"Although I intensely dislike the term, concierge medicine, as I practice it, is incredibly personalized service based on the needs of the individual patient. The only way this can be done is for a patient to be part of a very small primary care practice where the doctor has the time, staff, expertise, and desire to give the service that every patient deserves. Ideally, all medical practices should give this kind of service, but in this day and age, with time and financial constraints that most doctors face, it is impossible. An annual fee is typically required because paltry insurance payments do not cover the cost of the additional time given to patients. As in life, you get what you pay for. Given the time requirements to care for the average mature adult, an internist cannot deliver adequate care for a panel of more than 600 patients. Most internists these days have more than 2000 patients at any one time. They cannot possibly care for all of their patients all of the time. I intentionally limit my practice to no more than 500 patients. The best doctor in the world is of no value if you can’t see him when you need him. The only reason I have openings in my practice is because many of my newer patients are mobile and leave the area after a couple of years. In the very near future I will be closing my practice to new patients and will accept patients only when an established patient leaves the practice. I will never be too busy to comfortably take care of my patients in the manner they deserve. In my practice, the annual fee of $2000 goes to cover services that insurance does not typically pay for. As part of my practice, every patient gets, every year, an extensive battery of tests, extensive blood work, an extensive evaluation which includes an overall assessment of health and detailed plans to attain optimal health, and a USB drive that includes the above. None of this is billed to insurance unless it is legally required (as it is for Medicare patients). The physical exam is also performed during the evaluation, and any required vaccinations are given and billed to insurance."