Man walking by forest path

When I began medical school in 2002 I wanted to be a transplant surgeon. I loved the idea of being able to undertake large, complex operations that bring life-saving results. One day in my 3rd year of medical school, upon arising at 4:45 am to do OB post-partum rounds I said to myself, “I’m never going to voluntarily get up this early for work again.”

Now I work for myself as the founder of Echelon-Health, a concierge medicine practice in Wesley Chapel, Florida. I can truly say I am doing what I was born to do. Going to ‘work’ doesn’t even feel like a job. I have been blessed to do something that I love, and have people pay me to do it.

So what do I do? As a concierge medicine physician I am an advocate, physician, and friend to my patients. We call our patients ‘members.’  A yearly membership includes all office visits, procedures, and routine in-office medications. We provide our patients with wholesale pricing on labs and medications. They pay what we pay.

Since we do not accept insurance payments we are free from the burden of coding, prior authorizations, and all other associated overhead seen in a typical primary care practice. We are free to spend all of our time with the patient.

As a concierge medicine physician, I am part of a larger group of practitioners of Membership Medicine. Membership medicine includes concierge medicine physicians, direct primary care physicians (DPC), and nurse practitioners and physician assistants of both. The difference between concierge medicine and DPC is a somewhat murky one. Some say that concierge medicine is for the ‘rich’ since the monthly membership fee is usually greater than $120/month and DPC is more economical because fees are often $50-75/month.

Because some concierge medicine doctors also bill insurance, critics say concierge medicine doctors are just providing an ‘add-on luxury’ package to insurance.  However as time goes on, the difference between DPC and non-insurance billing concierge medicine physicians will become less about operations and more about branding and style.  Concierge medicine tends to have higher cost and more amenities compared to lower cost and higher volume DPC.  DPC practices typically have 600-800 patients while concierge medicine practices may have only 300 or fewer members.

For sure membership medicine is not without detractors.  It’s called elitist, discriminatory, and worse. I’ve been told that I am ‘unethical’ more than once.  Most of the criticism revolves around the payment of doctors directly (without insurance playing a role), the cost of the membership, and the perception that it is worsening the ‘doctor shortage.’ While many of these arguments are based on personal preference (should I pay for a private doctor or see an ‘in-network doctor, how much is a membership worth to me?) the ‘doctor shortage’ argument is easier to address with numbers.

It is true that a membership medicine doctor’s panel is dramatically smaller than that of a typical insurance-based primary care physician (300-800 vs 2500-5000).  But, membership medicine allows the doctor to be more flexible and efficient. Without the burden of insurance and the need to generate codes to be paid, a physician can handle many issues through email, text, or cell phone. We can even do video visits. At Echelon-Health, we utilize AtlasMD for our electronic medical record. It allows us to do all of this telemedicine without leaving the chart. Also, the reasons for the doctor shortage in primary care is due to poor job satisfaction and relatively low pay.  We don’t have that problem in membership medicine and as more students are exposed to it, the more they will choose primary care. Primary care shortage solved.

The future of membership medicine is exciting. One of the pillars of healthcare reform needs to be a return to consumer directed health care. Membership medicine is destined to grow as a result of the dwindling attractiveness of insurance-based primary care medicine and the desire of patients to have a more robust relationship with their physician.  I am very happy to be involved in sports and family medicine as a solo practitioner and even happier to do it as a concierge medicine physician.

Ask Dr. Tommy

Tommy McElroy, MD
President of Echelon-Health
Medical Director of MedFirst Partners
Host of the Dr. Tommy Show

Echelon-Health.com

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