Paying for Enhanced Service

Comparing Patients’ Experiences in a Concierge and General Medicine Practice
  • Justin M. Ko
  • Hector P. Rodriguez
  • David G. Fairchild
  • Angie Mae C. Rodday
  • Dana G. Safran
Original Research Article


Background: Concierge medical practice is a relatively new and somewhat controversial development in primary-care practice. These practices promise patients more personalized care and dedicated service, in exchange for an annual membership fee paid by patients. The experiences of patients using these practices remain largely undocumented.

Objective: To assess the experiences of patients in a concierge medicine practice compared with those in a general medicine practice.

Methods: Stratified random samples of patients empanelled to each of the four doctors who practice at both a general medicine and a concierge medicine practice separately situated at an academic medical center were drawn. Patients were eligible for the study if they had a visit with the physician between January and May 2006. The study questionnaire (Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey, supplemented with items from the Ambulatory Care Experiences Survey) was administered by mail to 100 general medicine patients per physician (n = 400) and all eligible concierge medicine patients (n = 201). Patients who completed the survey and affirmed the study physician as their primary-care physician formed the analytic sample (n = 344) that was used to compare the experiences of concierge medicine and general medicine patients. Models controlled for respondent characteristics and accounted for patient clustering within physicians using physician fixed effects.

Results: Patients’ experiences with organizational features of care, comprising care co-ordination (p < 0.01), access to care (p < 0.001) and interactions with office staff (p < 0.001), favored concierge medicine over general medicine practice. The quality of physician-patient interactions did not differ significantly between the two groups. However, the patients of the concierge medicine practice were more likely to report that their physician spends sufficient time in clinical encounters than patients of the general medicine practice (p < 0.003).

Conclusion: The results suggest patients of the concierge medicine practice experienced and reported enhanced service, greater access to care, and better care co-ordination than those of the general medicine practice. This suggests that further study to understand the etiology of these differences may be beneficial in enhancing patients’ experience in traditional primary-care practices.

Supplementary material

40271_2012_2020095_MOESM1_ESM.pdf (117 kb)
Supplementary material, approximately 120 KB.


  1. 1.
    Stein M. Independent personal medical care. J Am Physicians Surgeons 2007; 12(1): 28–9Google Scholar
  2. 2.
    US Government Accountability Office. Physician services: concierge care characteristics and considerations for Medicare [report to Congressional Committees; GAO-05-929]. Washington, DC: US GAO, 2005 Aug [online]. Available from URL: [Accessed 2008 Feb 17]Google Scholar
  3. 3.
    Carter J. What makes a high-earning family physician? Fam Pract Manag 2005 Jul; 12(7): 16, 19-20PubMedGoogle Scholar
  4. 4.
    Glendinning D. Medicare trustees: gloomy forecast for physician reimbursement rates. Am Med News 2005 Apr 11 [online]. Available from URL: [Accessed 2008 Feb 17]
  5. 5.
    Brennan TA. Luxury primary care: market innovation or threat to access? N Engl J Med 2002 Apr 11; 346(15): 1165–8PubMedCrossRefGoogle Scholar
  6. 6.
    Landon BE, Aseltine Jr R, Shaul JA, et al. Evolving dissatisfaction among primary care physicians. Am J Manag Care 2002 Oct; 8(10): 890–901PubMedGoogle Scholar
  7. 7.
    Landon BE, Reschovsky JD, Pham HH, et al. Leaving medicine: the consequences of physician dissatisfaction. Med Care 2006 Mar; 44(3): 234–42PubMedCrossRefGoogle Scholar
  8. 8.
    Montgomery JE, Irish JT, Wilson IB, et al. Primary care experiences of medicare beneficiaries, 1998 to 2000. J Gen Intern Med 2004 Oct; 19(10): 991–8PubMedCrossRefGoogle Scholar
  9. 9.
    Murphy J, Chang H, Montgomery JE, et al. The quality of physician-patient relationships: patients’ experiences 1996–1999. J Fam Pract 2001 Feb; 50(2): 123–9PubMedGoogle Scholar
  10. 10.
    Murray A, Montgomery JE, Chang H, et al. Doctor discontent: a comparison of physician satisfaction in different delivery system settings, 1986 and 1997. J Gen Intern Med 2001 Jul; 16(7): 452–9PubMedCrossRefGoogle Scholar
  11. 11.
    LeClaire J. Is there a doctor in the house? Edward Goldman thinks patients will pay a premium for personalized preventive health care through membership in MDVIP. South Florida CEO 2006 Mar [online]. Available from URL: [Accessed 2008 Feb 12]
  12. 12.
    Safran DG, Karp M, Coltin K, et al. Measuring patients’ experiences with individual primary care physicians: results of a statewide demonstration project. J Gen Intern Med 2006 Jan; 21(1): 13–21PubMedCrossRefGoogle Scholar
  13. 13.
    Rodriguez HP, von GT, Chang H, et al. Patient samples for measuring primary care physician performance: who should be included? Med Care 2007 Oct; 45(10): 989–96PubMedCrossRefGoogle Scholar
  14. 4.
    Stata Statistical Software. Release 10 [computer program]. College Station (TX): StataCorp LP, 2007Google Scholar
  15. 15.
    Damberg CL, Raube K, Williams T, et al. Paying for performance: implementing a statewide project in California. Qual Manag Health Care 2005 Apr; 14(2): 66–79PubMedGoogle Scholar
  16. 16.
    Rodriguez HP, Anastario MP, Frankel RM, et al. Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention. BMC Med Educ 2008; 8: 3CrossRefGoogle Scholar
  17. 17.
    Tai-Seale M, McGuire T, Colenda C, et al. Two-minute mental health care for elderly patients: inside primary care visits. J Am Geriatr Soc 2007 Dec; 55(12): 1903–11PubMedCrossRefGoogle Scholar
  18. 18.
    Tai-Seale M, McGuire TG, Zhang W. Time allocation in primary care office visits. Health Serv Res 2007 Oct; 42(5): 1871–94PubMedCrossRefGoogle Scholar
  19. 19.
    Bodenheimer T, Laing BY. The teamlet model of primary care. Ann Fam Med 2007 Sep; 5(5): 457–61PubMedCrossRefGoogle Scholar
  20. 20.
    Yarnall KS, Pollak KI, Ostbye T, et al. Primary care: is there enough time for prevention? Am J Public Health 2003 Apr; 93(4): 635–41PubMedCrossRefGoogle Scholar
  21. 21.
    Ostbye T, Yarnall KS, Krause KM, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005 May; 3(3): 209–14PubMedCrossRefGoogle Scholar
  22. 22.
    Rodriguez HP, Rogers WH, Marshall RE, et al. The effects of primary care physician visit continuity on patients’ experiences with care. J Gen Intern Med 2007 Jun; 22(6): 787–93PubMedCrossRefGoogle Scholar
  23. 23.
    Rodriguez HP, Rogers WH, Marshall RE, et al. Multidisciplinary primary care teams: effects on the quality of clinician-patient interactions and organizational features of care. Med Care 2007 Jan; 45(1): 19–27PubMedCrossRefGoogle Scholar
  24. 24.
    Wagner EH, Reid RJ. Are continuity of care and teamwork incompatible? Med Care 2007 Jan; 45(1): 6–7PubMedCrossRefGoogle Scholar
  25. 25.
    Alexander GC, Kurlander J, Wynia MK. Physicians in retainer (“concierge”) practice: a national survey of physician, patient, and practice characteristics. J Gen Intern Med 2005 Dec; 20(12): 1079–83PubMedCrossRefGoogle Scholar
  26. 26.
    Sweeney J, Hausknecht D, Soutar G. Cognitive dissonance after purchase: a multidimensional scale. Psychol Marketing 2000 May; 17(5): 369–85CrossRefGoogle Scholar
  27. 27.
    Goroll AH, Berenson RA, Schoenbaum SC, et al. Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care. J Gen Intern Med 2007 Mar; 22(3): 410–5PubMedCrossRefGoogle Scholar
  28. 28.
    Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ 1995 May 1; 152(9): 1423–33PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Justin M. Ko
    • 1
  • Hector P. Rodriguez
    • 2
  • David G. Fairchild
    • 1
  • Angie Mae C. Rodday
    • 3
  • Dana G. Safran
    • 1
    • 3
    • 4
  1. 1.Department of MedicineTufts University School of MedicineBostonUSA
  2. 2.Department of Health Services, School of Public Health and Community MedicineUniversity of WashingtonSeattleUSA
  3. 3.The Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts Medical CenterBostonUSA
  4. 4.Blue Cross Blue Shield of MassachusettsBostonUSA
  5. 5.Department of MedicineSt Luke’s Roosevelt HospitalNew YorkUSA

Personalised recommendations