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\n Illustration: Olivier Heiligers\n <\/p>\n<\/p>\n
This article was featured in New York\u2019s One Great Story<\/a> newsletter. Sign up here<\/a>.<\/p>\n The premiere episode of the Scrubs reboot<\/a>, which debuted just a few months back, finds internist J.D. (played by Zach Braff<\/a>) working as a concierge physician, having succumbed to the financial reality of the American health-care system. In a montage, he makes a house call to apply a liquid bandage to a man\u2019s toe with a gleaming pool visible through the window and examines another patient\u2019s unabated four-hour erection<\/a> while sipping tea. Later, he spends hours at the bedside of an older woman who seems to be mostly well but has been hospitalized as a precaution after fainting. By the end of the first episode, however, an internal wake-up call has whisked him out of this soulless milieu \u2014 in which patients pay him untold sums in exchange for VIP amenities \u2014 and planted him back on an inpatient hospital floor among grateful, less-rich sick people. The implication is clear: Doctors who ditch the masses to only serve the wealthy are sellouts \u2014 not heroes worthy of a TV plotline. They are also ubiquitous enough to be part of mainstream culture.<\/p>\n A 2025 report<\/a> noted that from 2018 to 2023, the number of fee-based practices grew by 83.1 percent and estimated that between 10 and 20 percent<\/a> of primary-care physicians now work within them. These practices include concierge medicine and direct primary care, where patients pay a fee not necessarily for high-end amenities but for an easier time getting an appointment or a call back. In both concierge medicine and DPC, physicians say they see fewer patients and offer better care. Since DPC doesn\u2019t accept insurance, doctors also say it allows them to avoid certain Sisyphean administrative tasks. They also tend to earn more income without pulling 12-hour days. Proponents see membership medicine as the future of primary care, a win-win system that benefits everyone \u2014 except, of course, the millions who can\u2019t afford to buy into it and are increasingly likely to struggle to find a primary-care doctor at all.<\/p>\n The rise of concierge and DPC medicine is far from the only factor feeding the shortage. Pandemic burnout<\/a>\u2013driven exits from the field and baby-boomer doctors retiring are known<\/a> contributors as well. In many cases, departing docs don\u2019t get replaced with younger ones because PCPs are now notoriously underpaid relative to other specialists. One study<\/a> found that 31 percent of medical-school students who intend to pursue primary care switch specialties once they realize they may struggle to repay their student debt. A 2024 survey<\/a> revealed that only one in five current PCPs feel adequately compensated, and another report found that in 2026, they are earning, on average, $298,000<\/a> per year to a specialist\u2019s $417,000.<\/p>\n Still, experts say, the shift to concierge medicine is something of a warning signal. \u201cWhen a physician converts to one of these models, there are fewer physicians available to treat the general population,\u201d says Jordan Weiss, an assistant professor at the NYU Grossman School of Medicine who studies health and aging.<\/p>\n Currently, the nation is some 13,000 PCPs short<\/a> of what the population requires, and it\u2019s been predicted<\/a> that by 2038, patients will face a shortage of 70,610 PCPs, or roughly five times the current deficit. More than 100 million Americans<\/a> do not have consistent access to a PCP. A survey<\/a> published in March found that 36 percent of patients have struggled to find a PCP who accepts their insurance, and another 36 percent have been told by PCPs that they\u2019re not taking new patients.<\/p>\n Carol DerSarkissian, herself a physician in New York City, says the primary-care physician she has been seeing for ten years works for a health system that recently added a concierge practice to\u00a0many of the doctors\u2019 caseloads, which has severely limited the time each physician has for their in-network patients. \u201cOnce that happened, I had to book at least nine months in advance to see her,\u201d she says. \u201cI liked her, but now I go in and it\u2019s a 15-minute visit. The last time I was there, she was talking about the concierge practice, and she\u2019s like, \u2018Yeah, I enjoy those more. I get more time.\u2019 And I was like, Wow, you shouldn\u2019t be saying that to me.\u201d\u00a0Several New York hospitals, including Mount Sinai<\/a> and Weill Cornell<\/a>, have added concierge services to their roster of offerings.<\/p>\n And the problem extends beyond New York. Nicole Baker, a marketing strategist in Portland, Oregon, has been in what she calls \u201cdoctor-shopping purgatory\u201d for years. \u201cI try to find a new person every few months, then get frustrated and give up,\u201d she says. For the last several years, she has settled for a provider who once told her she was not prediabetic even though Baker had just received labs confirming the diagnosis. \u201cShe realized she was looking at the wrong patient\u2019s file,\u201d Baker says. \u201cI have very little faith in her as a doctor, but I have no choice.\u201d<\/p>\n The ethics of concierge medicine are a contentious topic. A recent Institute of Clinical Bioethics post<\/a> questioned whether these models contravene the sacred doctrines of medicine: beneficence, non-maleficence, autonomy, and justice. These precepts are perhaps especially pertinent in primary care, which has a reputation for attracting altruistic physicians interested in making a difference in the lives of their patients over years of contact. The American Medical Association also publishes principles<\/a> to which a doctor must abide, including that physicians shall \u201cparticipate in activities contributing to the improvement of the community and the betterment of public health\u201d and \u201csupport access to medical care for all people.\u201d The upshot of the institute\u2019s post was that concierge medicine can be ethical with safeguards, but problems will inevitably arise. But arguing that membership-based models, particularly at the very expensive concierge level, align with these ideals requires mental contortion not all doctors are willing to undertake. The author of an article<\/a> in the AMA Journal of Ethics wrote that participating in this style of medicine would \u201ccorrode\u201d his sense of duty to his patients. \u201cJust focus on this: What is the meaning of a patient-physician relationship if it can be terminated abruptly and for such coarse reasons?,\u201d he writes.<\/p>\n Marc Price, a family doctor in Malta, New York, has resisted the concierge model for the same reason. \u201cI like that connection with the patients. I like that they come in and they don\u2019t just see whoever is on that day; they point to me and say, \u2018That\u2019s my doctor.\u2019 For me to throw that away, it feels wrong.\u201d Price says that while one concierge service, MDVIP, has \u201cbeen courting me for years,\u201d the patients unable to follow him there would haunt him. \u201cI\u2019m still idealistic, unfortunately,\u201d Price says. Plus, while concierge medicine increases members\u2019 health-care spending by 30 to 50 percent, it does little to improve mortality, on average, a 2023 study<\/a> found.<\/p>\n There is no shortage of concierge clinics in New York City, and new ones seem to be opening all the time. Private Medical on the Upper East Side charges around $40,000 a year for adults and $25,000 for children. With five locations in the city \u2014 only two of which are accepting new patients MD2, a concierge primary-care clinic, runs slightly cheaper at $2,500 per month<\/a>. One practice, Sollis, touts itself as a VIP version of urgent care: You might go if you sprain your ankle or get a bad sunburn, but you can also get a physical or request labs, which suggests some patients might use the service as a kind of ad hoc primary care. Scott Braunstein, chief medical officer at Sollis and former ER doc at Cedars-Sinai, tells me he sees the concierge model and the way it tiers patients as a \u201chealthy, natural correction\u201d to a system that doesn\u2019t work, which may \u201cput pressure on that system to do better.\u201d He adds that doctors are leaving their practices \u201cin other ways \u2014 retiring early \u2014 so I wouldn\u2019t say concierge is part of the problem.\u201d Sollis also charges less than other places, Braunstein points out. (Membership starts at $4,000<\/a> per year and goes up to $12,000<\/a>.)<\/p>\n The criticisms of concierge medicine may explain why even established outfits seem loath to acknowledge the dark side of their business. For this article, I approached several doctors from a concierge practice offering both primary and specialty care with locations in New York, Palm Beach, and Beverly Hills, as well as seasonal home services in the Hamptons. The practice charges an annual membership fee of $20,000 to $70,000 per person. A company spokesperson learned of my inquiries and emailed me directly. \u201cWith a clinic, institute and non-profit arm,\u201d the email read, the organization \u201cdoesn\u2019t fit the mold of concierge medicine\u201d and therefore could not comment. It was a strange statement, in part because it was illogical and in part because it suggested that simply admitting what the company offers could harm its brand.<\/p>\n On the flip side of the membership-based service debate is a more nuanced picture \u2014 one not of craven PCPs abandoning patients for cash but of circumstances that have pushed them to the brink. As Weiss puts it, \u201cthese physicians are responding to a broken system.\u201d<\/p>\n A PCP\u2019s patients fall into one of three categories: well people who need a checkup; people visiting for ongoing disease management; and sick people, usually with common ailments like respiratory infections and UTIs, but whose symptoms may indicate a more serious or complex problem. A straightforward annual well visit for an existing adult patient nets a PCP an average insurance reimbursement of $128<\/a>, while an established patient\u2019s sick visit nets<\/a> between $80 and $120, depending on insurance and location. (By contrast, an orthopedic surgeon performing a knee replacement might receive a reimbursement of $2,000<\/a> for that two-hour<\/a> procedure \u2014 roughly what a PCP will earn seeing 15 patients.) These relatively meager sums incentivize PCPs to take on huge patient panels to keep their clinic\u2019s lights on. And unfortunately, this large caseload comes with ceaseless unpaid administrative <\/a>work. Specialists perform administrative tasks, too, but can often afford to hire medical coders to help. Because PCPs operate on some of the thinnest margins<\/a> in medicine, hiring sufficient support staff is often a nonstarter.<\/p>\n Kelsey Smith opened a DPC practice in Stillwater, Oklahoma, in 2021. She charges a $75 initiation fee for the first month,\u00a0and $100 per adult and $50 per child for every month thereafter.\u00a0\u00a0(There is a maximum fee of $350 per month for a family.) She describes a daily avalanche of busywork in her old practice, spending her life chained to the exam table by day and to electronic health records by night. \u201cI would stay up till midnight and still not be caught up,\u201d she says. \u201cMy husband would ask, \u2018What are we doing this weekend?\u2019 I\u2019d be like, \u2018I don\u2019t know what you and the kids are doing, but I\u2019m working on charts.\u2019\u201d Now, she keeps a smaller patient panel, seeing ten a day versus 30, and gives each patient a half-hour instead of 15 minutes. If a patient emails with a question, she simply answers it instead of asking them to come in so she can bill them. \u201cUnder the insurance system,\u201d she says, \u201cyou don\u2019t get reimbursed for your time and wisdom unless you have somebody walk through your doors.\u201d<\/p>\n Overloaded doctors aren\u2019t generally great doctors. Smith says at her old practice, her medical assistant would tell patients to prioritize their concerns \u2014 that is, \u201cpick your top two\u201d <\/strong>\u2014 due to the doctor\u2019s time constraints. And Sharifa Glass, a Houston pediatrician who now runs her own concierge service, says in her old practice, she used to get hassled by the corporate administrators for spending too much time with patients. \u201cThey would say I was taking too long. That felt like poor health care to me,\u201d she says. I spoke with several physicians who\u2019ve made the switch to DPC or concierge, and most said some version of the same thing: I\u2019m so much better at my job now.<\/p>\n When I asked a few of these doctors how they felt about the patients they no longer see, the ones who couldn\u2019t afford to join their membership-based practices, they revealed something startling. If I hadn\u2019t made the switch, they told me, I was going to have to leave medicine altogether, and then I\u2019d be seeing no patients. Weiss says, \u201cpeople argue that concierge medicine or DPC isn\u2019t right. But it has developed for a reason. You don\u2019t have to fight it \u2014 you just have to make staying in traditional practice more viable.\u201d<\/p>\n All of the PCPs I interviewed who have moved into membership models painted their career choice as the only solution to an intractable problem. But some in the field are working on alternative ideas that don\u2019t leave lower- and middle-class patients behind. \u201cThe first move would be shifting away from pure volume toward a model that compensates PCPs for the time they spend working and also for keeping their patients healthy,\u201d says Weiss. \u201cSome kind of blended payment model where a practice gets an amount based on health outcomes rather than just a fee per\u00a0visit.\u201d Other proposed solutions have included 2024\u2019s bipartisan Pay PCPs Act<\/a>, which aimed<\/a> to nudge the Centers for Medicare & Medicaid Services into better rewarding PCPs who achieve positive outcomes for patients. (The bill appears to have stalled in committee.) Some experts advocate for financial incentives<\/a> for med students interested in primary care, like more generous deferments on student-loan interest.<\/p>\n Others are working to create tech-based solutions that help patients obtain care. Shulin Zhang, who is 86, told me through a translator that he went without a PCP for three years as a diabetic octogenarian after moving here from China in 2019, having found that few doctors took his insurance, fewer spoke his language, and many weren\u2019t accepting new patients. His stopgap solution was to fly to Beijing to once a year to see his doctor son-in-law, who prescribed him enough medication to last until he made the trip again. He finally found a PCP through Rendr<\/a>, a non-DPC health-care network designed to help Chinese New York City residents connect with the doctors they need. Meanwhile, AI-driven triage centers and telehealth services like MinuteClinic<\/a> seek to lift some of the burden on already stretched PCPs, while staffing agencies like Medicus<\/a> place temporary PCPs in areas lacking them.<\/p>\n Other doctors are trying to split the difference to avoid leaving patients behind. Wayne Strouse, a family physician in the Finger Lakes region, created a hybrid DPC clinic that allows patients to choose their coverage model based on their means and needs. \u201cOne of the big knocks on DPC is, \u2018Well, we don\u2019t have enough doctors already, and now you\u2019re cutting down your patient panel from maybe 2,000, 2,500 to between 400 and 600,\u2019\u201d he says. \u201cAnd that\u2019s not true in my practice. I have close to 2,000 charts.\u201d He says his patients who come often usually opt to pay a monthly fee, while those who come rarely pay for each appointment separately. Earlier in his career, Strouse came so close to burnout that he dropped his practice and moved to New Zealand for a year to recover. When the feeling came back a few years ago, he knew the solution was to stop working with insurance companies and switch to a hybrid model.<\/p>\n Curious to know if the cost is worth it, I spoke to a patient who, after fruitlessly searching for an in-network PCP for almost five years, finally made the switch to membership medicine. Yoon Hang Kim, who lives in San Antonio, says one PCP he met with asked for all of his health information before agreeing to accept him as a patient, which he saw as an indication that they were \u201ccherry-picking\u201d potential patients. Another offered him an appointment, but when he arrived, he saw a nurse practitioner instead of the physician he booked. \u201cI felt that was deceptive,\u201d Kim says. He switched to his current DPC partially to solve the finding-a-doctor problem and partially because he wants pricing to be transparent. \u201cIt can be very opaque, what\u2019s covered and what\u2019s not,\u201d Kim says. Now there are no surprises.\u00a0His doctor\u2019s fee is about $150 per month.<\/p>\n I asked Kim what he does for a living. He told me he\u2019s a physician who trained in both family and preventive medicine. \u201cAre you a PCP yourself?\u201d I asked. \u201cNo,\u201d he answered. He left primary care behind to pursue integrative medicine. \u201cWhat\u2019s your practice like?\u201d I asked.<\/p>\n \u201cWell,\u201d Kim said, chuckling, \u201cI\u2019m terrible \u2014 it\u2019s a concierge practice.\u201d<\/p>\n Correction: A previous version of this story misstated the fees for Dr. Kelsey Smith\u2019s primary-care practice.\u00a0<\/p>\n Stay in touch.<\/p>\n Get the Cut newsletter delivered daily<\/p>\n Vox Media, LLC Terms and Privacy Notice<\/p>\n