Resident Options: Concierge Medicine

 Our new Residency Options series will focus on the wide variety of specialties and areas of practice that medical residents may consider to pursue.  We will be interviewing MDs and exploring their decision making process as they decided what career path they would take. Concierge Medicine is described on Wikipedia (forgive us for going there, but we have discovered just how many residents use it):

Concierge medicine (also known as direct care) is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors provide enhanced care.^[1] Other terms in use include boutique medicine, retainer-based medicine, and innovative medical practice design.

The practice is also referred to as membership medicine, concierge health care, cash-only practice, direct care, direct primary care, and direct practice medicine. While all concierge medicine practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the fee charged. Estimates of U.S. doctors practicing concierge medicine range from fewer than 800^[2] to 5,000.^[3]

To find out more about working in Concierge medicine, we interviewed Dr. Tiffany Sizemore of Choice Physicians of South Florida to learn how she decided to pursue a career in Concierge:

Where did you attend Medical School?

Nova Southeastern University in Ft. Lauderdale Florida.

Where did you do your Residency?

At Palmetto General Hospital- Miami FL

Where there other specialties you considered before deciding on Concierge Medicine?

Internal medicine and cardiology.  I am currently a cardiology fellow as well. Upon completion of my cardiology fellowship, our concierge members will be grandfather'ed in to the cardiology practice as well, if they need to be. I have not yet decided how I am going to approach my outpatient cardiology practice when I graduate. I may offer concierge cardiology as well.

Did you have a mentor who guided you towards Concierge?

Honestly, no. I had heard about concierge medicine from various sources and did a tremendous amount of research on the field prior to jumping in.

What first piqued your interest in Concierge? 

After finishing internal medicine residency, I was convinced that seeing 50 internal medicine patients in one day was not right for me (or for the patient, for that matter). I began to research how I could make a good salary, yet practice medicine the way I thought it was meant to be practiced. I liked the idea that I could see 8 patients a day, not 50. I also liked that I would have the time flexibility to actually follow my patients in the hospital if they had to be admitted. I am a true believer in continuity of care, and concierge medicine helps make that process easier.

What was the biggest challenge beginning your practice right out of Residency?

Lack of business knowledge. My husband and I had to teach ourselves everything. We had to get a business set up with the state, get group NPI numbers, get on all of the insurance plans, market, make brochures and logos, design a website...not including hiring a staff and building a sleep lab. I think I learned more about opening a business in 6 months than most learn in a lifetime.

What has been the biggest ongoing challenge? 

Getting patients! Let me tell you, it is easier said than done. Nowadays, the vast majority of new grads are becoming employed. As a "private" doc, you are in a constant struggle to fight with big groups hospitals for patients and contracts. Most of our patients  have found us through a Google search or by word of mouth. I don't regret the decisions I have made, but it is taking me much longer than I thought it would to get patients;  not just concierge patients but general patients too!

What is the greatest benefit in the choice you made for your career? 

Time and independence. I enjoy being able to form my office schedule around my life. I am very involved with the American Heart Association as well as my fellowship, so having the ability to work around my schedule is wonderful. I am blessed to have my husband in on this adventure with me so he can help with patients during the day if need be. Also, the independence is wonderful. There is no one I have to answer to but myself. If I don't like the way something is going, I change it. If I want to close on a Monday, I do. I have the autonomy to be flexible and do what works for us, without having to run it by someone else first. My husband and I make all of the decisions.

What advice would you give a Resident considering Concierge?

Do your research. Opening an office and practice is VERY time consuming and very costly. We were lucky to have enough money in savings, so we did not have to take out another loan. Have solid goals (but be realistic with them), and make a business plan. Talk to other concierge practices and see how they are doing. Research if your community is in need of such a practice model, before jumping in.  Dr. Tiffany Sizemore owns and practices at Choice Physicians of South Florida, and blogs at www.SizemoreHeart.com.  You can also follow her on Twitter and connect with Choice Physicians on Facebook, Twitter and Google+,