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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Concierge Physicians: The Good, The Bad, and The Ugly

Concierge (kôn-syârzh’) n.

  1. A staff member of a hotel or apartment complex who assists guests or residents, as by handling the storage of luggage, taking and delivering messages, and making reservations for tours.
  2. A person, especially in France, who lives in an apartment house, attends the entrance, and serves as a janitor.

[UPDATE: Since my original post, I have had several conversations with Jay regarding his practice, his photography, and his view of the profession. I have subsequently retracted an uninformed, derogatory comment that was contained when originally published. Mea Culpa. Looking forward seeing Jay and others continue to push the boundaries of health care delivery].

I have been fascinating the by changing relationships between physicians and their patients through the introduction of technology. I made the argument at the recent Health 2.0 conference that the fundamental relevances of all these technology advances is most palpably noted in the changing relationships within the healthcare. See the attached slide for my take:

The sanctity of the patient – physician relationship is unique in medicine, law, and social science. The inherent contract, as evidenced by everything from the Hippocratic Oath to the HIPAA laws guaranteeing privacy of personal health information, preserves this sanctity. In fact, people who violate these provisions are subject to severe personal (felony) and professional penalties (fines, license revoked, etc). There are also ingrained, unwritten, and highly traditional dynamics associated with this relationship that are passed apprentice style from the old guard attendings to the new school residents and medical students. It has been this way for years.

But . . . this isn’t your father’s patient-physician relationship anymore. The dynamics of the internet, the unrelenting advance of technology, the progressive rise of social networks, and the ongoing empowerment of consumers has already dramatically changed the nature of this relationship. I have commented specifically that Physicians will move from their current role of authoritarian to more of an advisory role in the future. We are starting to see this in all kinds of new ways – particularly as it relates to personalized or concierge style medicine. A new take on this relatively new theme caught my attention late last week as both Bob Coffield and Bryce Roberts pinged me on the topic.

It appears that Jay Parkinson, MD has a new model for next generation personalized medicine. Known as Dr. IM, this recent residency graduate wants to create a brand new style of healthcare practice. For a fixed fee of $500, he will provide a range of advisory/consultative services designed to help the new age consumer get exactly what they need, when they need it, and in a manner in which they want to receive it. This is done by leveraging information technology to the hilt, being accessible 24×7, and creating a value network of common services for cash paying patients. Jay plans to limit his practice to 1,000 patients in order to meet their expectations for his availability, his level of service (house calls), and the physical limitations of his person serving 1,000 patients. Interesting approach and shows some excellent gumption on Jays part.

So, will it take? Or, what’s my take?

The Good. I love many aspects of this manifestation of “physicians as advisors“. Jay has recognized that many, if not most people, need a trusted guide to help them navigate the “healthcare hairball“. Why not have access to a medically trained, board-certified, preventative-medicine expert to help you along the way? The degree of service is adequate for the young, healthy population he is serving, the cost is more than reasonable as compared to current alternatives, and the bundling of services is attractive. His ability to connect with this type of patient just exponentially got better as well since he will certainly leverage social networking (Facebook site for his practice?) in building his practice. Social Networking allows Jay to connect with exactly the style of patients that he is as a person. So, while I can promise you my mother would never in a million years would ever go to Jay; I can also state that my mother isn’t vlogging, sending text messages, or hoping to connect with her doctor at 4AM after raving all night. It is a kind of natural eHarmony self-selection mechanism. Very smart and cool use of technology, combined with new product (all inclusive for $500), and a high degree of personalized service seems to add up to a great solution for the subsegment that he targets.

The Bad. Who is Jay? Is he legitimate? Is he a good doctor? Would you want this dude rolling up to your house without having any relationship with him? As a recent graduate does Jay have the skills to take care of your needs without the benefit of physician colleagues and mentors? Would I as a referring physician want to take Jay’s patients? This dramatic departure from the traditional patient-physician relationship can have some dramatic consequences. Creating your practice outside the constructs of current medicine seemingly would disconnect the patients further from an already disconnected system. In addition, I have personally found that communicating primarily online is a recursive and progressively consuming process. The more you email, IM, and communicate electronically, the more people will communicate back to you through these channels. There is an incessant ramp up and exponential demand (“electronic tax”) as more and more messages demand your attention. Jay makes a large assumption that the the $500 x 1,000 patients is going to make it worth his time to be available as he outlines (BTW, this salary [minus his cost which probably are minimal] would place him in the top1% of all general practitioners in the country). You have all felt it when you went away on vacation to find that your unrelenting inbox has filled up with another 300-500 messages that require a response. It is a beast. Personally, I can mitigate this by prioritizing senders but this could be a dangerous form of triage for Jay. Will Jay be able to keep up on the electronic treadmill?

The Ugly. For all the positive stuff Jay is doing, there is also a negative underbelly. For starters, a quick search of “Who is Jay” reveals some very personal stuff that I professionally would not want associated with my trusted medical practice. I am sorry, man, but I just don’t need to see my doctor half-naked or posing in his underwear with his dog.  I mean, that is just way too much information for me (although I realize that there will be a sub-segment of the population that will be attracted to this truly “alternative” style medical practice). Furthermore, this style of provocateuring sets you up BIGTIME for some problems when you try to do your home visits and build your practice. How long will it be before Jay is charged with some form of sexual impropriety given the blurred lines that already exists given the intimate nature of medical practice?

But hey, I am sure that Jay has thought through many of these things in creating the concept for his (practice) site. So in the spirit of Health 2.0, transparency, “physicians as trusted advisors”, and the ability to self-select patient populations – Jay is pushing the envelop in impressively innovative ways. To traditional medical bureaucrats, Jay is a major threat and represents the worst the future of online interactivity holds. To us who are documenting, evaluating, and predicting the influence of these new trends, Jay represents a wild Health 2.0 offshoot whose fate will ultimately be determined by the unrelenting Darwinian forces of the free market (Prosper or Perish).

I, for one, am rooting for a form of this style of practice to succeed as it is a promising branch off the old oak of traditional medicine. However, while this new style of concierge medicine is growing up, just keep your underwear on Jay.

3 comments on “Concierge Physicians: The Good, The Bad, and The Ugly

  1. Jay Parkinson, MD says:

    Thanks for the post. Am I a good doctor? What does that mean? Let’s see, I’m trained as a physician both clinically and administratively. I’ve got a pretty damn smart brain. I’m a good listener. My patients always loved me more than any doctor they’d ever had. There’s something in my personality people really appreciate. I’m attentive. I practice the best evidence-based medicine and have a keen eye for an accurate diagnosis. As you know, none of this can be proven until you meet me.

    As far as my photography goes, I’m extremely proud of my art and my success within the art world. If you view my photography and don’t grasp that I’m subverting sexuality in the vast majority of my photographs, then you haven’t looked long enough at the images. You should read deeper into them than strictly seeing them as images of scantily clad women. I feel sorry for any person who is sexually aroused by my photographs. They are by no means soft-core porn. That’s simply laziness to call them that. I find sexuality and the images of sexuality in our culture fascinating, not arousing. I’m a human being with a sexuality that I sometimes express in my photographs. The fact that I take photos of women has nothing to do with my practice as a physician. I liken taking photographs of scantily clad women to performing pelvic exams in a physician’s office — it’s absolutely not sexual in any way. If people can’t understand this comparison, then there’s no point in trying.

    I am a professional and my behavior toward my patients in their homes is 1000% always respectful and courteous and almost too appropriate. Please ask to talk with me or video conference with me or what have you before you make statements that allude to the possibility of misbehavior because you assume I’m some sort of sexual deviant because of my photography. While I understand why many people wouldn’t want to show themselves in their underwear on the internet considering this obesity epidemic, it doesn’t mean it’s wrong or unprofessional to do so. But by all means, your judgements of me are quite misguided. You should probably contact people before you write things like this for the general public to see. Also, when this dude rolls up to see them, I guarantee they are automatically put at ease. I simply have that type of personality.

    Also, I have plenty of support from clinicians I trust As a matter of fact, I’m getting such an amazing amount of support from physicians all over the nation asking if they can help with consults and questions. It’s nice to know there are physicians who care. I also have plenty of physicians in the area who trained me who are always more than happy with me asking questions and consulting them. I’m not a loner.

    One thing I think you don’t understand is how this population interacts with the healthcare system. They are used to going to clinics or doctors they’ve never seen and will never see again. I am trying to instill the value of continuity in their minds. Based on the interest and the amount of enrollees, I think I’m doing a good job with this. I’m not disconnecting these people. I’m actually connecting them more than they ever have been with the system. I’ve formed an informal network of specialists, radiologists, pharmacies, etc, that provide high quality care for the best price. I’ve found specialists who they can afford.

    I’m not worried about keeping up with my communications. I’ve streamlined the process so much (with RSS feeds, patients having their own personal medical blogs, etc) that it’s a non-issue. You’d have to see my set up to understand.
    While I thank you for the post and appreciate your opinion, you should probably be a little more open minded about people who wouldn’t treat your mother because they are a little different than you.

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