Concierge Medicine: Health Care for the Wealthy
The Million Dollar Question: What does the highest-tier U.S. concierge medicine practice — Private Medical, the family-office-style firm in San Francisco, New York, and Miami — charge per adult patient per year?
A) $4,000 B) $15,000 C) $40,000 D) $100,000
Read on for the answer.
A working explainer of concierge medicine — what it actually is once you strip the marketing, the four bands of patient who use it, the twenty-fold price ladder from a $1,800 rural retainer to a $40,000-a-year family-office-style practice, and the misconceptions the category collects more than almost any other corner of the wealth-services market.
What it is
Concierge medicine is a primary-care model in which the patient pays a doctor an annual retainer, on top of insurance, in exchange for a panel small enough to permit same-day visits, longer appointments, direct phone or text access, and active care coordination. The retainer pays for what insurance never covered: the unhurried 30- to 60-minute appointment, the after-hours call, the doctor reading the whole chart before the visit, the introductions to specialists. Insurance still pays for the labs, imaging, prescriptions, and hospitalization themselves.
The category is often confused with three adjacent things, and the confusion is part of why the price ladder is so wide.
It is not the same as direct primary care (DPC), where the doctor refuses insurance entirely and the patient pays a flat monthly fee — typically $50 to $100 per month — for unlimited visits. DPC is built for cost-conscious uninsured or underinsured patients; concierge is built for time-and-access-conscious insured patients. The panel-size and insurance-billing differences are the cleanest way to tell them apart.
It is not the same as an executive physical — the one-shot annual top-to-bottom exam at an academic medical center. Executive physicals are a discrete product (you fly in, you spend a day, you leave with a binder); concierge is an ongoing relationship.
And it is not the same as longevity medicine — the moonshot category of biological-age testing, hormone optimization, and full-body MRIs that gets most of the breathless press. That story belongs to a different post on this site (#25 Longevity). The vast bulk of what concierge practices actually do is mainstream primary care, delivered with more time and more access.
The category has been around long enough to have a brand-name layer: MDVIP, the largest U.S. network with more than 1,300 affiliated physicians; SignatureMD, Specialdocs, PartnerMD, and Castle Connolly Private Health Partners in the mass-market and higher-end tiers; Sollis Health as the 24/7 private-ER specialist; and Private Medical at the top of the ladder, the practice CNBC profiled in 2024 as “the private doctor to the wealthy — at $40,000 a year.” The mass-market and higher-end tiers are populated by the network brands; the family-office tier is a much smaller, mostly private group of practices.
Who uses it
Three readable bands.
The mass-market concierge patient. Aging upper-middle-class households — typically over 50, often retired or nearing retirement, with a family doctor who has “gone concierge” and is asking the panel to convert. This is the MDVIP and SignatureMD core. The retainer ranges from roughly $1,800 to $5,000 per year, the doctor still bills the patient’s insurance for visits, and the conversion is often less about wealth than about an unwillingness to lose a long-trusted physician to the 11-minute-appointment economy. A meaningful share of these patients are in the $1M–$5M wealth band rather than higher; for them the membership is a real but defensible household line item, not a luxury.
The HENRY-and-up coastal professional. A demographic that overlaps cleanly with the readers of the HENRY piece — dual-earner couples and senior individual contributors in NYC, the Bay Area, Boston, Washington, LA, and Miami, often in their late 30s through 50s, with kids at home, and with no patience for the time tax of a hospital ER visit. This is the band that joins Sollis Health for $4,000 to $13,000 a year. Sollis is not strictly concierge primary care — it is a 24/7 private urgent-care and emergency network — but it sits in the same retainer-on-top-of-insurance model and gets bought for the same reason: time saved.
The ultra-wealthy family. $30M+ households that treat health as a portfolio managed by a small team. This is Private Medical territory, and the practice is explicit about the framing — its founder Dr. Jordan Shlain describes it as “a full-service, family office for health and medicine”, with a team of physicians, nurses, and clinical staff handling every part of a family’s medical life from routine visits to second opinions on complex cases. The fee, again per CNBC’s 2024 reporting, is approximately $40,000 per adult and $25,000 per patient under 18 per year, covering office visits, tests, and procedures but not hospitalization. The firm reportedly serves more than 1,000 families. PHM (Private Health Management) offers a related advisory layer that often sits on top of a concierge GP for high-acuity cases.
The bands are not bright lines. A wealthy family in San Francisco might use Private Medical for the family-office layer, an MDVIP-style local doctor for the in-network primary care, Sollis for the late-night ER alternative, and Mayo for the annual executive physical. The product label is the same; the products are different in kind.
Why they use it
The motivators are five, and they line up cleanly with the recurring frame this site uses for any wealth-services category.
Time saved. The traditional U.S. primary-care visit averages something close to 15 minutes once the patient is in the room, and the route to that 15 minutes runs through phone trees, portals, weeks-long waits, and waiting rooms. The concierge equivalent is a same-day appointment, taken at the time the patient asks for it, with the doctor reading the chart in advance. For a senior corporate executive whose hourly opportunity cost is meaningful, the math closes quickly even at the upper end of the price ladder.
Access. The patient can text or call the doctor directly, at any hour. For acute issues — a child’s fever, a parent’s chest pain, a question about a new prescription — the concierge model collapses a multi-day process into a single conversation. At the top tier, that access extends to the doctor’s specialist network: the patient is not on a six-month waiting list to see a leading cardiologist because the family doctor is making the call directly.
Coordination. A patient with three chronic conditions, two specialists, and a recent hospitalization carries a chart no insurance-paid GP has time to read end to end. Care coordination — the work of one human reading the entire history, comparing the cardiologist’s plan against the endocrinologist’s plan, catching the duplicate prescription — is the under-marketed core of what concierge actually buys. It is also one of the few features that scales meaningfully into measurably better outcomes for complex cases.
Privacy. Small practices keep small records. A concierge GP often holds the patient’s chart on a single internal system, restricted to the practice, rather than shoveling it into a national portal that any covered entity can pull from. For households who treat invisibility as infrastructure — see Privacy — that fact alone justifies the retainer.
Risk reduction. The catch-it-early framing. An executive whose absence is operationally expensive — a CEO, a managing partner, a sole-earner founder — buys the concierge model as a form of personal disaster insurance. The annual physical is more thorough; the borderline number gets a second look; the strange symptom gets seen this week instead of next month. None of this is exotic medicine; it is mainstream medicine delivered without the friction.
The least-discussed motivator is the second one. The retainer is, in part, the price of admission to the doctor’s personal Rolodex of specialists, which is often the actual product the patient is buying.
How it works
The mechanics are straightforward once the pieces are named.
The retainer pays for what insurance does not. The 30- to 60-minute appointment, the after-hours call, the care coordination, the chart-reading time, the introductions. Insurance still pays for the labs, imaging, prescriptions, ER visits, and hospitalizations themselves. Per MDVIP’s own patient FAQ, members are still expected to maintain a primary insurance plan — usually a high-end PPO and, for older patients, Medicare — and the concierge fee sits on top.
Panel size is the structural variable. A traditional U.S. primary-care physician carries a panel in the range of roughly 1,800 to 2,500 patients, with the historical “industry standard” of 2,500 widely argued to be infeasible given the actual hours required for guideline-based care; a concierge practice typically caps the panel at 300 to 600 patients, and the smallest boutique practices run under 200. The math of access works downstream of that single decision. A doctor with 300 patients can take a long appointment with each one and still have the day to return calls; a doctor with 2,500 cannot.
A handful of large players. MDVIP is the largest U.S. network at more than 1,300 affiliated physicians and has changed hands several times — Procter & Gamble (2009), Summit Partners (2014), Leonard Green (2017), and most recently Goldman Sachs Asset Management together with Charlesbank Capital Partners (2021). SignatureMD, Specialdocs, PartnerMD, and Castle Connolly Private Health Partners sit in the mass-market and higher-end bands. Sollis Health runs the 24/7 private-ER vertical with locations in New York, the Hamptons, Los Angeles, Miami, and now Palm Beach; the firm raised $33 million in late 2024 and is one of the most aggressive growth stories in the segment. Private Medical, Crossover Health, and PHM sit at the top of the ladder.
Private equity has rolled the segment up. As ABC News reported and as the U.S. concierge medicine market data makes clear, hospitals and PE-backed groups have been acquiring concierge practices at a steady clip. The U.S. market was sized at roughly $7.35 billion in 2024 and is projected to grow at about 10% annually through the end of the decade. Consolidation is changing the economics: a doctor selling to a network gets capital and back-office relief, but the patient often sees a fee bump and a colder version of the original practice within a year or two.
What it costs
A five-rung ladder, all 2026 numbers, USD throughout.
Rung 1 — direct primary care, the cousin. $50–$100 per month, no insurance billed by the practice, $600–$1,200 per year. DPC is closer to a different category and the boundary is worth naming cleanly: DPC patients are buying access to a flat-fee doctor who refuses to deal with insurance at all; concierge patients are buying additional access on top of insurance. Many DPC patients still carry catastrophic insurance for the things their doctor cannot do.
Rung 2 — mass-market concierge. MDVIP, SignatureMD, PartnerMD, Specialdocs. The retainer runs roughly $1,800–$5,000 per year, with a national average around $2,500–$3,000. Insurance is still billed for labs and visits. The MDVIP model tops out near the lower end of that range in most markets; PartnerMD discloses fees of roughly $2,600 to $3,600 annually depending on location. This is the rung the typical concierge patient is on.
Rung 3 — higher-end concierge. Castle Connolly Private Health Partners, top SignatureMD practices, top single-physician boutiques in coastal cities. $5,000–$15,000 per year. The product is a smaller panel (typically 100–300), a more capable practice, and meaningfully more responsive after-hours access. Some practices at this rung also fold in an annual executive-style physical at no additional charge.
Rung 4 — executive physical add-ons (separate from concierge but often bundled into the same household budget). Mayo Clinic Executive Health runs roughly $5,000–$11,000 for a one-shot annual exam; Cleveland Clinic’s Premier Executive Health Program ranges from approximately $5,000–$25,000 depending on testing, with the upper end including coronary calcium scoring, cardiac stress testing, and full vascular screening, per Cleveland Clinic’s published Premier brochure and Mayo’s pricing guidance. Many corporate plans pick up part of this for senior executives.
Rung 5 — family-office-style top tier. Private Medical at approximately $40,000 per adult and $25,000 per child; PHM as an advisory overlay on top; Sollis Health membership at $3,500–$13,000 per year for 24/7 private-ER access. A wealthy family of four using the full stack — Private Medical for the GP layer, Sollis for the after-hours alternative, an annual Cleveland Clinic Premier exam, and PHM for high-acuity case navigation — is on the order of $130,000–$200,000 per year in retainers and one-shot fees, all on top of insurance plan costs.
A taxes-and-deductibility note. Concierge retainers are generally not HSA- or FSA-eligible to the extent they pay for access (the IRS treats access fees as non-medical) and most are not deductible on Schedule A either. The 2026 treatment, summarized in this practitioner explainer, is essentially that the medical-services portion of the fee may be partly deductible if it can be allocated, but most practices do not break the fee down and the IRS default is conservative. In other words, the sticker price is approximately the after-tax price.
Hidden costs and tradeoffs
Five things the brochure does not say.
The retainer is on top of insurance, not a replacement. A coastal family of four carrying a high-end PPO plan is already paying $25,000–$40,000 per year in plan costs and out-of-pocket spending before the concierge fee starts. The full stack at the top tier roughly doubles the family’s all-in healthcare line — for a household in the $30M+ wealth band, immaterial; for a HENRY household, a real budget decision.
Geography binds the value. The model is built around a specific doctor in a specific city. A family that moves, travels heavily, or splits time across multiple homes finds that the concierge fee buys far less than it appeared to. Sollis has tried to address this by building a multi-city network, and Private Medical has expanded to the cities its clientele actually live in, but the typical mass-market concierge patient who relocates loses most of the value of a five-year-old relationship in a single move.
The concierge GP is the navigator, not the surgeon. For routine and even moderately complex care, the small panel and long appointment time are real value. For a serious oncology diagnosis, a complex cardiac procedure, or pediatric subspecialty care, the concierge model’s value is care coordination — getting the patient to the right surgeon at the right academic center quickly — not the specialty care itself. The marketing in the segment often blurs that boundary; the honest version is that the GP’s network is the product, and the surgeon at the academic medical center is doing the actual work.
Panel concentration risk. When a popular concierge MD retires, the panel is stranded mid-relationship. Replacement physicians, particularly at PE-rolled-up networks, often raise fees and re-screen the panel within a year. The patient’s leverage at that point is small — switching practices means rebuilding a five-year medical relationship, and most do not.
The two-tier critique. Every patient who switches from a 2,500-patient panel to a 300-patient panel removes the equivalent of one doctor from the public-supply side of the equation. The empirical literature on this is contested but consistent in direction; Fierce Healthcare’s coverage of the trend lays out the access-displacement argument fairly. The point is not moral but operational: a household considering concierge medicine should know what its fee is buying and what the broader system is losing.
What people get wrong
Five corrections, tight.
1. Concierge medicine is overwhelmingly primary care, not anti-aging or longevity. The IV drips, biological-age testing, full-body MRIs, hormone-replacement protocols — that is longevity medicine, and it lives in a different category and a different post (#25 Longevity). The vast bulk of concierge practice is mainstream care delivered with more time and more access. Conflating the two reads a $40,000 retainer as buying immortality, when it is mostly buying responsiveness.
2. Concierge is not direct primary care. They look similar from a distance and are different in kind up close. DPC refuses insurance and serves cost-conscious patients at $600–$1,200 per year. Concierge sits on top of insurance and serves time-conscious patients at $1,800 and up. The same patient might benefit from one and not the other; the right framing depends on whether the bottleneck is access or affordability.
3. The $2,400 retainer is not the upper bound. The same product label covers a 20-fold price range, from $1,800 at a rural MDVIP affiliate to $40,000 at Private Medical, and at the wide ends those are different products in kind, not just degree. Comparing a national average against the family-office tier is the same category error as comparing a Honda Accord’s price against a private jet’s.
4. Insurance is still required, and it still does most of the work. The retainer is for access, time, and coordination — not for the labs, the imaging, the prescriptions, the ER visit, or the hospital admission. Patients who confuse concierge for a replacement plan find this out at the first emergency. The only exception is direct primary care, which is a different model with a different set of tradeoffs.
5. Price is not a clean proxy for medical quality. Some of the most respected clinicians in the country practice at $3,500-a-year MDVIP affiliates because the model lets them do their best work. Some of the most expensive boutique practices buy access and discretion more than they buy clinical excellence. Price tracks access more cleanly than it tracks medicine. The patient who selects on the wrong axis can pay ten times the rate and end up with a less skilled doctor.
Bottom line
Returning to the opening question: per CNBC’s 2024 profile, Private Medical charges approximately $40,000 per adult patient and $25,000 per patient under 18 per year — Answer C. That number anchors the top of a 20-fold price ladder that runs from $1,800-a-year mass-market MDVIP affiliates to family-office-style practices serving $30M+ households as the medical complement to a single-family office.
The honest framing is that “concierge medicine” is four different products sold under one label. The mass-market version, at $1,800–$5,000 per year, is an upgrade most upper-middle-class households in the $1M–$5M wealth band can buy without changing their lives — a $200-a-month answer to the 11-minute appointment. The higher-end version, at $5,000–$15,000, is the same thing with a smaller panel and more responsive access. The 24/7 private-ER version, at $4,000–$13,000 through Sollis, is a time-and-friction product for coastal HENRY-and-up households that have run out of patience for hospital waiting rooms. And the family-office version at $40,000+ per adult is, as Private Medical puts it, the medical equivalent of the single-family office — a clinical team that knows the entire family’s history and is on call.
What the category is not is the moonshot. The biological-age tests and full-body MRIs that get the press belong to longevity medicine, which is a different post. Concierge, at every rung, is mainstream care delivered with more time, more access, and more coordination. That is a genuinely useful upgrade. It is also, at the top of the ladder, the most underexplained part of how wealthy families actually manage the
