The Concierge Catch

Better access for a few patients is disrupting care for many
By Josh Rossheim

“You had to pay the fee, or the doctor wasn’t going to see you anymore. “

That was the takeaway for Terri Marroquin of Midland, Texas, when her longtime physician began charging a member- ship fee in 2019. She found out about the change when someone at the physician’s front desk pointed to a posted notice. 

At first, she stuck with the practice; in her area, she said, it is now tough to find a primary care doctor who doesn’t charge an annual membership fee from $350 to $500.

But last year, Marroquin finally left to join a practice with no membership fee where she sees a physician assistant rather than a doctor. “I had had enough. The concierge fee kept going up, and the doctor’s office kept getting nicer and nicer,” she said, referring to the décor.

With the national shortage of primary care physicians reaching 17,637 in 2023 and projected to worsen, more Americans are paying for the privilege of seeing a doctor—on top of insurance premiums that cover most services a doctor might provide or order. Many people seeking a new doc- tor are calling a long list of primary care practices only to be told they’re not taking new patients.

“Concierge medicine potentially leads to disproportionately richer people being able to pay for the scarce resource of physician time and crowding out people who have lower incomes and are sicker,” said Adam Leive, lead author of a 2023 study on concierge medicine and researcher at University of California- Berkeley’s Goldman School of Public Policy.

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