What Is Concierge Medicine? How the Relationship Works Day to Day

Ashley Harwyn, PA-C, ABAAHP  |  Published April 24, 2025  |  Last updated October 6, 2026  |  19 min read

A smaller patient list, longer visits, and one clinician who knows you. Here is what that looks like in practice, how it fits with insurance, and where the evidence stops.

That is the short definition. The longer answer is about what the arrangement looks like from week to week: how you reach your clinician, how long visits run, how labs and specialists are handled, how it sits next to your insurance, and what it does not do. Solcara Health is a concierge practice, so we will also describe how our primary care works, using only what we can stand behind. Prices are deliberately left out of this guide.

• Concierge medicine is primary care paid for partly through a membership or retainer fee, usually in exchange for a smaller patient list, more time, and easier access.[2][4]
• In the federal government's own survey of concierge physicians, average practice size fell from 2,716 patients before conversion to 491 after, and patients seen per day fell from 26 to 10.[4]
• The features offered most often were same- or next-day appointments, 24-hour phone access, and periodic preventive exams, each reported by 99% of responding physicians.[4]
• Many concierge practices still bill insurance for covered care. In that survey, about three-fourths did.[4] Read what the fee covers before you change any coverage.
• The AMA's ethics code says a retainer practice should not imply that more or better medical services come with the contract.[1]
• Research on health outcomes is limited. Satisfaction is better documented than clinical benefit, and one outcome study of MDVIP members lists its first author at MDVIP.[9][10]

What does concierge medicine actually mean?

There is no single legal definition, which is part of why the term confuses people. The American College of Physicians groups these arrangements under one heading: any practice that contracts with patients to pay out of pocket for some or all of its services, or that charges an administrative fee, sometimes called a retainer or concierge fee, often in return for a promise of more personalized and accessible care.[2] A report prepared for the Medicare Payment Advisory Commission lists other names for the same idea: retainer-based medicine, boutique medicine, or direct care.[5]

The federal Government Accountability Office used a two-part test when it studied the model for Congress. A concierge physician, in its definition, had a direct financial relationship with patients in the form of a membership or retainer fee, and offered enhanced services or amenities, such as same-day appointments or preventive services not covered by insurance.[4] Nearly all of the 112 concierge physicians who answered its survey practiced primary care, mostly internal medicine and family medicine.[4]

A report prepared for the Medicare Payment Advisory Commission put the trade in plain words: doctors limit the number of patients they see, and offer greater access, longer appointments, and more personalized care.[5] Typically, it added, the fee also covers some care, such as an annual physical or wellness exam.[5]

Notice what stays the same. The diagnoses, prescriptions, screenings, and referrals are the same kinds you would get in any primary care office. The AMA's ethics guidance frames the retainer as paying for special non-medical services and amenities, and says that all patients in a practice must receive the same quality of medical care whatever their contract.[1] Read that way, concierge medicine is a change in structure: fewer patients per clinician, and a different way of paying for the services and amenities around the medical care.[1][4]

The model is also growing. A 2025 study in Health Affairs found that from 2018 to 2023, the number of concierge and direct primary care practice sites grew by 83.1%, and the number of clinicians working in them grew by 78.4%.[6] Over the same period, the share of those clinicians who were physicians fell from 67.3% to 59.7%, while the share of advanced practice clinicians rose.[6]

Why does a smaller patient list change the care you get?

The model turns on one number: how many people a single clinician is responsible for. When the GAO surveyed concierge physicians, they reported an average of 2,716 patients in the year before they converted. Afterward, the average was 491, and nearly two-thirds had fewer than 400 concierge patients.[4] The number of patients they saw on a typical day fell from an average of 26 to 10.[4]

Why does that matter so much? Because preventive care takes time that a large list does not leave. A study in the American Journal of Public Health estimated how long it would take one physician to deliver every service recommended by the US Preventive Services Task Force to a panel of 2,500 typical patients. The answer was 1,773 hours a year, or 7.4 hours of every working day, before any sick visits or chronic disease care.[8] The authors concluded that time constraints limit the ability of physicians to follow those recommendations.[8]

Actual visit length tells a similar story. Using electronic health record timestamps from about 21 million primary care visits in 2017, researchers found that the average exam lasted 18.0 minutes.[7] Visits scheduled for 10 or 15 minutes were more likely to run over than those scheduled for 20 or 30.[7]

Concierge physicians interviewed for the Medicare Payment Advisory Commission described what they did with the extra room. One said the time she set aside for a physical had grown from 30 minutes to 90 minutes, and the report called that fairly typical among the physicians it interviewed.[5] Among the retainer-only physicians who could estimate it, panels ranged from 100 to 425 patients.[5]

Here is what concierge physicians reported offering, from the same federal survey. These figures describe what practices offered in 2004, not a promise from any one practice today.[4]

Two cautions about that table. First, the data are self-reported by 112 physicians more than twenty years ago, so they show the shape of the model, not a current national average.[4] Second, not every practice offered every feature, as the percentages show.[4] The only way to know what a given practice includes is to read its written terms.

What does a concierge relationship look like week to week?

Here is a general rhythm, based on the features practices report and on how concierge physicians describe their own work.[4][5] Treat it as a general picture, since every practice sets its own terms.

• Getting in. Same- or next-day appointments for nonurgent problems were the most common feature in the federal survey.[4]
• Reaching your clinician between visits. In the federal survey, 99% of concierge physicians offered 24-hour telephone access and 94% offered access by email.[4] How fast replies come, and through what channel, is something to confirm in writing.
• The longer preventive visit. Periodic preventive physical exams were offered by 99% of surveyed physicians,[4] and the MedPAC report noted that the fee typically also covers some care, including annual physicals.[5]
• Labs with a purpose. The AMA's opinion asks that treatment recommendations in a retainer practice rest on evidence, guidelines, and judgment.[1]
• Coordination. Concierge physicians interviewed for MedPAC described getting specialists' reports back, reviewing them, and discussing them with the patient.[5]

The lab point deserves a closer look. The AMA's ethics opinion says that in a retainer practice, treatment recommendations for every patient must rest on scientific evidence, relevant professional guidelines, and sound judgment.[1] At Solcara, our primary care page describes building a preventive visit around screenings with strong evidence behind them, and adding deeper work, such as annual full panel labs or advanced lipid testing, only when there is a clear reason.

In the interviews done for the Medicare Payment Advisory Commission, concierge physicians described making sure they got reports back from specialists, reviewing them, and often discussing the results with the patient before the patient decided how to proceed.[5] Many said they were able to visit patients in the hospital more often than before, and a few went with patients to specialist appointments.[5] The report also noted that this coordination is particularly appealing to individuals or families coping with multiple medical issues.[5]

None of that replaces the rest of the health system. In the MedPAC interviews, physicians still worked with specialists, getting their reports back and reviewing them,[5] and at Solcara, when you need a test we do not do in the office, such as a mammogram or colonoscopy, we help you arrange it. For a sense of how that plays out with heart risk, see our page on cardiac health.

Wondering how this would look for your own care? Call 843-981-0870. Ask how visits, labs, and follow-up work with Ashley, and ask for the membership terms in writing before you decide anything.

Does concierge medicine replace health insurance?

No. The GAO defined the concierge fee as a direct financial relationship between patient and practice, paired with enhanced services or amenities.[4] The sources cited here do not describe that fee as paying for hospital, emergency, specialist, imaging, or pharmacy costs, so read what your agreement covers before you change any insurance.

How the fee and your insurance fit together depends on the practice. In the GAO survey, about three-fourths of concierge physicians billed patients' health insurance for covered services, and nearly all of those also billed Medicare.[4] About one-fourth did not submit claims to any insurer.[4] The American Academy of Family Physicians describes concierge practices the same way: they may continue to accept insurance plans and government programs and bill insurance for covered services.[3] That is one structural difference the AAFP draws from direct primary care, which the AAFP describes as relying solely on patient fees.[3] We cover that comparison in more depth separately.

The AMA's ethics opinion sets out what a patient should be able to expect from the paperwork. A physician offering a retainer contract should present its terms clearly, including what it means for the patient's current insurance if that is known, and should clearly separate charges for special services from medical services billed to insurance.[1] It also says the decision to join must be voluntary, and that a physician should help with the transfer of care for any existing patient who chooses not to join.[1]

Medicare. If you have Medicare, there are extra rules. The GAO reported that federal health officials allow concierge arrangements as long as they do not break Medicare requirements, and that a membership fee must not result in extra charges for services Medicare already pays for.[4] In 2004, the HHS Office of Inspector General warned participating physicians that asking Medicare patients to pay for covered services beyond the usual deductible and coinsurance could bring civil monetary penalties.[4] Federal officials also said a retainer arrangement may not stand in for a Medicare supplement policy.[4] Some concierge physicians instead opt out of Medicare entirely, which the GAO noted meant giving up Medicare reimbursement for a two-year period.[4] If your clinician has opted out, Medicare will not pay for those visits, so ask about this directly before you sign.

A short checklist for any membership agreement. Before you join any concierge practice, ask for the agreement in writing and look for clear answers to these questions:

• What does the fee cover, and what is billed separately?
• Does the practice bill your insurance or Medicare for covered visits and tests, or neither?
• How do you reach the clinician after hours, and who answers when they are away?
• What happens to your records and care if you leave?

What concierge medicine is not

A clear definition also needs its edges. Here is what falls outside it.

It is not emergency care. Call 911 for chest pain, sudden weakness on one side, severe trouble breathing, or a serious injury, whatever membership you have.

It is not a promise of better medicine. The AMA's ethics opinion tells physicians to take care not to imply that more or better medical services will come with a retainer contract, and to make sure every patient in the practice gets the same quality of medical care.[1] The same opinion frames the retainer as paying for special non-medical services and amenities.[1]

It is not more testing for its own sake. The same ethics opinion asks that recommendations rest on evidence, professional guidelines, and prudent stewardship.[1] Ask why each test is on your list and what decision its result will change.

It is not the same as direct primary care. The two are often lumped together. The AAFP's short version is that concierge practices may still bill insurance for covered services, while direct primary care practices typically do not accept insurance at all.[3] A full side-by-side comparison is beyond this guide.

Cost can be a barrier. The AAFP describes concierge practices as catering to higher-income populations.[3] The American College of Physicians notes that concerns have been raised that practices paid directly by patients may cause access problems for people who cannot afford it, and its position paper makes recommendations to soften any harm to underserved patients.[2] The AMA's opinion likewise reminds physicians in retainer practices of their duty to promote access to care for people in need.[1] Those are fair questions to ask any concierge practice, including ours.

Does concierge care lead to better health?

The short answer: patients and clinicians report liking the model, but solid evidence that it improves health outcomes is thin.

A 2025 review in the American Journal of Medicine put it directly: limited evidence exists to confirm the benefits of concierge medicine on patient clinical outcomes, while patient and physician satisfaction are significantly higher.[9]

One outcome study comes from MDVIP, which a MedPAC report described as helping physicians move to a retainer model and then helping manage their practices.[5] Using hospital discharge data from five states between 2006 and 2010, it reported that MDVIP members were about 42% to 62% less likely to be hospitalized than nonmembers, depending on the year, and that by 2010 discharges among Medicare-age members were 79% lower.[10] Those are large numbers, and they need context. The first author's listed affiliation is MDVIP, and the design was a comparison of hospital discharge rates between members and nonmembers, using a hospital database from five states.[10] The authors wrote that they believe more physician interaction explains the lower hospital use.[10] The 2025 review cited above, published later, still described the evidence on clinical outcomes as limited.[9]

So where does that leave someone deciding? The structural features are well documented: a smaller list and fewer patients per day.[4] The review cited above found limited evidence on clinical outcomes.[9] If a practice promises outcomes, ask what the claim is based on.

How concierge care works at Solcara Health

Solcara Health is a concierge practice with offices in Mount Pleasant and downtown Charleston. Care here is led by Ashley Harwyn, PA-C. Ashley is a physician assistant who is board certified in anti-aging and functional medicine through the A4M (ABAAHP), and you can read more about her training on her bio page. As our primary care page puts it, because the same person sees you visit after visit, your history does not have to be retold, and a small change in your numbers from one year to the next is easier to catch.

Primary care is the base. A preventive visit here is organized around the screenings that have solid evidence behind them for someone of your age, sex, and risk, along with vaccines and follow-up on anything we find. Several tests can be done right in the office: comprehensive blood panels, advanced lipid testing, STD testing, Pap smears, and fertility labs. When you need something we cannot do on site, such as a mammogram, a colonoscopy, a Cologuard kit, or a DEXA bone density scan, we help you arrange them.

Our functional and longevity work sits on top of that foundation. When your symptoms or history raise a specific question, Ashley may go further, for example with thyroid care or the wider approach described on our anti-aging and functional medicine page. Screening you are due for does not get skipped in favor of specialty work. If you want a sense of how we think about longevity care downtown, our post on longevity medicine in downtown Charleston goes further.

You can see Ashley at the Mount Pleasant office, 496 Bramson Ct, Suite 120, or downtown at The Longevity Club, 163 Rutledge Ave, Suite 202. Ask us for the membership terms in writing, including what they cover and how billing works, and read them with the checklist above in hand. To get started, call 843-981-0870 or book online, and bring your last lab results, a list of your medications and supplements, and the dates of any past screenings you remember.

Ashley Harwyn, PA-C PA-C, ABAAHP · Founder, Solcara Health Online

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