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You call your doctor’s office and the first opening is a month out. When you finally get there, you have fifteen minutes — five of them, maybe, on the problem that brought you in. And on the day you’re actually sick and need to be seen, you often end up with whoever is free rather than the physician who knows you.

Concierge medicine promised a way out. Pay an annual fee — often a few thousand dollars — and you buy back the one thing modern primary care has squeezed out: time with an excellent doctor, and easy access when you need it. Same-day visits. A cell number. Someone who remembers your history because they aren’t juggling two thousand other patients.

When I first talked about this on the podcast, I described it as a reasonable option for people who couldn’t find a doctor willing to spend time with them. My own brother sees a concierge internist and is thrilled with the care. So let me be clear up front: the original idea is a good one.

But the field has changed, and the label now covers a far wider range of things than it used to. That’s worth understanding before you write a check.

Where it came from — and where it’s going

Concierge medicine started with a simple frustration. Experienced internists decided that twenty minutes per patient wasn’t the kind of medicine they wanted to practice. So they shrank their panels — often from around 2,000 patients down to 300 to 500 — charged a retainer, and traded volume for depth. In exchange, patients got same-day appointments and the ability to reach their doctor by text, email, or phone.

The numbers show how fast that quiet idea became an industry. Between 2018 and 2023, the number of concierge and direct primary care practices grew by 83 percent. Over the same stretch, corporate-affiliated practices grew by 576 percent. And the share of these clinicians who are physicians dropped — from about 67 percent to under 60 percent — as nurse practitioners and physician assistants moved in. What began as seasoned doctors opting for a slower pace is increasingly a for-profit, corporately owned business.

Some of that growth reflects a real and worsening problem. The country is projected to be short roughly 86,000 primary care physicians over the next decade. When good doctors are scarce, a model that promises access to one is going to sell.

The concern is what’s being sold alongside the access. Increasingly the pitch comes wrapped in slick marketing and leans heavily on hormones, “longevity,” and functional-medicine protocols — long menus of tests, supplements, and treatments. That is a very different product from the attentive internist who simply has time to listen.

What the evidence shows

Here the research points in two directions at once.

On satisfaction, concierge patients are clearly happier. A systematic review found the model delivers significantly higher patient and physician satisfaction — but also noted there’s limited evidence that it improves clinical outcomes. The first half of that sentence is easy to believe. More time and better access feel better, and that’s a real benefit.

Feeling well cared for, though, is not the same as living longer or being healthier. On that question, the best study we have is sobering. Researchers followed Medicare patients whose doctors switched to concierge practice and tracked their spending and their survival. Spending rose sharply — by as much as 50 percent. Mortality didn’t budge. Patients paid more and received more care, yet were no less likely to die.

That is the tension at the heart of this. More time with a good doctor should mean better decisions. But more time can also mean more testing, more incidental findings, more follow-up that leads nowhere useful. The fee can buy you better judgment. It can also just buy you more medicine.

Four questions before you sign up

None of this makes concierge medicine a bad choice. For the right person it can be excellent. It means the label alone tells you very little, so you have to look under the hood. If you’re weighing it, I’d sit with four questions.

First, how satisfied am I with the doctor I have? If you already trust a physician who gives you real time, you may have most of what a retainer would buy.

Second, what exactly does the fee include? Longer visits and direct access are worth a great deal. A standing menu of proprietary tests and supplements is a different proposition — and a fair thing to be skeptical about.

Third, who will actually take care of me — during office hours, and at 2 a.m. on a Saturday? Meeting the physician who will be responsible for you, and understanding how after-hours access truly works, tells you more than any brochure.

Fourth, what is the practice’s philosophy about annual testing? A doctor who orders everything every year isn’t necessarily practicing better medicine. Sometimes they’re generating findings that lead to worry, more tests, and cost — without making you any healthier.

The core idea behind concierge medicine — a knowledgeable doctor with the time to know you — is worth real money, and for many people worth paying for. But the term has been stretched to cover everything from that thoughtful internist to a corporate longevity boutique selling supplements. The higher satisfaction is real. Better health outcomes are not guaranteed, and in the strongest data we have, they didn’t appear.

So, caveat emptor. If you have a doctor you like who gives you time, treasure that. And if you don’t, concierge care may be a fine answer — as long as what you’re buying is better judgment, and not simply more medicine.

Live long and well.