Patients ask me to explain the difference between concierge medicine, direct primary care, and the national membership networks almost every week. The honest answer is that the three models differ on two things that matter and a dozen that do not. The two that matter: how many patients your physician carries, and whether your visits still get billed to your insurance. Everything else, the branding, the welcome packet, the name they give the annual physical, follows from those two answers.
Here is the whole thing, laid out.
The one number that explains most of it
A conventional primary care physician in the United States carries somewhere north of two thousand patients. Some carry three thousand.
That number is the reason for almost everything patients dislike about primary care. It is why the visit is fifteen minutes. It is why the portal message takes three days. It is why the physician is typing while you talk, and why the person who calls you back about your labs has never met you. Nobody in that system is doing a bad job. The arithmetic does not permit a different outcome.
Every membership model is, at bottom, a way of buying a smaller number.
Direct primary care: the billing answer
Direct primary care is defined by what it refuses to do, which is bill insurance.
You pay a monthly fee. The practice takes no insurance at all, which means no coding, no prior authorizations, no billing department, and no negotiated rates. Because the overhead of running insurance is a genuinely enormous share of a primary care practice's cost, DPC practices can charge relatively modest fees and still shrink the panel meaningfully.
The tradeoff is scope. Most DPC practices are built around excellent, unhurried, bread-and-butter primary care. Advanced testing, hormone work, and longevity medicine are usually not part of what you are buying.
Concierge: the panel answer
Concierge medicine is defined by the panel, not the billing.
You pay an annual or monthly membership fee, the physician cuts the panel down to a few hundred patients, and you get longer visits, faster access, and in most programs a direct cell number. What surprises people is that in the majority of concierge practices, your visits are still billed to your insurance. The membership fee buys the access. The medical care is billed the way it always was.
That is not a criticism, but it is a thing to know before you sign. It means the membership fee sits on top of your premium, your deductible, and your copays rather than instead of them.
Where national networks fit
The large national membership networks, of which MDVIP is the best known, are a standardized version of the concierge model. A local physician affiliates with the network, reduces the panel, and delivers a program built around a thorough annual physical, with the network providing the branding, the systems, and the patient materials.
The strengths are consistency and portability. The things to ask about are the ones specific to the structure: whether there is an initiation fee on top of the annual membership, and whether visits are still billed to insurance. In most of these programs the answer to the second is yes.
Side by side
| Insurance-based | Direct primary care | Concierge (typical) | National network | |
|---|---|---|---|---|
| Panel size | Typically 2,000+ | A few hundred | A few hundred | A few hundred |
| Membership fee | None | Modest, monthly | Higher, often annual | Higher, often annual, sometimes plus initiation |
| Visits billed to insurance | Yes | No | Usually yes | Usually yes |
| Visit length | 15 to 20 minutes | Unhurried | Unhurried | Unhurried |
| Access between visits | Portal, staff-triaged | Direct, usually text or cell | Direct in most programs | Direct in most programs |
| Advanced and longevity testing | Not included | Usually not part of it | Varies, often a paid add-on | Varies, often a paid add-on |
The rows describe how these models are typically structured. Individual practices vary, which is exactly why you ask rather than assume.
What none of the three names tells you
Here is the part that gets lost in the vocabulary. None of these three labels tells you anything about the medicine.
A concierge practice can order the same standard panel your last physician ordered, read it the same way, and tell you that everything is normal. It will simply do it in a nicer room, with more time, and a phone number that works. That is worth real money to a lot of people, and I am not being sarcastic about it. Access is a legitimate thing to buy.
But if your actual problem is that you feel wrong and your labs keep coming back fine, access alone does not solve it. What helps is a different kind of reading: your results interpreted together and over time, in the context of your history, your goals, the clinical evidence and standard medical assessment, rather than one at a time against a population range.
A TSH of 3.8. A ferritin of 35. A vitamin D of 28. A fasting insulin of 12. All inside the range. All worth interpreting in context for someone who does not feel like themselves.
How I built mine
I took the billing model from direct primary care and the panel size from concierge, and then went further on both.
No insurance is billed, ever. Labs and medications are billed by those organizations at their own price, with no markup from me, and I make $0 markup on anything I order. The panel is a handful of households at a time rather than a few hundred patients. And the longevity work is built into the membership rather than sold as a five-figure add-on: the deep testing, the metabolomics, the written plan, with my fee for the work stated plainly before anything is ordered.
The reason I set it up that way is not generosity. It is that the moment I make money on what I order, you can no longer be certain why I ordered it. The fee for my time is the entire business model, which is exactly how I want it.
What to do with this
If you are comparing practices in Charlotte, ignore the brochures and ask three questions. Is there an initiation fee on top of the membership. Will my visits still be billed to insurance. Does the practice make money on the labs, supplements, and imaging it recommends.
Whatever practice you end up with, those three answers tell you more than any tour of the office will. If another physician in this city answers them in a way that fits you better than I do, go there. They are the right questions either way.
The full breakdown of how my practice answers them, with the numbers, is on the concierge medicine page and the cost page.
