Show me the money.
Fair enough. Here is all of it, in order. First, what you pay us, and what else it takes to open the doors. Then the bills nobody mentions when you leave a job. Then what the practice brings in and what it costs to run. Last, what it is worth when you are done. Some of this, nobody selling you on going independent will tell you. I have put it in anyway.
One price. Everything in it.
You pay us one monthly fee. No extra charge when you need help, and no contract to keep you. If we do our job, you’ll stay.
- Year oneYour first 12 months are the Concierge Catalyst. It starts the day you sign. We build your story, help open your practice, then put it to work. It is included. There is no separate startup fee.
- After thatMonth to month, for as long as it’s working for you.
- If you leaveNo penalty and no hard feelings. Your website, your films and your clips are yours to keep.
- Not in itPaid ads. Those are optional, and you pay the ad platforms directly. See Local Boost.
No minimum term. Leave any time, and keep what we built.
- Concierge Catalyst: your whole first year, startup included
- The co-op, working for you every day
- Your own website, built and kept fresh
- Your founder’s interview and keystone film
- Monthly Check-Ins, cut into clips for you
- A simple recording kit for your desk
- Content you can use yourself, anywhere
- A monthly report, and time with me to go over it
- Help whenever you need it
Not included: paid ads. Those are optional, with your own ad budget. See Local Boost.
The rest of the startup bill.
Our fee is one line. Here is every other core cost of starting your own practice, who you pay it to, and whether you need it. Most of it is paid by your practice, straight to the people who provide it. None of it comes through us.
| The line | Paid to | What it runs | Do you need it? |
|---|---|---|---|
| Your membership with us | Concierge Medicine Alternative | $2,500 a month. Everything in the box above, year one included. | Our fee |
| Before you commit | |||
| Your own health care attorney | A lawyer you choose, in your state | Often $1,000 to $2,000 for the review. He sits down with you and your spouse and explains what you are going into, before you spend real money. Why we insist on it. | YesBefore you sign anything |
| To practice | |||
| State medical licenses | Each state’s medical board | You already hold one. Every added state has its own fee and its own renewal. Start in the state you are in. | YesMore states are your call |
| Your own malpractice policy | Your carrier | Priced on your specialty, your state and what you actually do. A small remote panel is not a hospital’s number. Your broker will quote it. Leaving your old coverage is Bill 01 below. | Yes |
| Medical record, video and phone | The platform you pick | Some platforms bundle all of it. Some charge for each piece. The platforms publish their prices. | Yes |
| Payment processing | Your card processor | A small cut of each payment. Easy to ignore, and it grows with every member you add. | Yes |
| Your company, books and tax return | Your state, your bookkeeper, your CPA | Setting up the entity, the monthly books, and a business tax return each year. None of it large. All of it certain. | Yes |
| Only if you want paid ads | |||
| Local Boost ad budget | Google, Meta and Nextdoor, directly | About $1,000 a month is a suggested start, aimed only at your own ZIP codes and only in states where you are licensed. How Local Boost works. | OptionalNever required |
| Health care ad certification | The accreditation body the ad platforms use | About $975 to apply and $2,150 a year per website. The platforms won’t run telemedicine ads without it. We prepare the application; the practice applies and you sign. | Only with ads |
No lease. No staff. No billing company.
Look at what is missing from that list. The biggest bills of opening a normal practice never show up, because you start remote and you keep your job while you build.
The attorney range, the suggested ad budget and the certification fees are estimates of what others charge. They change, they vary by state and by vendor, and they are paid by your practice directly, not to us. Check each one before you budget. Our fee is the only figure here we set. See the Legal Disclosures.
The six bills nobody mentions.
None of these are reasons not to do it. They are reasons to know the number before somebody asks you to sign something.
Malpractice, in two directions
The coverage you are leaving. Most employed physicians are on claims-made coverage, which protects you only while the policy is live. When you go, the work you have already done still needs covering — and there are two ways to do that, not one. Your old carrier can sell you a tail. Or your new carrier can grant prior acts, setting your retroactive date back so the new policy picks up the old work. They are alternatives: you generally need one, not both, and prior acts is often the cheaper road. What you cannot afford is a real gap between them. Before any of that, find out whether your employer has agreed in writing to buy the tail — many do, and that settles the question. If your coverage is occurrence-based rather than claims-made, you may need nothing at all.
The coverage you are buying. Your employer’s policy does not follow you out of the building. An independent physician carries his own, and the premium is priced on his specialty, his state and what he actually does — which for a small remote panel looks nothing like the number on a hospital’s book. That one is an operating cost, not an exit cost, and it is the single most commonly forgotten line in the whole arithmetic.
Everything your employer quietly buys
Health coverage for your family. Disability. The retirement match. Life. Dental. The CME allowance, the licence and board fees, sometimes the phone. None of it shows on your pay stub as a cost, and all of it becomes yours. Add it up honestly before you decide what the practice has to earn.
The non-compete you have not read
Most employed physicians have one. Most have never read it closely. What matters is the radius, the duration, and whether it reaches a telemedicine patient who happens to sit inside it. Enforceability varies by state and the law here has been moving. That is a question for a lawyer with your actual contract in front of him — not a question for a website, including this one.
The day your W-2 becomes a 1099
Self-employment tax arrives. Quarterly estimates arrive. A set of deductions opens up that never applied to you before. An S corporation election can help, but only above a level of profit that depends on your numbers — below that line the payroll and filing cost more than the election saves. This part is arithmetic, and it is specific to you.
Your loans, and one trap
If you work for a non-profit hospital and you are counting on Public Service Loan Forgiveness, leaving stops that clock. Payments made outside qualifying employment do not count toward it. Depending on how far along you are, that is either irrelevant or it is the largest number on this page by a wide margin. Find out which before anything else.
Building the panel
Between the day you begin and the day the practice can pay you, your members have to be found — and finding them costs money before it brings any in. Here, that is the membership at the top of this page, plus any ad budget you choose to add. It is a cash requirement before it is a return, and in most transitions it is the largest single number on the list.
It is also the whole reason the advice here is to keep the job while you build. With an income still arriving, the runway question stops being a question. What it costs to run covers the ongoing side of it.
You don’t lose the benefits. You change which side of the desk you buy them from.
An employed physician takes whatever plan the system picked for him. A practice owner buys coverage through his own entity, where it is a business expense and usually sits inside a group policy. That is how every business owner you have ever envied handles it, and it is one of the quiet reasons they are not losing sleep over it.
The treatment is not uniform — it turns on how the practice is organised — which is exactly why it is worth an hour with somebody who does this for a living instead of a paragraph on a website.
And whatever else you decide: nobody gives up health insurance. Not your patients, not you. There is no level of income at which that becomes a good idea.
What actually arrives, and what actually leaves.
A membership practice is not a smaller version of an insurance practice. The whole shape of the money is different, and the difference is not the fee — it is everything that used to sit between you and getting paid.
What you bill is what you collect
No contractual adjustments. No denials, no appeals, no coding audits, no ninety-day receivable. In an insurance practice a meaningful slice of what you bill never arrives, and the staff who chase the rest are themselves a cost. Here the gross and the net are close enough to see at once.
It is recurring, and it is known
Memberships bill monthly whether or not anybody came in. That is the opposite of a visit-driven practice, where a slow February is a smaller cheque. You are not chasing volume to hold the month together.
You set the dial
You set the fee. You set how many members you take. You set which days and hours appointments are even available. Almost nothing about the revenue of this practice is decided by somebody else — which is the part that has nothing to do with money and is usually the real reason people do it.
And what it costs to run.
Four lines. One of them is much larger than the other three, and it is the one most people leave out of the arithmetic entirely.
Getting patients
The big one. Patients do not arrive because you exist — somebody has to put you in front of them, repeatedly, and that costs money whether you buy it as advertising or pay for it with your own evenings. Your earliest members cost the most; the number falls as reputation and referral start doing the work. With us, this line is the membership.
The record, and the way you talk to them
A medical record you actually own, and a compliant way to message, call and see people — secure messaging, video, and a phone number that is not your mobile. Some platforms bundle all of that and some charge for each piece, and that difference matters more than the headline price. The platforms publish theirs.
Payment processing
Small per transaction, easy to ignore, and it grows with every member you add. As the technology page puts it: the software is the small line — watch the processing fee.
The standing costs
Your own malpractice. A state licence and renewal for every state you practise in. Board fees and CME. The entity, the bookkeeping and the tax return. None of them large on its own. All of them certain.
You pay to get a member once. He pays you every month after that.
That is the entire economic shape of this practice, and it is why the arithmetic can work on a panel a fraction the size of the one you carry now. It also means the number that decides everything is not what a member costs to acquire — it is how long he stays. Anyone modelling this on a single year of revenue is understating it badly if members stay, and kidding himself if they do not.
One day you will want to sell it, or stop.
Ask most physicians what their practice is worth and they have never run the numbers. It is the question a CPA is built for, so here it is. Medical practices sell. The market is active, and insurance-based practices are the overwhelming majority of what changes hands — concierge is a sliver of it. So the question is not whether yours will find a buyer. The question is what yours is worth next to the one down the road.
Here is the part that is true well beyond medicine. In almost any industry, a business built on monthly subscriptions is valued at a premium to one that bills per service or per item. Buyers pay for revenue they can forecast, and lenders will advance more against revenue under contract than against revenue that has to be won again every month. It holds for software, for service companies, for professional practices — and the premium is not small.
A concierge practice is a subscription business that happens to practise medicine. Same dollars, different quality of dollar.
And the advantage compounds, because the margin is different too. A practice with no billing staff, no coders and no receivable to chase converts more of every dollar into profit than an insurance practice of the same size. Better revenue, and more of it reaching the bottom line, valued on a better multiple.
Now the part a broker will not lead with. It is worth something to somebody else only to the degree that it is not entirely you. If every relationship in the panel runs through your mobile number and nothing is written down, you have built a very good job rather than a sellable business. Whether that matters depends on what you want out of it — but it is a choice to make deliberately in year one, not a thing to discover in year twelve.
What yours would actually fetch is a conversation with a valuation professional holding your real numbers. Anyone quoting you a multiple before they have seen them is selling something.
A general comparison of how the two models are built — not a valuation, an appraisal, or a promise of a sale price. What any individual practice is worth depends on its own revenue, retention, contracts and market at the time it is sold. See the Legal Disclosures.
Could you go back?
Hospitals commonly want to see recent clinical work before they will credential you, so a gap of a few months can turn into a re-entry problem that did not exist the day before. State boards ask about time away from practice. The exits that look cleanest on paper — the non-clinical jobs, the industry roles — are the ones that quietly close that door behind you.
Which is why the advice here is what it is. You do not resign and then work it out. You keep practising, you keep the licence current and the credentials clean, and you build the other thing beside it on the hours you choose. The door you came through stays open the entire time.
That is not a small feature. For most doctors it is the whole reason the plan is survivable.
Nothing on this page asks you to jump. The entire point is that you do not have to.
“Any website that prints a number for your tail coverage is guessing at your expense.”
Our fee is ours to set, so it is printed at the top. So are the outside costs we can fairly estimate. Every other figure worth having depends on your state, your carrier, your contract, your entity and your own arithmetic. What the rest of this page is for is making sure you know the line items exist — before somebody hands you something to sign.
I have been doing this arithmetic since 1973.
I am a CPA, licensed since 1973, and I have worked with physicians since the 1990s. I am not your accountant, this is not advice, and the answers here are specific to you rather than general. But I have sat across a desk from a great many doctors working through exactly these questions, and I would rather you had it in front of you than not.
Adrian Keith Skane, CPA