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What are your patients actually paying for when that membership fee comes out of their account every month?
If you run a concierge or direct primary care practice (or you’re thinking about moving to one), you’ve probably spent plenty of time on the questions everyone asks first:
- what patients will pay,
- how many visits are included,
- how much time they get with the physician, and
- how much access they get to you versus your staff.
Those are good questions, and they’re where many physicians get stuck. The question almost nobody asks, and one I rarely hear come up when I talk with physicians who run these practices, is what exactly patients are paying extra for.
Most physicians assume the answer is obvious, because patients pay a premium to see the doctor. I’d like to challenge that, because if you’ve never checked it against what your patients actually value, it may be the reason your growth is stuck, stagnant, or taking far longer than it needs to.
Two practices with the same problem
I recently sat down with an endocrinologist I know both personally and professionally. He moved his practice into a subscription model about 3 years ago, so I asked him what his biggest business struggle was right now.
“Frankly, it’s filling my PA’s schedule,” he said.
When I asked why he thought that was, he told me, “People are paying money to come and see me. They’re not paying money to come and see her.”
So I asked whether that was actually true, or just a belief he held. That stopped him in his tracks, because he’d never considered it might be a belief, not a fact.
Not long after, I met the owner of a direct primary care practice that had been running on a subscription model for about 10 years. (I told him he was way ahead of the curve, and he said, “Yeah, but it’s been really slow growth.”) They had just added a PA, and you can probably guess where this is going, because they couldn’t fill her schedule either. Without any prompting from me, he explained that their plan was to lower the membership fee for patients who saw the PA.
My jaw just about hit the floor, which I suspect was his first clue that discounting the membership might not be in his practice’s best interest.
I asked him the same question I’d asked the endocrinologist: “Is it true that your patients won’t pay the full membership to see someone other than the doctor, or is that an assumption you’ve made?” He looked at me and said, “I don’t know. I never thought to ask.”
What practices usually try
If you’re a newer concierge practice that couldn’t bring your previous patients with you, growth probably feels like a slog. If you’re more like these two physicians, the doctor’s calendar is full, and the person you brought on to help has an open calendar. Either way, the usual path looks familiar. You research what competing practices offer, conclude patients will only pay extra to see the doctor, and decide the answer is to recruit another physician as fast as you can.
That’s rarely easy. Convincing a physician to leave a stable position for a concierge model comes with plenty of trepidation, and many physicians lack the business background to succeed without extra support and a team behind them. The logic that patients pay a premium and therefore expect physician access holds up as far as it goes, but it skips a more useful question.
What patients actually pay for
Look at what people pay a monthly fee for outside of medicine. Amazon Prime members pay for faster delivery, easier returns, and streaming, but nobody pays for access to a particular Amazon employee. Inside healthcare, people pay out of pocket for telehealth, weight-loss programs, chiropractic, acupuncture, functional medicine, and med spas, often hundreds of dollars at a time, for care their insurance doesn’t cover.
Weight loss is a good example. The WeightWatchers clinical membership runs from $74 a month on an annual commitment to $149 a month on a month-to-month plan, and the medication is billed separately on top of that. Members get a clinician, registered dietitians, and lifestyle support, and nobody who signs up expects to pick a specific person. They’re paying for the result.
When I look at what patients are really buying in a membership, it tends to fall into a handful of categories:
- Access to someone who can support them when they need it
- Responsiveness from the practice
- Continuity, knowing the same team will always be there
- Convenience, including care coordinated under one roof
- Expertise and more time than a traditional visit allows
- Help navigating a problem traditional medicine hasn’t been able to solve
- A proactive partner in their health, rather than a place to go only when something is wrong
Almost none of those point directly to the physician relationship. The endocrinologist’s office, for example, does a great job of letting patients know when the doctor will be out for the holidays or on vacation, and that the team will still handle prescriptions and anything else that doesn’t need his input. They offer in-house lab work, so patients don’t have to make a second trip somewhere else. The team greets people by name when they walk in. Patients value all of that, and none of it requires the doctor to be in the room.
The benefit he only mentioned once
The endocrinologist had another advantage he didn’t highlight well. His membership includes access to a nutritionist and a trainer in his community who can support patients with nutrition and exercise. My son is a patient at his practice, so I asked him why this was the first time I was hearing about it. He paused, and I don’t think it had ever occurred to him that people were paying for this.
That benefit puts his practice head-to-head with consumer programs like WeightWatchers and Noom. His membership is close to $200 a month, and it includes an endocrinologist, in-house labs, a care team that knows patients by name, and nutrition and fitness support. When I pulled up a weight-loss program’s website and showed him what patients pay there and what they get for it, the light went on because his membership offered more.
Then I asked the question that really landed. Many of his patients are managing diabetes, and GLP-1 medications are a big part of his practice. If people are only paying to see him so they can get a GLP-1, how does he explain the people who pay a monthly membership, on top of their medication costs, for a program where they never speak with him? They aren’t paying for the doctor; they’re paying for the result, and he’d been talking as though he was the result.
His medical knowledge absolutely matters, especially for patients dealing with more than their weight. What most of them need from him is his education and experience around rebuilding their lifestyle, so that when they stop taking the medication, the health challenges they have today don’t come right back. His team can carry much of that knowledge too, with access to him when a question genuinely needs his input.
3 reasons your PA’s schedule isn’t full
- The physician is right, and patients see the PA as a downgrade. If your membership promises that patients will always see the physician, that’s not a patient problem; it’s an offer design problem. Your offer needs a revamp, and your patients need to be re-educated about how the practice is moving forward. That conversation isn’t always easy, but it can be positive and a chance to promote everything else the membership includes.
- Nobody has introduced the PA effectively. Many patients don’t even know what “PA” stands for. When the front desk says, “Dr. Smith is booked out through November, but we can get you in with his PA tomorrow,” and offers no explanation of the PA’s training or how their care compares, you’ve essentially told the patient that option A isn’t available, but option B is. Nobody wants option B when they’re paying extra for option A. When the team explains that the PA can handle the same visit and will bring the doctor in if needed, the conversation changes completely.
- The practice doesn’t really trust the PA. Sometimes the physician wants to share the load but has a bit of a control issue. It shows up as every follow-up landing on the doctor’s calendar, a physician who never introduces the PA to patients, marketing that centers entirely on the doctor, a website that barely explains the PA’s expertise, and staff who aren’t sure which visits the PA can take. That’s a communication problem, not a patient problem, and definitely not a subscription problem.
Language plays a bigger role here than most physicians realize. Physicians are very smart and love their medical terminology, and patients often don’t understand much of what they’re hearing but won’t say so, because admitting it makes them feel dumb. If you can’t explain the difference between you and your PA at about a 7th-grade level, that alone may be why people won’t book with the PA or stay with your practice.
What this is costing your practice
For the endocrinologist, the stakes are personal; he wants to sell his practice and retire in the next 5 to 7 years, so I asked what happens to that plan if patients pay only because he’s the doctor. A practice whose entire value walks out the door with its founder isn’t very sellable to another physician. Making the transition possible means opening up the conversation about everything else the membership offers, and bringing in a physician who shares his beliefs about patient care, not just his specialty.
If the belief that patients only pay for the physician goes unchallenged, the costs stack up quietly:
- The physician stays overloaded, and the wait for an appointment grows as the practice gets busier, until some patients go somewhere else.
- The PA stays underused, and the practice pays for capacity it never fills.
- The doctor works longer days, nights, and extended clinic hours, which erases the reason they moved into concierge medicine in the first place: getting some of their time, life, and sanity back.
- Members cancel, and at roughly $200 a month, every member who leaves takes about $2,400 a year with them.
One of my business mentors taught me that the reason someone gives out loud is almost never the real reason. When a patient says the membership costs too much, what they’re really saying is that they don’t see the value in paying an extra $200 a month. Every membership, from Amazon Prime to the car wash, depends on members continuing to feel that value, and medicine is no different.
Your 3-Step Action Plan:
You don’t have to fix the entire system at once, but you can take action in the right direction.
Test the belief.
Instead of having your team ask, “Would you mind seeing our PA?”, start gathering information:
- How often patients are offered the PA, how many accept, how many decline, and why they decline
- Whether the appointment type changes whether patients accept
- Whether new or existing patients are more likely to decline
- Which appointment types go to the doctor versus the PA, and whether complex visits are being offered to the PA when routine or follow-up visits would be a better fit
You’ll probably discover that your team doesn’t have a clear system for which appointments go to which provider. Once it does, the doctor’s schedule opens up for new patients, the PA’s calendar fills with visits that are right for them, and you have room to add another PA or physician when you’re ready to grow.
nd, for 1 week only, write down every place work stalls. Don’t fix anything yet. Look for:
- Spots where someone consistently has to step in because part of the process is broken, like a staff member outside the authorization team chasing an authorization
- Where people are waiting for answers, how long they wait, and what a reasonable wait would be
- Where work piles up that nobody gets to
- Every situation where the doctor becomes the final say or the fix, which is one of the clearest indicators of why your physicians feel burned out
- Every time someone says “only Sarah knows how to do that” (fill in your own Sarah)
At the end of the week, choose the single biggest bottleneck, the one with the bright red box around it that kept showing up, and only that one.
Ask your patients what they're paying for.
New members often get buried in features at their first visit. It’s like buying a new car; you get shown every feature under the sun and then can’t remember how to turn on cruise control on your first road trip (and you don’t go back to the dealership; you look it up on YouTube). By the time a new member leaves that first appointment, half of what you told them has walked out the door, and they’ll never remember the other half. Asking gives you facts, not guesses. You might hear things like:
- “We want to see Dr. Smith specifically.”
- “We can get in the same day when we don’t feel well.”
- “We love virtual visits, because when we’re sick, we don’t want to leave the house.”
- “My provider spends more time with me and asks the questions my previous provider never had time for.”
- “I know everyone on the care team, and they’re all invested in my health.”
- “They help me be proactive instead of only seeing a doctor when something is wrong.”
Use those answers to align your offer and your pricing with the value patients actually perceive, and to improve how you talk about the benefits you already have. (For the endocrinologist, that nutritionist and trainer access deserves a lot more airtime.)
Transfer trust before you transfer patients.
Before sending patients to the PA, the physician should make the introduction personally, with something like: “I’m always happy to see you, and my PA often has better availability. I’d love for her to help with your follow-up visits, or answer your questions on the app when I’m on vacation.” Then reinforce it everywhere, including your website, your scheduler, your other providers, your membership onboarding, and how you describe follow-up care, so patients know their care won’t be diminished in any way.
Your patient messaging app is a great place to start. Many concierge practices offer text or instant-message access, and some patients join for that benefit alone, because it beats searching WebMD. Let the PA start answering those questions, introduce herself, and pass along anything that needs the doctor. You’re not replacing the physician; you’re expanding the care team around the patient, and that more than justifies the membership fee.
This was never really about PAs
This episode isn’t really about PAs, or even about concierge medicine. It’s about the assumptions every practice (or business) makes about the people it serves. If you run an accounting firm that includes a QuickBooks review for every new client, and half of your clients don’t use QuickBooks, what are you really providing? When you take the time to find out where people actually are and meet them there, you serve them better in a way that costs you less time, less money, and a whole lot less frustration.
If you’d like an outside perspective on what’s actually holding your growth back, that’s exactly why I designed the Growth Review Call. Together we’ll uncover the biggest challenge in your practice, what’s really causing it, and a 3-step plan to fix it, which might be as simple as filling your PA’s calendar without overhauling your entire practice. Book your Growth Review Call with the link below.
Find Out Where Your Practice Growth Is Stuck
If you don’t have an outside perspective on your practice, that is exactly what I provide during a free 20-minute Growth Review. Together, we will identify your practice’s biggest growth challenge so you know where to focus your energy to eliminate it.
Do the Math for Your Practice
Download the free worksheet that walks you through exactly how to find these numbers, calculate your referral completion rate, and see the revenue impact specific to your practice. The free worksheet takes about five minutes to complete.
About the Author
Alisa Conner is a Strategic Growth Advisor who helps independent medical practices and professional service organizations find where their growth is stuck and empower their teams to run efficiently, so owners can focus on serving the people they want to serve. She hosts The Profit Loop, a weekly podcast and YouTube series, and is based in Boulder, Colorado.
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Frequently Asked Questions
Will concierge medicine patients see a physician assistant?
Many will, when the PA is introduced well. Patients most often decline when the PA is offered as a fallback (“the doctor is booked, but the PA is available”) without explaining the PA’s training or how their care compares. A personal introduction from the physician and clear messaging across the practice can change that answer.
Why isn't my PA's schedule filling up?
The 3 most common reasons are an offer that promises patients will always see the physician, a PA who has never been properly introduced to patients, and a practice that routes every follow-up to the doctor out of habit or a reluctance to let go. Tracking how often you offer the PA, who accepts, and why people decline will show you which one applies.
Should I lower the membership fee for patients who see the PA?
Test the belief before you discount anything. Ask patients what they value about the membership. Most memberships deliver access, responsiveness, continuity, and convenience that have little to do with which provider is in the room, and discounting signals that the PA is a lesser option.
How do I find out what my patients are paying for?
Ask them directly with a short survey or in conversation what made them join and what keeps them. Their answers let you base your offer, your pricing, and your messaging on facts instead of assumptions.
What does a concierge membership include beyond access to the physician?
It depends on the practice, but common benefits include same-day or next-day access, virtual visits, messaging with the care team, in-house labs, care coordination, longer visits, and wellness support such as nutrition or fitness guidance. Many practices mention benefits once and never communicate them again.