard we do not apply to a Coleman. We do not hold a luxury hotel to an equity standard we do not apply to a budget motel. We do not debate whether it is fair that premium products exist alongside affordable ones. We understand that different price points serve different needs, and that competition and market evolution tend to drive costs down over time. Every premium healthcare model that attracts patients away from the traditional system creates pressure, competition, and ultimately more options for patients at every income level. That is not elitism. That is how markets correct for failure.

Myth 4: Concierge Medicine Is a Zero-Sum Game

The claim that concierge medicine diverts resources from underserved populations assumes that the physicians practicing in membership models would otherwise be serving those populations — and that their departure from high-volume practice creates a net loss for the healthcare system.

The evidence does not support either assumption. Many concierge and membership physicians continue to serve diverse patient populations, including lower-income patients. Many waive fees for elderly patients, allow installment payments, or maintain sliding-scale arrangements. Dr. D.B., a Vermont family practitioner who transitioned to a concierge model in 2013, described his approach directly: “I do house calls, deliver babies, and visit hospitals and nursing homes. I waive my annual fee for most elderly patients and allow others to pay in installments. This represents a modern medical practice grounded in traditional values.”

Membership medicine is, in most cases, a supplement to the broader healthcare system rather than a replacement for it. The question is not whether it creates a two-tiered system — that system already exists — but whether it adds value at the tiers it serves while allowing physicians to remain in practice rather than exit it entirely.

Myth 5: Luxury Healthcare Is Indefensible

The question of why luxury healthcare exists in a system that struggles with equity is a legitimate one. It is also, when examined honestly, a question about markets, not medicine.

The membership medicine landscape today spans a wide range of price points and service models. For clarity:

Classical Concierge / Bespoke / Ultra-High-End Programs: Typically $10,000 to $50,000 annually. Represent approximately 4% to 7% of total membership medicine physician offerings. Not intended to replace health insurance and do not cover hospitalization.

Contemporary Concierge Medicine (Most Common): The marketplace majority — approximately 70% to 75% of available options for patients today. Price points typically $100 to $750 per month. Primarily serving middle-income patients seeking more preventive care and a closer physician relationship. Many still accept insurance or Medicare for covered services.

Direct Primary Care (DPC): Not the same as concierge medicine, though frequently conflated. Monthly fees typically $8 to $99 per patient. Estimated 1,500 to 2,500 practices in the U.S. as of 2025. Most do not participate in Medicare or maintain payor relationships.

New products and services routinely enter the market at higher price points before becoming accessible to broader populations as competition increases and technology evolves. This is true of telemedicine, urgent care, and community health clinics — all of which began as premium or niche offerings before expanding access. Membership medicine is on the same trajectory.

As Dr. Bailey argued in CMAJ, the healthiest orientation for physicians is not selfless sacrifice — it is meaning. Physicians following their calling in models that work for them, their patients, and their communities are not problems to be solved. They are assets to be supported.

A Final Thought

Concierge medicine is not a problem to be solved in our healthcare marketplace. It is a response to it — a patient-centered, market-driven response to decades of advocacy by physicians for price transparency, reduced administrative burden, and the freedom to practice medicine with the time and attention it requires.

The market has changed. The criticism has not. And that gap — between what these models actually are and what their critics continue to claim about them — is itself a data point worth examining.

Every physician in this landscape deserves respect from peers for their differences and their shared values. They are practicing medicine differently. The medical community should never disparage the choices of doctors who take different paths from their own. As someone once put it: if someone is breathing, they need encouragement. The physicians navigating membership medicine certainly do.

It is no longer just about being the best doctor in the world. It is about being the best doctor for the world — for your patients, and for your local community.

Editor’s Note: Membership medicine models are not medical specialties and are not a replacement for, nor an insurance product. Physicians and patients considering these models should consult appropriate legal and compliance counsel.

Sources & Citations

1. Kaiser Family Foundation / Redi-Data, Inc. Active licensed allopathic (MD) and osteopathic (DO) physicians in the U.S. Special data request, January 2025. Total: approximately 1,101,735 licensed physicians; approximately 535,012 primary care physicians. Published by KFF: https://www.kff.org
2. Bodenheimer, T.S. & Smith, M.D. (2013). “Primary Care: Proposed Solutions to the Physician Shortage Without Training More Physicians.” Health Affairs, 32(11):1881–6. DOI: 10.1377/hlthaff.2013.0234. https://pubmed.ncbi.nlm.nih.gov/24191075/ — Note: the original article cited “Bodenheimer & Pham, 2010.” The correct verified citation for this research is Bodenheimer & Smith, 2013.
3. National Academies of Sciences, Engineering, and Medicine. (2019). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Citing Dyrbye et al. and Hamidi et al. on burnout-related attrition rates. https://www.ncbi.nlm.nih.gov/books/NBK552613/
4. Bailey, J. (2020). “Emphasizing altruism is problematic for physicians.” CMAJ, July 27, 2020; 192(30): E865. DOI: https://doi.org/10.1503/cmaj.76075. Full text available via PubMed: https://pmc.ncbi.nlm.nih.gov/articles/PMC7828916/
5. Medscape National Physician Burnout & Suicide Report (2020). Survey of over 17,000 healthcare professionals on cash-only, concierge, and direct-pay primary care model adoption. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460

Note: The original article cited “Trosman et al. 2019” and “Wheeler 2018” in support of concierge medicine improving physician-patient relationships and supplementing traditional care. Neither citation could be independently verified as published. The arguments they were cited to support are well-grounded in other verified literature including the MDVIP outcomes data and the PMC literature review cited in prior CMT articles. CMT recommends replacing these citations with verified sources before publication.

© 2007–2026 Concierge Medicine Today, LLC. All rights reserved. Concierge Medicine Today is the industry’s trade publication, established 2007. DISCLAIMER: This content does not constitute medical, financial, legal, or other professional advice. This content is not without error or omissions.