Are you exhausted by three-month appointment delays, followed by an hour in the waiting room—only to receive a perfunctory ten-minute consultation with your regular doctor? Infuriated by an automated system that loops you through “press 3 for refills” when you urgently need to speak with a nurse?
Concierge medicine may offer a compelling alternative.
Physicians in these models manage smaller patient panels sustained by retainer fees, enabling them to devote unhurried, meaningful time to each individual patient.
Yet, amid a persistent national physician shortage, does this approach remain ethically defensible?
If one views healthcare a right, the answer is no. If one prioritizes individual liberty and private contract, the answer is yes.
What Is Concierge Medicine?
Concierge medicine, also known as retainer-based care, establishes a direct relationship between a patient and, typically, their primary care physician, whereby the patient pays an annual fee or retainer. In exchange, physicians commit to enhanced services, including ample time and reliable accessibility for each patient.
While models vary in structure and nuance, the core principle remains: patients pay an additional fee for prioritized access and elevated care. This does not inherently reflect superior clinical expertise, but rather improved service delivery—expedited scheduling, longer appointments and often direct physician contact, such as personal cell phone access.
To sustain this model, concierge physicians maintain smaller patient groups overall and see fewer patients per day.
The Doctor Shortage
According to the Association of American Medical Colleges, the United States faces a projected physician shortfall of up to 86,000 by 2036, driven by population growth, aging demographics, and stagnant residency expansion. Compounding factors include pervasive burnout from administrative overload and declining reimbursements that discourage primary care careers.
Concierge medicine mitigates some—but not all—of the external administrative pressures. By design, it reduces administrative complexity, allowing physicians to dedicate more time to each patient. With fewer patients overall and reduced financial strain from volume-based reimbursement, practitioners gain greater professional autonomy and potentially lower burnout risk.
However, this relief comes at the cost of withdrawing capacity from the broader system, potentially intensifying access disparities amid an already strained workforce.
What Does Concierge Medicine Actually Mean For Patients?
Patients receive dedicated, one-on-one care and bypass many frustrations inherent in overburdened systems. From my own practice, patients grow weary of endless phone trees, opaque bureaucracies of “the system” and multiple potentially unreliable online portals. These are essentially customer-service failures.
For the community at large, however, concierge medicine carries realistic consequences: fewer physicians are now accessible, especially to those unable to afford annual fees of $2,000–$4,000, even for hospital-affiliated programs.
Concierge practices typically maintain panels of 400–600 patients, versus 2,000 in traditional settings. Conventional primary care physicians see 20 patients daily; concierge counterparts manage 6–10. This ensures exceptional access and continuity—for those who can pay and secure a position. For all others, the available physician supply contracts, widening disparities in an already stressed system.
Such tiered service is also deeply embedded within hospitals.
Hospital’s Concierge Medicine
Major nonprofit academic health systems are increasingly capitalizing on concierge medicine, leveraging it to cultivate a premium patient demographic within their ecosystems. This model draws affluent individuals—typically equipped with robust baseline insurance—who, in turn, generate high-value referrals for revenue-intensive interventions, such as neurosurgical procedures in brain and spine domains. For instance, Northwestern Medicine in Chicago operates a personal physician care concierge program, where members pay an annual fee for tailored primary care. Logically, this internal pipeline streamlines access to advanced services; a patient requiring, for example, intricate spinal surgery would benefit from seamless institutional coordination, expediting consultations and perhaps even smoother operative scheduling.
Medicare’s 2026 reimbursement for a single-level spinal fusion, under the inpatient prospective payment system, approximates $23,507 to $38,782—figures derived from diagnostic-related group (DRG) benchmarks for such procedures. These represent negotiated government rates, yet concierge enrollees, often holding superior commercial coverage, command reimbursements exceeding Medicare baselines, amplifying institutional margins. More elaborate spinal interventions routinely surpass $100,000, underscoring the model’s fiscal allure.
Medicare claims analyses reveal that concierge patients incur 30–50% higher program expenditures post-enrollment. Possibly empowered by prioritized access, patients pursue diagnostics like MRIs and CTs with greater alacrity—predominantly executed within the sponsoring system’s imaging suites, further concentrating revenue flows and perpetuating a stratified care paradigm.
Is Healthcare Is A Right? It’s Complex Question For Concierge Medicine
This is a profound philosophical and policy question that cannot be fully resolved here. It distills to the tension between positive and negative rights, and core principles of property ownership.
Can or should government compel physicians to see a certain number of patients? Can or should the government compel physicians to accept all insurance types? Can or should it prohibit tiered care, knowing such bans may contravene Rawlsian fairness? The “difference principle” allows inequalities only if they improve conditions for the least advantaged.
Many in medicine invoke “healthcare justice” within institutional halls, yet systems, grounded in reality, often operate otherwise.
UCLA, for instance, maintains a robust Office of Health Equity and Inclusive Excellence. Its mission, per the website, declares: “We are committed to anti-racism and antidiscrimination in our care and workplace. Our diverse perspectives make us stronger. We strive for excellence in our care delivery, workplace culture, and community partnerships. Every person who comes to UCLA Health deserves compassionate, world-class care.”
This ethos stands in contrast to UCLA’s Executive Medicine Concierge Comprehensive Care Program, which delivers elevated service to select patients, thereby illustrating the stratification inherent in healthcare delivery.
The program states: “Beginning with your first call, concierge services are provided by attentive executive liaisons. Individualized business-related consultative services including travel vaccinations, nutrition services and stress management counseling are also available.” Leadership adds: “The UCLA Comprehensive Health Program is a world-class program for annual executive health care, with a level of individualized service and attention second to none.”
This is a pragmatic scarcity issue. There aren’t enough doctors to provide everyone with world-class attention and care, so the wealthy secure increased access for a nominal fee. Many claim the medicine is the same and only the service differs, but anyone who actually cares for patients knows that’s not exactly how it unfolds.
UCLA is hardly unique. Most major hospitals maintain VIP wings or stratified care tiers.
Even more so, these world-class institutions, by definition, employ some of the world’s most expert surgeons. Who gets to see these surgeons? Are they compensated based on case type and equity or on revenue generation? When a flagship center—explicitly or implicitly—restricts its top talent from accepting lower-reimbursing plans like Medicaid, or ties surgeons’ compensation to collections, such policies are not equity-driven; they diminish access for lower-income patients. Access to surgery becomes the concierge medicine.
This is less an ideological stance than an identity choice shaped by pragmatic realities and systemic incentives.
Concierge Medicine And Primary Care
Many within medicine view concierge medicine as primary care’s effort to reclaim professional dignity. Adjusted for inflation, physician reimbursement has declined 33% since 2001.
Primary care physicians bear the brunt. They must see more patients for less revenue while sustaining staff, overhead, and the desire to deliver high-quality care—creating, to put it mildly, stress.
This tension is articulated incisively in Dr. Lisa Rosenbaum’s seminal New England Journal of Medicine article, which captures the physician’s yearning to practice free from external interference within the broader policy context..
Take-Home Point On Concierge Medicine
Robust debates persist about healthcare as a right. Yet concierge medicine reveals a deeper truth: both patients and physicians hunger for an unencumbered doctor-patient relationship—the very reason physicians enter medicine and patients seek care. Patients and physicians alike seek to minimize administrative intrusion into that sacred domain
