The Rise of Concierge Medicine: What It Means for Academic Faculty
The Pitch Is Getting Harder to Ignore
A faculty physician I coach recently told me she had lunch with a former colleague who left academic medicine two years ago to start a direct primary care practice. The former colleague described her week: 40 patients total, no insurance billing, no RVU targets, no committee meetings, and a six-figure income she controls entirely.
My client went back to her office and stared at a schedule with 22 patients that afternoon. She loves teaching residents. She loves the intellectual rigor of academic medicine. But she told me, "For the first time, I understood why people leave."
She is not alone. The concierge and direct primary care movement is growing fast, and it is pulling talented physicians away from academic medical centers at a rate that should concern every department chair in the country.
What Is Actually Happening
Concierge medicine and direct primary care are not new, but their growth has accelerated dramatically. A 2023 report from the American Academy of Private Physicians estimated that the number of DPC and concierge practices in the United States has more than tripled in the last decade. That growth shows no signs of slowing.
The appeal is straightforward. Physicians in these models see fewer patients, spend more time per visit, eliminate most insurance paperwork, and often earn comparable or better income than their academic counterparts. They get to practice medicine the way they imagined when they started medical school.
For academic faculty, who already face a well-documented compensation gap with the private sector, this creates a new and potent competitor for talent. It is not just large health systems and private groups recruiting your best people anymore. It is the promise of autonomy and simplicity that academic medicine structurally cannot match.
Why Academic Medicine Should Pay Attention
The physicians drawn to concierge and DPC models are not the ones who were struggling. They tend to be experienced, highly capable clinicians who got tired of a system that values throughput over relationships. That profile sounds a lot like the faculty members academic institutions can least afford to lose.
Here is the uncomfortable truth. Every time a talented academic physician leaves for a concierge practice, the institution does not just lose a clinician. It loses a teacher, a mentor, and often a researcher. The residents and fellows who trained under that physician lose a role model. The pipeline gets thinner.
Robert Pearl, former CEO of The Permanente Medical Group, makes a related argument in Uncaring: How the Culture of Medicine Kills Doctors and Patients. He describes a healthcare system that systematically burns out its best people by prioritizing production over purpose. Concierge medicine is, in many ways, a rational response to exactly that problem.
What Institutions Need to Do
Academic medical centers cannot compete with concierge medicine on panel size or schedule flexibility. That is not the game. But they can compete on the things that drew faculty to academic medicine in the first place, if they are willing to actually protect those things.
- Protect what makes academic medicine worth choosing. If a faculty member spends 90 percent of their time on clinical volume, they are doing the same work they could do in a concierge practice with a fraction of the patients and none of the institutional overhead. Protected time for teaching, research, and mentorship is not a budget line to cut. It is the retention strategy.
- Invest in professional development and coaching. Faculty who feel supported and who have a clear career trajectory are far less likely to fantasize about hanging a shingle. The physicians most at risk of leaving are often the ones who feel invisible, not the ones who feel underpaid.
- Have honest conversations about career sustainability. Most faculty will not bring this up on their own. They will quietly research DPC conferences, talk to colleagues who made the jump, and one day hand you a resignation letter. Department chairs need to initiate these conversations before it gets to that point.
- Acknowledge the competition. Pretending that concierge medicine is a fringe movement or that it only appeals to physicians who could not handle academic life is a losing strategy. It appeals to good doctors who want to practice good medicine without the bureaucratic weight. Academic leaders need to take that seriously.
The Real Takeaway
The rise of concierge and direct primary care is not a threat to academic medicine because it offers physicians more money. It is a threat because it offers them something academic medicine keeps promising but often fails to deliver: the ability to practice meaningful medicine without burning out in the process.
Academic institutions that respond by doubling down on what makes them genuinely different, the mission of education, discovery, and clinical excellence, will hold onto their best people. The ones that keep piling on clinical volume while cutting development support will keep watching talented faculty walk out the door.
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