Ask any longtime patient what frustrates them most about seeing a doctor and you'll hear some version of the same story: a three-week wait for an appointment, a rushed ten-minute visit, and a physician who barely looks up from the computer screen before writing a referral. It's not that doctors don't care. Many of them are boxed into a system that rewards volume over attention, and it's pushing more and more of them out the door.
That exodus has a name: concierge medicine. Over the past two decades, a growing number of primary care physicians have walked away from insurance-based practice altogether, choosing instead to build smaller patient panels supported by a retainer fee rather than a fee-per-visit insurance model. The shift isn't about avoiding hard work. It's about wanting to practice medicine the way most doctors imagined they would when they went to medical school in the first place.
Dr. Kenneth Redcross, M.D., founded Redcross Concierge in 2005 after years of watching insurance-based practice squeeze both the doctor-patient relationship and the time it takes to actually practice good medicine. He's spent more than two decades building that alternative and has talked about it on national television, including appearances on The Doctors, The Insider, and E! Entertainment Television. If you're new to the concept, our guide on how concierge medicine works for patients walks through the basics. The more interesting question, if you're weighing whether to make the switch yourself, is why so many physicians are choosing this path in the first place.
Why Are So Many Doctors Moving to Concierge Medicine?
Most doctors move to concierge medicine because insurance reimbursement rates force them to see 20 to 30 patients a day just to keep the lights on, leaving only a few rushed minutes per visit. A retainer-based model flips that math, letting physicians see far fewer patients while spending real time on each one.
The economics are blunt. Under a typical insurance-based practice, a primary care physician needs a large patient panel, often 2,000 patients or more, just to cover overhead, billing staff, and declining reimbursement rates. That pressure trickles straight down to patients in the form of rushed exams and delayed callbacks. Doctors who leave that model for concierge care typically cut their patient panels down to a few hundred, which is what makes 24-7 access and same-day appointments possible instead of a three-week wait. In our own practice, that smaller panel is what allows house calls and work calls, not just office visits, to stay part of the deal.
What Is Concierge Medicine, Exactly?
Concierge medicine, sometimes called retainer-based or membership medicine, is a model in which patients pay a physician's practice directly for enhanced access rather than relying solely on a fee charged per insurance-billed visit. It sits alongside your existing health insurance plans rather than replacing them, since the retainer covers access to your doctor, not the cost of labs, specialists, or hospital care. Research on the model traces its growth directly to physician dissatisfaction with high-volume, insurance-driven practice, a pattern documented in the peer-reviewed literature on the direct primary care and concierge medicine model, and that dissatisfaction is exactly what's driving the trend we opened with.
How Concierge Medicine Actually Works
The mechanics are simpler than the debate around them suggests. A physician caps their patient panel, often at 300 to 600 patients instead of the 2,000 to 3,000 typical in an insurance-based practice, and charges each patient an annual or monthly retainer for the access and time that smaller number makes possible. The fee covers the relationship itself: same-day scheduling, longer visits, and direct phone or email contact with the physician instead of a nurse line or answering service.
"A growing number of physicians are opting out of the traditional insurance-based system altogether, trading larger patient panels for smaller, retainer-based practices that let them spend more time with each patient."
— Forbes
That trade shows up most clearly at the yearly checkup. Instead of a 20-minute visit built around insurance billing codes, an in-depth annual physical exam in a concierge practice typically runs closer to an hour, with room for a real conversation about stress, sleep, family history, and lifestyle instead of just vitals and a referral slip.
How Does Concierge Medicine Work With Insurance?
Concierge medicine and insurance operate side by side rather than one replacing the other. The retainer fee covers access and time with your physician, not the cost of labs, imaging, specialist visits, or hospital care, so most patients keep their existing health insurance plans and treat concierge membership as a layer on top, not a substitute.
This is where the confusion tends to creep in. A retainer fee isn't an insurance premium, and it isn't submitted to any carrier for reimbursement. It's a direct payment for a different kind of relationship with your doctor. You'll still want solid major medical coverage for anything beyond primary care, the same way you'd compare car insurance quotes from Progressive or Farmers before renewing a policy, or weigh a term life insurance option against your family's actual needs instead of taking the first auto insurance or car insurance rate you're offered. Comparing coverage and cost is smart. It's just a separate decision from whether concierge care fits your day-to-day healthcare.
We go much deeper into billing, out-of-network coverage, and what your carrier will and won't pay for in our breakdown of how concierge medicine and health insurance interact. The short version: keep your insurance, add the membership, and use each for what it's actually good at.
How Does Concierge Medicine Work With Medicare?
Medicare patients can join a concierge practice. The retainer fee is a separate, non-covered administrative charge for access and amenities, while Medicare continues to pay for covered medical services exactly as it would anywhere else, as long as the physician remains a participating Medicare provider.
Some concierge physicians opt out of Medicare entirely and bill patients directly under a private contract. Others stay enrolled and simply add the membership fee on top for the concierge-specific extras: same-day visits, longer appointments, and direct phone or email access. It's worth asking any practice you're considering which structure it uses, since that changes what Medicare will and won't reimburse.
What Does a Concierge Membership Actually Include?
Every practice structures its retainer a little differently, so it pays to read the fine print before you sign on. Most well-run concierge practices, ours included, build the membership around a handful of core services:
- 24-7 direct access to your physician by phone or email, not an answering service or on-call rotation
- An in-depth annual physical exam that goes well beyond a standard insurance-covered checkup
- Same-day or next-day appointments with real visit time, not a rushed ten-minute slot
- House calls and work calls for patients who can't easily get to an office
- Coordinated specialist referrals, with the physician managing the handoff instead of leaving you to navigate it alone
- Preventive and wellness-focused planning, including stress management and sleep guidance
- Access to integrative or homeopathic treatment options for patients who want them
What it typically does not include is the cost of labs, imaging, prescriptions, specialist visits, or hospitalization. That's still billed through your insurance or paid out of pocket, which is exactly why the membership and your coverage need to work together instead of in place of each other. We break down the exact line items, and the ones patients are most often surprised by, in our guide to what's actually included in a concierge medicine membership.
Concierge Medicine Pros and Cons
Concierge medicine isn't the right fit for everyone, and any physician who tells you otherwise probably isn't being straight with you. The honest picture has real trade-offs on both sides.
On the upside, patients get a caring, trusting relationship with a physician who actually knows their history, same-day access instead of a multi-week wait, and a customized approach to care that accounts for work travel, stress, and family history instead of treating every visit like a checklist. For patients managing something chronic, like heart disease or diabetes, that continuity can catch small changes before they become emergencies.
On the downside, the retainer fee is a real cost on top of whatever health insurance plans you're already paying for, typically somewhere between $1,500 and $5,000 a year depending on the practice and the services bundled in. That's out of reach for some households, and if you're generally healthy, rarely see a doctor, and don't mind waiting for appointments, a traditional insurance-based practice may serve you just fine. We'd rather say that plainly than pretend concierge care is the answer for every patient who walks through the door. If you want the full cost comparison, we laid it out in detail in our breakdown of what patients really pay in concierge medicine versus traditional primary care.
What Is the Real Problem With Concierge Medicine?
The most common criticism is access: when a physician shrinks their patient panel from a few thousand down to a few hundred, the patients who don't join have to find care somewhere else, and in areas already short on physicians that can strain an overstretched system. It's a legitimate concern, and a responsible concierge practice should be transparent about it instead of pretending it doesn't exist.
Critics also point out that retainer fees create a two-tier system where attentive care goes to whoever can pay for it, a fair critique of the model in general even when it doesn't reflect how any one practice operates. The physicians who do this well don't disappear on their existing patients or treat the switch as a shortcut. They use the smaller panel to actually deliver on what a doctor-patient relationship is supposed to look like, exceptional bedside manner included, not just a smaller number on a spreadsheet.
"Building an ongoing relationship with a primary care physician, one who knows your history and can spot changes over time, is one of the most effective ways to catch health problems early and manage chronic conditions before they become serious."
If the cost or the model doesn't fit your situation, that's worth saying out loud too. Direct primary care clinics, community health centers, and even a well-chosen traditional practice with a doctor you trust can all deliver solid, attentive care. Concierge medicine is one good option among several, not the only path to being well cared for.
What to Expect After You Switch
Patients who move from an insurance-based practice to a concierge model usually notice the access difference within the first week. Same-day scheduling and a doctor who actually answers the phone tend to stand out immediately. The deeper value builds over months, not days.
Expect your first visit to run long, often 60 to 90 minutes, as your physician works through a full history instead of the abbreviated version most insurance-based visits allow. Over the following three to six months, that groundwork usually turns into a genuinely proactive plan: updated screenings, a real look at stress management and sleep, and a physician who's already thinking about your next physical before you've scheduled it. We've watched this pattern hold over more than two decades in practice, and it shows up in the numbers, too: our patient satisfaction has stayed above 95%, according to data reported in the Journal of Medical Practice Management. The relationship, not any single visit, is what ends up mattering most. Sleep is one of the areas we address early with almost every new patient, and if you want a closer look at why, our guide on why quality sleep is your best medicine covers the specifics.
For a closer look at how a concierge visit actually differs from a typical office visit, this short video walks through what direct access and a customized approach to care look like in practice.
Questions to Ask Before You Switch to Concierge Care
Not every concierge practice operates the same way, so a little due diligence goes a long way before you sign a retainer agreement. A few things worth asking upfront:
- How many patients does the physician actually see, and how does that compare to a typical insurance-based practice?
- What's included in the retainer, and what still gets billed separately to your insurance?
- Is same-day or 24-7 direct access truly direct, meaning the physician's own phone or email, not a call center?
- Does the practice coordinate specialist referrals, or are you still on your own to schedule and follow up?
- What happens to your care if you cancel the membership mid-year?
- Can you talk to a current patient about their actual experience before committing?
The doctors leaving insurance-based practice aren't walking away from medicine. They're walking back toward the version of it that actually works: personalized healthcare, direct access, and a physician who has the time to notice when something's off before it becomes an emergency. Concierge care isn't a decision to make based on hype. It comes down to your health, your budget, and how much you value having a doctor who already knows your name when you call, and if that sounds like the trusted care you've been missing, it's worth a conversation to see what a customized approach to your health could actually look like.