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January 12, 2012

Career Move: Concierge physician

Dirk Frater, M.D., practices concierge medicine in Dallas and Jordan Shlain, M.D., San Francisco.

Dirk Frater, M.D., practices concierge medicine in Dallas and Jordan Shlain, M.D., San Francisco.



TITLE: Physician
EMPLOYER: E. Barrow Medical Group, Dallas
EDUCATION: Graduate of Yale University. Attended medical school at Albert Einstein College of Medicine in the Bronx. Residency at Parkland Memorial, Dallas.
BACKGROUND: Practiced internal and emergency medicine prior to becoming a concierge physician in 2008.

What do you like best about being a concierge physician?
The main thing is that I get to practice medicine the way it used to be and how I envisioned it when I went into medicine. Just having enough time to communicate with folks and take care of problems in an in-depth way. To really be a patient’s quarterback.

Is there anything you don’t like about it?
No. You have to be willing to be available all the time. That shouldn’t be something that throws you off or makes you regret you’re doing it.

Why did you choose to become a concierge physician?
My day-to-day practice required I spend less time with each patient so I could see more patients each day to maintain my income. I finally drew the line in the sand and said I wasn’t going to see any additional patients. It was a combination of having to do what was required to keep up with costs and how that was affecting how I was able to practice medicine.

Do you have any advice for physicians who are interested in the concierge model?
They should be encouraged. There’s more and more opportunity that’s going to be created for smart young doctors who want to work hard and want to really be involved in their patients’ care.

In your experience, do you think a physician new to the profession could begin as a concierge physician?
You have to build up a practice - have a track record, if you will - for patients to be willing to make that kind of move to a concierge practice.

Do you have a hybrid concierge practice?
I’m strictly on a retainer model. My concern with the hybrid model is treating patients differently than others. I want to treat everyone the same.

Was there anything that surprised you?
Mostly just how respectful patients were of my time. There’s still some folks who had a problem and then didn’t call. Part of the reason for me doing this was for them to be able to get ahold of me whenever they need me.

How would a physician get started on the path to becoming a concierge physician?
Speak to physicians who are doing it. There is a course offered by NPI, National Procedures Institute, which is an effective introduction to the topic. I think the key for most concierge physicians is that they really want to practice medicine the old-fashioned way where you are the patient’s main source of information, advice, referral and recommendation for problems large and small. If a physician really wants that kind of involvement, then they should aspire toward this type of practice because that’s what they’ll be able to do.


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TITLE: Physician
EMPLOYER: Current Health, San Francisco
Education: Graduate of University of California, Berkeley. Attended medical school at Georgetown University.
BACKGROUND: President, American Academy of Private Physicians (AAPP); Northern California medical director for Lufthansa Airlines.

What do you like best about being a concierge physician?
I have the time and ability to think through a lot of the nuances that is medicine. For example, two people can have diabetes, but their circumstances can be wildly different. I have the time and ability to really get involved. It’s not that I think I’m a better doctor, I just have the luxury of more time. Furthermore, I have the lifestyle that gives me more time off for myself. I get to enjoy my life.

Is there anything you don’t like about it?
No, nothing.

What if a patient needs you on a holiday? Would that be a downside?
Not really. The beautiful thing is the Internet, text messages and the phone - there’s a lot of methods of communication. Part of the promise I make to my patients is that they can always get in touch with me, 365 days of the year. I have partners. If I’m not working that day, my partners are. They still have the ability to contact me if they want. Like any doctor, there are no holidays. You’re always on call, so it’s no big deal.

You became a concierge physician early in your career. Is that unusual?
Totally unusual. As president of the association (AAPP), we give conferences. There’s usually 50 to 100 physicians in their 50’s wondering if they should switch models and go into this. I tell them that as soon as patients buy into a practice, they have the loyalty to the doctor. That’s an asset you can sell someday when you decide to retire or you decide to sell your practice.

So, you don’t have to be an older, established physician to go into concierge medicine?
No, but you have to have the ability to ride it out for a few years. You might only make half of what you’d make in routine primary care initially, but you might triple that amount once you get established. Never take your eyes off the prize. Always deliver on your promise, which is that you’ll be good, available and incredibly helpful. People will pay for value all day long. Health care is no different. Doctors are just small businesses.

What about new physicians who would like to do this?
It’s really hard. You need to have some patients. You need to find a private doctor who’s growing, and join that guy. Make sure you have a good contract and you’re part owner. That could take awhile because you have to build a practice. Once you become established, then you start talking to your patients and put out a survey to see if they would join at $1,000 a year, for example.

Was there anything that surprised you about your practice?
How appreciative my patients were. How much they loved it, and how much they disliked the other model.

What advice would you give physicians who would like to become a concierge physician?
It’s your future. You should invest in yourself. No one is going to look out for you like you are going to look out for you. If you want to be independent and want to have some control of your destiny, this is how you do it. If you want to learn more about it, American Academy of Private Physicians ( is a great resource.
Also, don’t skimp on your website. Aesthetics are important.
…Once you do this, it’s so liberating. You can’t believe you ever did it another way.

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