Physicians in retainer (“Concierge”) practice

A national survey of physician, patient, and practice characteristics


BACKGROUND: Retainer practices represent a new model of care whereby physicians charge an up-front fee for services that may not be covered by health insurance. The characteristics of these practices are largely unknown.

DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional mail survey of 144 retainer physicians (58% response rate) and a national random sample of 463 nonretainer physicians (50% response rate) to compare retainer and nonretainer practices. Outcomes of interest included physician demographics, size and case-mix of patient panel, services offered and, for retainer practices, characteristics of practice development.

RESULTS: Retainer physicians have much smaller patient panels (mean 898 vs 2303 patients, P<.0001) than their nonretainer counterparts, and care for fewer African-American (mean 7% vs 16%, P<.002), Hispanic (4% vs 14%, P<.001), or Medicaid (5% vs 15%, P<.001) patients. Physicians in retainer practices are more likely to offer accompanied specialist visits (30% vs 1%), house calls (63% vs 26%), 24-hour direct physician access (91% vs 40%), and several other services (all P values <.05). Most retainer physicians (85%) converted from nonretainer practices but kept few of their former patients (mean 12%). Most retainer physicians (84%) provide charity care and many continue to see some patients (mean 17%) who do not pay retainer fees.

CONCLUSIONS: Despite differences between retainer and nonretainer practices, there is also substantial overlap in services provided. These findings, in conjunction with the scope of patient discontinuity when physicians transition to retainer practice, suggest that ethical and legal debates about the standing of these practices will endure.

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Corresponding author

Correspondence to Dr. G. Caleb Alexander MD, MS.

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The authors have no conflicts to declare.

See editorial by Troyen Breennan, p. 1190

This research was supported by the Institute for Ethics at the American Medical Association, the Robert Wood Johnson Clinical Scholars Program, and the MacLean Center for Clinical Medical Ethics. The funding sources had no role in the collection of the data, analysis, interpretation, or reporting of the data or in the decision to submit the manuscript for publication. This research was presented at the Society for General Internal Medicine Annual Meeting, Chicago, IL, May 2004, and New Orleans, LA, May 2005.

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Alexander, G.C., Kurlander, J. & Wynia, M.K. Physicians in retainer (“Concierge”) practice. J GEN INTERN MED 20, 1079–1083 (2005).

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Key Words

  • access to care
  • retainer
  • concierge
  • boutique
  • ethics