First off, consider yourself blessed if you’re part of the growing community of practicing doctors who left the insurance nightmares behind. You’re going to have a lot on your plate now, even at less than maximum patient capacity. You’ve got to get your head around new billing processes, new responsibilities (like answering the phone and scheduling your own appointments) and most likely, a new office. However, you’ll want to prepare yourself for some serious patient expansion around the 18-month mark.
So how much expanding should you do to your patient roster? The magic number that we hear quoted is 400 to 600 patients per concierge doctor. This is a rough/fair starting point. Ultimately, it depends on the type of practice, the type of medical specialty, and your goals as a physician.
Here’s an example to get you thinking as a specialist: An endocrinologist we spoke to in California sees two types of patients, diabetics — Type-I (juvenile) and Type-II — and also people who need human growth hormone. In his case, he wants to transition to concierge medicine. Speaking with him, he told us he would likely see 300-600 human growth hormone patients, since he actually only needs to see each patient once a year at most, and for only a few minutes each time. However, since diabetics in a concierge model will need different intensities of care (new diagnoses versus patients accustomed to their condition), he wants to differentiate his costs for each type of diabetic. He’s considering charging a premium rate for children with juvenile diabetes—parents will need major guidance in light of the tedious care they must help administer; couple that with inherent difficulties managing the condition during youth because of hormone variations, social pressures, etc. He is also considering charging more for adult diabetics during their first 3 months with the disease, when they will require focused care and start developing management techniques.
Again, this leaves the question of how many diabetics would he see? The deciding factor will lie in what he charges for a subscription. The more he charges, the fewer patients he needs to see to reach a comfortable salary, and the more time he can spend with each patient. However, he will also need to consider who can afford to pay each rate. His goal should be to offer his service at a price that dissuades needing a high cost PPO at all, otherwise only the wealthy will be able to take advantage of his straightforward, high-quality care.
As for us here at Atlas MD, where we’re practicing family medicine, we’ve chosen 600 patients as our cap. It provides each doctor with an admittedly handsome salary, and the ability to provide exceptional quality of care to every patient. In our experience, any more heads into that dreaded territory where we feel like we’re running a patient factory again. That’s an ironic twist of fate we’re committed to avoiding.