When general internist Edward Espinosa began his career at Piedmont Hospital in Atlanta nine years ago, he planned to eventually transition from hospital- to office-based practice. However, the more he learned about the frustrations of the traditional fee-for-service environment, the less confident he became about taking that path.
"The hospital was willing to set me up in a clinic but then I found out that I would need to see 25 patients a day," says Espinosa, 43, who now runs Buckhead Concierge Internal Medicine in Atlanta. "It defeated the reason I wanted to practice outpatient medicine in the first place, which was to decrease my volume of patients and be less impersonal and rushed."
He did some research into alternative practice models and zeroed in on concierge medicine, where patients pay an annual fee or retainer in exchange for enhanced care and expanded access to providers. The model has gained popularity in recent years, according to the 2014 Survey of America's Physicians conducted by executive search firm Merritt Hawkins, which reports that about 7 percent of all physicians currently practice some form of concierge or direct-pay medicine while 13 percent have plans to do so at some point in their careers.
For Espinosa, building a concierge practice from the ground up represented a huge challenge. However, he saw it as the best path to long-term financial stability and career satisfaction.
"Concierge medicine seemed like something that I could continue into my retirement years and still enjoy," he says. "I went into medicine because I like caring for people and I felt like I couldn't do that well in an environment where it's all about volume."
In between his shifts as a hospitalist, Espinosa talked to friends who were running successful concierge practices in California. He also conducted extensive market research and hired a consultant to help him develop a business plan.
Location is the most important initial consideration, he says. He eventually decided on the Buckhead section of Atlanta, a relatively affluent and vibrant neighborhood with the potential to support a membership-based practice.
While encouraged by the success of other concierge practices, he was cognizant of the unique challenges of his situation. Most physicians who transition to concierge already run established traditional practices and are able to immediately convert a percentage of those patients into paying members. However, Espinosa started from scratch when he opened Buckhead Concierge in 2008.