The concept of paying a premium for concierge-level access to doctors has been around for years but has gained particular popularity in the Bay Area, where doctors who charge tens of thousands of dollars for annual memberships say they have no issues filling their panels.
“In the Bay Area where people have, I’d say, more refined needs and more financial resources and the cost of running a practice is much higher, I’d say more standard concierge practices have done better here,” said Dr. Paul Abramson, medical director of My Doctor Medical Group, a concierge practice in San Francisco’s Financial District.
Local concierge providers, most of whom do not accept health insurance and charge patients monthly or annual membership fees, said they cater to a patient population that wants close relationships with their doctors and 24/7 access. Sources said that membership fees can range from around $7,000 to around $40,000 per patient per year, depending on how small the practice is and how much attention each patient receives.
Peninsula Doctor, an exclusive concierge practice in Menlo Park an hour south of San Francisco, is on the high end of that scale because of the amount of time its doctors spend with their patients, and how few patients each doctor sees in a day, said Sabina Shnapek, the practice’s head of business operations. That includes a physician accompanying them to their specialist appointments. Peninsula doesn’t disclose the cost. “We know these people really, really well,” she said. “The level of care we can provide and quality of service, it’s a whole different ballgame when you know your patients.”
At the same time, quite a different trend is taking shape. The high cost of practicing in the Bay Area is making it increasingly difficult for providers that treat low-income patients. Land value and commercial rents are very high even in impoverished neighborhoods like Tenderloin or Mission, which makes it difficult for providers that serve low-income patients to locate there, according to a draft version of the city of San Francisco’s forthcoming Health Care Services Master Plan.
The report also found that the high cost of doing business in the area is making it difficult for federally qualified health centers and community clinics to attract physicians. It says geographic and socioeconomic health disparities are expected to continue in the future.
San Francisco’s 2019 Community Health Needs Assessment cited racial health inequities and poverty as two foundational issues contributing to local health needs.
“We know it’s a challenge,” said Claire Lindsay, senior health program planner with the city’s public health department. “Because of other forces, because of reimbursement rates that exist outside of city’s jurisdiction, we know that it’s challenging for them to keep providers and pay them a fair salary and afford to live here because of the high cost of living.”
Since the proportion of patients who see concierge doctors likely only represents 2% to 3% of the market, it’s probably not contributing to the recruitment challenges facing providers that treat low-income patients in the Bay Area, said UCSF’s Coffman.
San Francisco County has a robust supply of doctors compared with the rest of the state, a Modern Healthcare analysis found. The county had 827 physicians across all specialties per 100,000 people, the highest of any California county, and compared with an average of 215 physicians per 100,000 people across all California counties. San Francisco County also had the highest number of primary-care physicians per 100,000 people in 2017: 158 compared with 70 on average.
Concierge medicine is likely to happen anywhere there’s a high saturation of doctors, especially those who are younger, forward-thinking and fed up with insurance rules and regulations, said Donovan Miske, executive director of Kona Medical Consulting, a Detroit-based company that manages concierge practices, including several in the Bay Area. “We’re kind of the punk rockers of the medicine field,” he said.
Miske said he thinks the Bay Area is particularly well suited for concierge medicine. Expensive real estate drives providers to look for more creative ways to use office space, such as shared workspaces or even seeing patients in their homes or offices, which they mostly couldn’t do if they billed insurance.
“San Francisco is going to increasingly become more and more concierge,” he said. “The density and prices to operate and own a business just keep skyrocketing.”