Increased demands associated with practice management and constraints on reimbursement dictate how modern-day health care is delivered. For many providers, this means seeing volumes that exceed what is reasonable, directly affecting the quality of care provided. When I began practicing, seeing 25 to 30 patients per day was the norm, but over time that number has increased by a factor of 1.5 to 2. Often, this translates to being double-booked or even triple-booked every 15 minutes.
Patients may require refraction, extensive testing, or an intervention at the slit lamp. The number of “near misses” can be quite high, which means providers must rely heavily on support staff to perform flawlessly. In the end, balancing productivity with high-quality care is extremely challenging.
But how do we define quality care? Is it outcome driven? Is it patient satisfaction—and if so, what are patients satisfied with? For some, quality care means being in and out quickly and scheduling appointments at their convenience. Others want more chair time and prompt responses to phone calls. Still others prioritize a perfect surgical outcome with a smooth postoperative course. Most patients want all of the above. With the time constraints facing providers, achieving this consistently is virtually impossible without burnout.
The Origins of Concierge Medicine
Concierge medicine emerged in the mid-1990s as physicians sought to improve health care delivery by reducing patient volume while increasing access and time spent with patients.1 The first widely recognized concierge practice, MD², was founded in 1996 in Seattle by primary care physicians Howard Maron, MD, and Scott Hall, MD. The model quickly gained attention, and other physicians and organizations adopted similar approaches.2
Beginning in 2000, MDVIP offered a comparable model but differentiated itself by billing insurance in addition to charging an annual membership fee. By maintaining larger patient panels, MDVIP was able to offer lower annual membership rates.2 SignatureMD, founded in 2006, provided physicians with more flexible options for transitioning to a concierge model.3 In 2017, Forward Health entered the field. Founded by former Google and Uber employees and backed by venture capital, the company offered concierge-style care at a lower monthly cost, with a focus on leveraging technology and standardizing health care delivery.4
The growth of concierge medicine has been substantial over the past quarter-century. In 2000, only a handful of concierge practices existed in the United States. By 2005, approximately 500 physicians were practicing under this model.3 In 2008, more than 100,000 patients were contracting with roughly 300 concierge physicians.5 By 2010, the model had expanded to more than 5,000 physicians across over 500 providers.6 By 2012, there were 4,400 private concierge physicians, representing a 25% increase from 2011.7 Today, it is estimated that there are about 8,000 concierge practices serving roughly 300,000 patients, with the top 6 specialties being family medicine, internal medicine, osteopathic medicine, cardiology, nephrology, and pediatrics.8,9
Several concierge medicine models exist:
- In a fee-for-care (FFC) program, patients pay a monthly, quarterly, or annual retainer that covers most in-office services. Items such as vaccinations, laboratory tests, imaging, and certain procedures are typically excluded and billed separately on a cash basis.
- A fee-for-extra-care (FFEC) program is similar to FFC, but covered medical services are billed to Medicare or private insurance, while the retainer covers enhanced access and amenities.
- In a hybrid concierge model, physicians charge a retainer for services not reimbursed by insurance or Medicare—such as extended visits, email access, annual physicals, wellness plans, and comprehensive evaluations—while continuing to bill insurers for covered services. This model allows physicians to serve both concierge and nonconcierge patients simultaneously.
- Some concierge practices operate on a cash-only basis, accepting no insurance; this approach is known as a direct primary care (DPC) program. By eliminating insurance-related administrative overhead, these practices often provide more transparent pricing while maintaining personalized care.
Starting a Concierge Ophthalmology Practice
Glaucoma care is particularly well suited to a concierge approach because it relies on frequent testing and the development of longitudinal patient relationships. However, launching a concierge ophthalmology practice presents a unique set of challenges, with workflow design and utilization management emerging as the greatest obstacles to long-term success.
Minimizing wait times is critical to maximizing patient satisfaction, but this can be difficult when visits require extensive workups, particularly for second or third opinions, as well as additional diagnostic testing. In many cases, the visit may already take 30 to 45 minutes before the patient even sees the provider. As the day progresses, bottlenecks can develop at multiple points in the workflow, compounding inefficiencies.
At the same time, to make the visit “worth it,” patients often expect more chair time with the physician. In a concierge practice, this expectation is likely to be even greater. Balancing efficiency with extended physician interaction becomes a central tension.
To meet these higher expectations, the practice must be carefully structured so that high-quality service does not break down into operational traffic jams, excessive wait times, or financial instability. Achieving this balance requires thoughtful planning around testing capacity, staffing, scheduling, and pricing.
Workflow as the Central Challenge
Glaucoma care is inherently test heavy. Optical coherence tomography (OCT), visual field testing, and disc photography are essential for diagnosis and ongoing disease monitoring. In a traditional high-volume practice, this testing is often performed by multiple technicians or photographers across several rooms, with patients moving through what can feel like an assembly line.
In a concierge practice, patients may seek a different experience—one with fewer handoffs, less idle time between tests, and a sense that the visit is efficient and time well spent. The challenge lies in obtaining the necessary clinical data without overburdening the system. This requires intentional scheduling templates, adequate office space, and well-trained staff who can anticipate needs and perform testing seamlessly.
Concierge practices should also be prepared to invest in redundant technology and maintain access to the latest diagnostic devices. Although costly, having multiple OCT systems or visual field analyzers may be necessary to deliver on the promise of minimal wait times and enhanced patient satisfaction.
Scheduling and Visit Frequency Variability
Another major challenge in concierge glaucoma care is accommodating wide variability in visit frequency. Some patients may require only 1 or 2 visits per year for routine monitoring or preventive care. Others, particularly those with moderate or advanced disease or postoperative needs, may require several visits per month and 10 or more visits per year.
This variability complicates scheduling and capacity planning. If too many high-utilization patients are enrolled, the practice risks overburdening its schedule and jeopardizing the concierge experience for all patients. Conversely, if pricing is set too high to account for worst-case utilization scenarios, patient volume may be insufficient to cover staffing and overhead costs.
To address this, practices must design appointment systems that protect access while maintaining flexibility. Double or triple booking should not occur, even if the practice appears to be “doing well,” as this is often a slippery slope that compromises the very goals of concierge care. Time slots must also be reserved for urgent visits or same-day access, even if they occasionally go unfilled.
Cultural and Ethical Considerations
Beyond logistics and pricing, concierge ophthalmology requires a cultural shift for both patients and staff. Many patients are already frustrated by high premiums, copays, and deductibles, and concierge care introduces an additional layer of cost. Patients are often more comfortable with what their insurance covers and may be reluctant to pay out of pocket for health care services. Although individuals may readily spend on discretionary items, they are less accustomed to doing so for medical care.
This raises broader questions. Should patients become more comfortable paying directly for health care? Are we approaching a paradigm shift in care delivery? Concierge medicine began in internal medicine, but as pressures on the health care system increase, it is reasonable to ask whether subspecialty practices will also move in this direction.
Ethical concerns are unavoidable. I have already lost weeks, and maybe months, of sleep debating this decision. Am I right to be offering this service? Is it really better for me and my patients? What about those patients who may not be able to afford the annual fee—how should I feel if they must turn elsewhere for care?
From a personal perspective, I believe this approach will allow me to deliver excellent care in the way that I want, while allowing more time devoted to patients, teaching, and volunteer work. It is possible that the concierge model could enable physicians to give back more and contribute to higher quality care overall, but only time will tell.
Conclusion
Starting a concierge ophthalmology practice offers significant potential, but success depends on optimized workflow and preserved access. The need for extensive testing must be balanced against wait times, and pricing must be carefully weighed against overhead and staffing costs. With thoughtful investment in efficient systems and a dedicated team of technicians and office staff, a concierge ophthalmology practice can deliver both an exceptional patient experience and long-term sustainability. Ultimately, however, both patients and physicians must be prepared to commit to this shift in health care delivery—and to the questions and scrutiny that inevitably accompany it. GP
References
1. Bowser BW. Concierge medicine: greater access for a fee. PBS NewsHour. July 9, 2012. Accessed February 6, 2026. https://www.pbs.org/newshour/show/concierge-medicine-greater-access-for-a-fee
2. Williams, D. Boutique medicine: when wealth buys health. CNN News. October 20, 2006. Accessed February 6, 2026. https://www.cnn.com/2006/US/10/19/bil.healthy.wealthy/index.html
3. Prince RA, Schiff L. The Influence of Affluence: How the New Rich are Changing America. Crown Publishing Group; 2008:103.
4. Robinson M. Google and Uber alums have created a doctor’s office that’s like an Apple Store meets ‘Westworld’—and it’s expanding nationwide. Business Insider. November 15, 2017. Accessed February 6, 2026. https://www.businessinsider.com/san-francisco-forward-office-tour-2017-1
5. Marcinko DE, Hetico HR. The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, 3rd ed. Springer Publishing Company; 2010:562.
6. Knope SD. Concierge Medicine: A New System to Get the Best Healthcare. Rowman & Littlefield Publishing Group; 2010.
7. Blumenthal K. Is paying for ‘concierge’ health care worth it?” The Wall Street Journal. March 23, 2012. https://www.wsj.com/articles/SB10001424052702303812904577295501951423484
8. Konstantinovsky M. Many doctors are switching to concierge medicine, exacerbating physician shortages. Scientific American. October 19, 2021. Accessed February 6, 2026. https://www.scientificamerican.com/article/many-doctors-are-switching-to-concierge-medicine-exacerbating-physician-shortages
9. Concierge Medicine Today. For the media. Accessed February 6, 2026. https://conciergemedicinetoday.net/media-desk