If you are in medical school, residency, or even working as an attending, you have probably heard of concierge medicine. Concierge medicine is actually one of the business models I have been considering, if I start my own medical practice today. More and more doctors are turning towards this model. What is the appeal?
To help answer my questions, Dr. Josh Umbehr, MD, the founder and CEO of AtlasMD, was kind enough to share his time and knowledge about his practice and experience with concierge medicine. I’m sure this would help you as much as it has helped me to understand more about concierge medicine.
Introducing Josh Umbehr, MD and AtlasMD
Interview with Josh Umbehr, MD
1. Can you tell us a little about yourself? How and why did you choose to go into family medicine?
I was born and raised in rural Kansas. And at the time, my father was a trash man. He’s a lawyer now (see Board of County Commissioners of Wabaunsee County, Kansas, v. Keen Umbehr), but I still tell people he’s a trash man because it is less embarrassing.
I chose family medicine because at the time, I didn’t think I was smart enough for a specialty. Now, I think I should have done something simple like neurosurgery! Actually, I’ve just always enjoyed interacting with people and so family medicine was a natural fit. Family medicine offers so much variety and opportunity. You get to be there for your patients throughout their lives and really bond with them.
2. What is AtlasMD? How long has it been in existence?
AtlasMD Concierge Family Practice was opened on September 2, 2010. So it has been in existence for about 1.5 years now. September 2 is a key date throughout my favorite book, Atlas Shrugged.
Alex’s note: Atlas Shrugged is a book by Ayn Rand. Lots of important events in the book happened on September 2. She chose that date because that is the date she started writing the book.
AtlasMD is very unique and is not your typical “concierge” practice.
3. What kind of business model does AtlasMD have? Why did you decide upon that business model instead of the standard insurance-accepting model?
AtlasMD can be best described as a retainer or membership style practice, wherein patients pay a flat rate per month (based only on their age) for unlimited home, work, office, and technology visits. This allows us to work directly with our members and eliminate the suffocating red tape of a traditional system.
Although it was a little nerve racking, the decision to avoid the traditional insurance based model was easy because I’ve seen insurance and government red tape choke the life out of the specialty that I love. It is quite sad to see how the insurance model has driven family medicine off of a cliff, resulting in doctors seeing 40-50+ patients per day and burning out.
I love my patients too much to let that happen to myself or to them. Opening an insurance free practice was my way of fighting for my patients so that they wouldn’t have to compromise their health. I love being able to spend hours with my patients if that’s what they need from me.
4. What were some challenges you faced with AtlasMD?
What didn’t we face!? I’ve never started a business but we were committed to the idea, so we took it one step at a time. I moonlighted (which means worked a second job) more hours and more weekends than I care to recall, to help get AtlasMD started and off the ground. However, AtlasMD really is a labor of love and it is exciting to learn how to run a business in the process.
5. Was it hard getting patients? If yes, why? If not, what was so appealing about AtlasMD?
Yes and no.
Yes, because we offer a radically unique style of practice and it does take a while to convince patients that it is better than the status quo.
No, because as they see our relentless emphasis on service and quality, they are very happy with AtlasMD and begin to refer their friends and family. Of course, it helps that we have extremely low prices compared to the “national” standard.
6. Is concierge medicine only for the rich? Are you patients mainly the rich?
That is the BIGGEST misconception patients and doctors have, and understandably so. No, our “brand of concierge” medicine is designed to be a very high value, low cost model that is accessible for 95% of the population.
Alex’s note: When I look at concierge medical practices, the very first thing I look for is the price. Is it catered to the rich? Looking at AtlasMD’s fee structure, the practice does seem to cater to the general public. Based on my research, the standard rate for concierge medicine is roughly $1,200 per year. For most people, except the 65 year old and older patients (who will need more care and attention), AtlasMD’s annual fee is 25%, even 50%, less than the industry average! With children’s fee at only $10 per month, that translates to a 90% discount from the average concierge fee. In addition, some concierge practices not only charge a membership fee, they also charge for each procedure. AtlasMD do not charge extra for procedures. Everything is included with the membership fee. You pay once and can get everything it offers.
7. How many patients do you care for? How much time can you devote to each patient?
Although the ideal number varies for each physician based off the complexity and average age of their patients, most concierge practices aim for 400 – 600 patients for each doctor.
Currently, I rarely feel that our patient care is limited by time. We’ll often spend several hours with a new patient to get to know them or even with any patient who needs more time. To give you an example, I’ve been fortunate enough to be able to do a home visit for a patient nearly weekly for over 1.5 years.
8. Did you make a profit within the first year?
No, we are not profitable yet, but that is due to part to our decision to forgo profit and reinvest revenue back into more equipment to better serve our patients.
9. How many supporting staff does the practice hire? How does the number compare to that required by a traditional practice?
We have 1 RN (registered nurse) for 2 MDs. That is a record-low staffing ratio but it works great because we all pitch in. When you remove the red tape and hassles of the insurance-based system, surprisingly little staff is required. The WSJ (Wall Street Journal) had a great article a few weeks ago that examined the finances of a typical 3 physician office and they had 22 employees for 3 doctors at a cost of $1.7 million per year.
Alex’s note: This is the article that Dr. Josh Umbehr is referencing. (If you cannot access the article, search for the article in Google and open it from there. That should allow you to access the whole article without subscribing.) The Westminster Medical Clinic, a more traditional insurance-accepting family medicine practice, has 7 staff for every 1 doctor. As a result, salaries ate up more than 80% of the total revenue. There would be very little money left for anything else, let alone investing in equipment without taking on more loans.
10. Did you start AtlasMD from scratch or did you join an established concierge network to help you get set up?
Scratch baby! With nothing but a dream and a mission to reinvent family medicine.
11. How does your salary / profit compare to the salary of family doctors who work in a traditional practice?
We made a business decision to continue to live on a salary near what we earned in residency while we support the new practice and reinvest in the office.
However, the average physician working in this model would average between $180,000 – $200,000 per year, plus benefits.
12. How much time per week do you spend with patients? How much time per week do you spend doing administrative work? How would the times differ if you were working in a traditional practice?
One of the very nice things about our practice design is that there is very little time spent on administrative duties. Due to our low-volume model, we only have 400 – 600 patients per doctor and only see 4 to 5 patients in the office per day. Obviously this varies widely from a typical medical practice where a physician may see 40 to 50 patients per day.
Alex’s note: So assuming that the doctors work 8 hours per day, each patient can potentially get more than 1 hour with the doctor. I’m sure that does a lot to boost a patient’s satisfaction with the doctor compared to a traditional primary care visit where the wait is 1 hour or more and the time with the doctor is only 10 minutes or so.
13. Are there any improvements that can be made to AtlasMD? What do you hope your practice would look like 10 years later?
Oh my, 10 years from now will be very exciting. We aim to continue expanding the model to include as many diagnostic and therapeutic services as we can. Technology revolutions will clearly be a major factor.
14. What advice would you give to someone who wants to have a practice like yours?
Go into this with eyes wide open. Sadly, I know more docs who started a concierge model, hoping to recruit the rich and it doesn’t work. But if done correctly, it can be very rewarding.
15. Is there anything else you would like to share?
I want medical students to see that concierge medicine isn’t what they thought it was. In fact, I wanted them to see that it can be an extremely high-value low-cost model that could be accessible to the masses. This model decreases the need for high-cost health insurance and drastically reduces the cost of care while improving quality. I hope that more medical students will keep an open mind to new innovative business practices and medical designs.
My Thoughts About AtlasMD
When I start my own practice, I too do not want to deal with insurance. The concierge business model does seem to provide a way to not deal with insurance companies. On the other hand, I want my medicine to be accessible to the general public, not just the elite. (Although one can argue that those that can afford health insurance are dwindling, and the status quo already favors the elite.) The interview with Dr. Umbehr showed that a concierge medical practice can be accessible to most people.
He feels so strongly for family medicine practiced under a concierge medicine model that he concluded the interview with the following statement:
“Concierge medicine (as it is currently known) will hopefully just become known as family medicine and we’ll all practice in such a way that provides an unprecedented level of quality, value and access to our patients. I don’t mean to sound bold or boastful, but I truly believe if more medical students could see how we practice, they’d come to see family medicine as the ideal specialty.”
Emulating my future medical practice after AtlasMD is something I will strongly consider.
If you are interested in learning more about AtlasMD, visit its website: www.atlas.md.
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This article is part of the Money in Medicine series. Click on the link if you want all the money-making secrets available to doctors.