The DocPreneur Leadership Podcast is the recorded history of membership medicine.
Hosted by Michael Tetreault, Editor-in-Chief of Concierge Medicine Today — and a nearly 20-year student of this industry from the patient side of the exam room — this podcast explores concierge and membership-based medicine through candid conversations with physicians, healthcare executives, attorneys, practice management experts, and industry innovators.
If you're a physician building, growing, or rethinking your practice — this is the conversation you didn't know you needed.
Topics: Concierge Medicine · Membership Medicine · Physician Leadership · Practice Management & Growth · Healthcare Entrepreneurship · Patient Experience & Hospitality · Practice Design & Culture · Precision Medicine · Whole Genome Sequencing · Pharmacogenomics · Longevity Medicine · Functional & Integrative Medicine · Physician Burnout & Wellbeing · Succession Planning · Legal & Compliance · Accounting & Financial Planning · Insurance & Payor Strategy · Staffing & Team Culture · Technology & AI in Medicine · Telehealth · Branding & Marketing for Physicians · Interior Design & Practice Environment · Nursing & Allied Health · Direct Primary Care (DPC)
Produced by Concierge Medicine Today (CMT) — the industry's independent trade publication since 2007. Host of the annual Concierge Medicine Forum.
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For general informational purposes only. Not medical, legal, or financial advice. Views are the speaker's own. Full terms: conciergemedicinetoday.com/tcpp
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Why Nurse Practitioners and Physician Assistants Are Finding Their Place in Concierge and Membership Medicine
Monday, September 21, 2026 • Duration 28:35
The evidence doesn't say nurse practitioners and physician assistants are simply interchangeable with physicians. It says something more specific, and honestly more useful. It says that for the visit types that make up most of what primary care and concierge medicine actually deliver day to day, prevention, chronic disease management, education, relationship, the research consistently finds NP and PA led care landing on par with physician led care, and on the measures patients say they care about most, time and feeling heard, often landing ahead.
Sources referenced in this episode
Association of American Medical Colleges, physician workforce shortage projections (March 2024).
Health Resources and Services Administration workforce projections, as reviewed in Journal of General Internal Medicine (2025).
U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Nurse Practitioners and Physician Assistants entries.
Neprash HT, et al., Medical Care (January 2021), EHR-based analysis of primary care visit duration.
Swan M, et al., "Quality of Primary Care by Advanced Practice Nurses: A Systematic Review," International Journal for Quality in Health Care (2015).
National survey study on NP patient satisfaction outcomes, Nursing Outlook (2019).
Nice Healthcare literature summary on nurse practitioner outcomes and patient satisfaction.
Health Affairs (2025) national study of concierge and direct primary care practice and clinician growth, 2018-2023.
American Association of Nurse Practitioners, State Practice Environment data.
American Academy of PAs, "PA Education: Preparation for Excellence."
Note: The practice example(s) described in this episode are a composite illustration drawn from patterns commonly reported across the concierge and direct primary care industry, not an account of a specific, verified individual or practice. This article is intended for educational and informational purposes for physicians and healthcare leaders. It does not constitute medical, legal, financial, or accounting advice. Workforce projections and state scope-of-practice laws change over time; readers should confirm current figures with the primary sources cited before relying on them for practice or policy decisions.
(Sneak Preview) CMF 2026 Keynote, Dr. Kyra Bobinet
Thursday, September 17, 2026 • Duration 54:58
In this conversation, Dr. Kyra Bobinet and Michael Tetreault sit down to discuss the habenula and its role in motivation and setbacks, why the traditional compliance model works against how the brain actually changes, the Iterative Mindset as an alternative framework for physicians and patients, and how this thinking should shape the physician-patient relationship in concierge and membership-based practices. They also preview Fresh Tri Pro, ahead of Dr. Bobinet's appearance at the Concierge Medicine Forum this October.
Dr. Bobinet earned her MD from UCSF and her MPH from Harvard, teaches health behavior change at the Stanford Medicine AIM Lab, and is CEO and founder of Fresh Tri, a clinician-facing behavior-change platform built on the neuroscience of habit formation. She is the author of the bestselling Well-Designed Life and the newly released Unstoppable Brain, and co-developed the Iterative Mindset Inventory with mindset researcher Dr. Jeni Burnette of NC State University. She is an enrolled member of the Leech Lake Band of Ojibwe.
The Story Your Patients Keep Telling Themselves (and How to Rewrite It) with Dr. Kyra Bobinet
Why do patients who genuinely want to get healthier so often fail to follow through? On this episode of the DocPreneur Leadership Podcast, host Michael Tetreault talks with Kyra Bobinet, MD, MPH, about the "know-do gap" and the neuroscience behind it.
This episode is educational and informational. It is not medical, legal, or financial advice.
We didn't stop at finding this pattern once. We checked it against 1,149 patients across the full archive, 416 from the early years of our data (2013 to 2018) and 733 from the recent years (2019 to 2024), asking the exact same question both times: what matters most to you?
By Michael Tetreault, Editor-in-Chief, Concierge Medicine Today
You know your medicine. Do you really know your practice?
Most physicians can explain their care in one sentence. Far fewer can say, honestly, whether their patients trust them, whether their marketing is actually reaching the people it's meant for, or whether someone quietly unhappy is about to leave without ever telling you why.
For eleven years, Concierge Medicine Today has been asking the people who matter most: the patients themselves. Why are you searching for a new doctor. Why are you leaving your last one. What matters most to you when you're choosing who to trust with your care. Over seven thousand patient conversations later, collected between 2013 and 2024, a pattern emerged that we didn't expect, and it's reshaping how we think this industry should market, welcome, and retain the patients it serves.
We tested a long list of variables against the data: age, income signals, geography, how patients found us, even how much they cared about the physical office space. Almost none of it mattered as much as we assumed. Hospitality and service, for instance, turned out to matter to nearly everyone, which means it isn't a dividing line at all. It's table stakes.
Two questions, and only two, consistently separated patients into meaningfully different groups:
How do they already feel about their current doctor? Happy, or ready for something new?
What do they want from insurance? Do they want their next doctor to still work with insurance and Medicare, or do they want independence from that system entirely?
The Four Types Ten Years of Proof, Not a Guess What This Means for Your Practice See Where Your Own Practice Fits
The Lexus Lesson for DPC: You Can't Discount Your Way to a Full Panel
Sunday, September 6, 2026 • Duration 42:59
Toyota didn't beat Mercedes by getting cheaper. It beat Mercedes by getting closer to the customer first. Here's the six-year research obsession behind the Lexus LS 400, and why undercutting your way to a full panel is a strategy that has already failed in a dozen other industries, and what Harvard's own pricing research says to do instead.
By Michael Tetreault, Editor-In-Chief, Concierge Medicine Today
"I'm a car guy, so bear with me on this one. There will be some good points [in this article], I promise. I know enough about engines to self-diagnose and wrench on them myself. Driving an old car with lifter problems through North Dakota and southern Canada in the '90s will teach you that."
~Michael Tetreault
Today's article isn't about concierge medicine directly. It's about a distant cousin in the subscription-based healthcare world, direct primary care, or DPC.
Over the past two decades, I've noticed more and more that there is a moment almost every DPC or low-cost, membership-based practice hits around year two or three, when the patient panel quietly stalls (catch the car pun).
Growth that used to feel automatic starts to flatten out, and you notice it before you can quite explain it.
That's usually right about when a competitor down the road launches at $59 to $93 a month, and a quiet voice in your head says: just drop the price. Fill the seats. Worry about margin later.
That instinct is understandable. It is also, according to decades of business research and a growing body of data inside concierge and membership medicine itself, one of the fastest ways to damage the very practice you built to serve patients better.
This is not a scolding. It is a strategy conversation, grounded in evidence, for low-cost subscription-based physicians who left, or are considering leaving, the insurance-driven system specifically to build something sustainable that has a low cost for the patients because you feel your altruistic nature pulling you to do so.
What "racing to the bottom" actually means The framework underneath the instinct What the data inside DPC and low-cost membership medicine is already showing The altruism problem no one names out loud What other industries learned the hard way The Lexus Lesson: Price Is a Result, Not a Strategy What to build instead Sources
She Named Her Practice After Her Son. Then Built It Around Everyone Else's.
Sunday, August 30, 2026 • Duration 58:16
She left academic medicine to build the practice her own family needed. Here's how, and why.
Dr. Priyanka Chopra spent years as an academic hospitalist watching a fragmented healthcare system fail the people who needed it most, including, eventually, her own family. That experience became the reason she left. Alongside her husband, she founded Nivaan Health, a mobile, in-home concierge practice in Miami built on a simple premise: patients deserve time, trust, and genuine care, not rushed visits and disconnected specialists.
In this episode, Dr. Chopra talks with Michael Tetreault about what it actually took to make the leap: the role her spouse played as both partner and support system, how she's used AI to handle the operational and branding work most physicians never trained for, and why she measures success by restored patient functionality rather than traditional volume metrics. It's a candid look at what "unreasonable hospitality" means in practice, and a practical guide for any physician quietly wondering if there's a better way to build a career in medicine.
Learn more about Nivaan Health: https://nivaan.health/our-story
What GLP-1 marketing built that most concierge practices haven't.
Monday, August 24, 2026 • Duration 31:44
"Patients have already told the market what they're willing to pay for a health outcome," CMT Editor-in-Chief Michael Tetreault said in an interview for this article. "A GLP-1 subscription and a concierge medicine membership now cost about the same, roughly $3,000 a year. The question isn't whether patients will invest in their health. It's who earns that investment."
By Editorial Staff, Concierge Medicine Today, August 2026(See full list of citations and sources and disclaimers at end of article)
Please note, this is market and editorial analysis, not medical, legal, financial, or accounting advice, and it does not evaluate the clinical merits of GLP-1 medications, which is a conversation between a patient and their physician. Concierge medicine is not, and should never be marketed as, a treatment alternative to any prescription medication, including GLP-1s. That distinction matters enough that we're stating it plainly here, before we go any further, and readers should keep it in mind throughout.
That said, let's unpack the topic. FULL ARTICLE: https://conciergemedicinetoday.org/2026/08/24/what-glp-1-marketing-reveals-about-concierge-medicines-opportunity/
A patient on a compounded GLP-1 and a patient enrolled in a concierge medicine practice are now spending almost exactly the same amount each year. Roughly $3,000.
We put the real numbers next to each other: GLP-1 telehealth pricing, our own 2026 concierge medicine benchmark survey, direct primary care spend, urgent care, etc.
The overlap doesn't stop at price. The age group spending the most on GLP-1s, 50 to 64, is also the core of the concierge medicine patient base.
Patients have already decided they'll pay out of pocket for a health outcome. That part isn't up for debate anymore. What's still open is who earns that trust, and why.
To be clear about what we're saying and what we're not: concierge medicine is not a substitute for any medication a patient and their physician decide is right for them. What it can be is the unhurried relationship where that conversation actually happens, something a fifteen-minute visit rarely allows. Full research, sourcing, and what this means for how practices market themselves are in the article.
Sources
The Habenula and the Exam Room: The Story Your Patients Keep Telling Themselves (and How to Rewrite It) with Dr. Kyra Bobinet
Monday, August 17, 2026 • Duration 54:58
The Story Your Patients Keep Telling Themselves (and How to Rewrite It) with Dr. Kyra Bobinet
Why do patients who genuinely want to get healthier so often fail to follow through? On this episode of the DocPreneur Leadership Podcast, host Michael Tetreault talks with Kyra Bobinet, MD, MPH, about the "know-do gap" and the neuroscience behind it.
Dr. Bobinet earned her MD from UCSF and her MPH from Harvard, teaches health behavior change at the Stanford Medicine AIM Lab, and is CEO and founder of Fresh Tri, a clinician-facing behavior-change platform built on the neuroscience of habit formation. She is the author of the bestselling Well-Designed Life and the newly released Unstoppable Brain, and co-developed the Iterative Mindset Inventory with mindset researcher Dr. Jeni Burnette of NC State University. She is an enrolled member of the Leech Lake Band of Ojibwe.
In this conversation, Dr. Bobinet and Michael discuss the habenula and its role in motivation and setbacks, why the traditional compliance model works against how the brain actually changes, the Iterative Mindset as an alternative framework for physicians and patients, and how this thinking should shape the physician-patient relationship in concierge and membership-based practices. They also preview Fresh Tri Pro, ahead of Dr. Bobinet's appearance at the Concierge Medicine Forum this October.
This episode is educational and informational. It is not medical, legal, or financial advice.
A New Category in Cancer Care, Built by the People Who Saw It Fail
Friday, August 7, 2026 • Duration 01:00:33
Moving Cancer Upstream: Dr. Jose Barreau on Prevention, Prime Time, and the Fight to Detect Cancer Earlier
Dr. Jose Barreau spent decades on the wrong side of a timeline every oncologist knows too well, treating cancer after it was found, often at a stage when the window for real intervention had already closed. That experience became the founding premise behind PreOncology, the company he built to move cancer care upstream from treatment to prevention.
Barreau's work recently reached a much bigger audience. He's featured in The Chase: Inside the Race to Cure Cancer, a documentary now streaming on Amazon Prime Video that follows real patient experiences and the healthcare teams navigating one of life's hardest journeys. In this conversation, we talk about what it was like being part of that project, why the film's message about early detection lines up so closely with PreOncology's mission, and what he wants viewers to take away from it.
We also get into the founding story behind PreOncology itself: why conventional screening was never built for the individual, why the technology to detect cancer earlier already exists but has never been properly integrated, and how an oncologist-led model is trying to close that gap. Barreau also shares lessons from his earlier work founding Doc Halo and Halo Health, healthcare communication platforms used by over 300,000 physicians nationwide.
Dr. Barreau will be speaking live at the 2026 Concierge Medicine Forum this October in Atlanta, GA, where he'll go deeper into what personalized cancer surveillance actually looks like in practice. If this conversation resonates, that session is one worth planning your schedule around.
Learn more about Dr. Barreau and PreOncology: https://preoncology.com/our-story/ Watch The Chase: Inside the Race to Cure Cancer on Amazon Prime Video.
This episode is educational and informational. Nothing discussed should be considered medical advice.
Meet Peds MD -- Ten years of knowing families by name.
Saturday, August 1, 2026 • Duration 01:02:42
Dr. Charles "Trey" Williams didn't set out to disrupt pediatrics. He set out to be the kind of doctor his own kids deserved. After a decade in corporate, insurance-driven practice and a stint inside a health-tech startup, Williams reached the same conclusion many physicians on this podcast have reached: the system was built for throughput, not relationships, and pediatrics runs on relationships.
In this conversation, Williams walks through the founding of The Peds MD, a concierge house-call pediatric practice built around what he calls Adaptive Primary Care, a model shaped by five pillars: environmental flexibility, true 24/7 access, root-cause methodology, direct communication, and removing the barriers that keep families from reaching their physician. We discuss what it actually took to leave a corporate practice, how an MBA changed the way he designed the business, and why he believes the future of pediatrics depends on doctors willing to rebuild the relationship model from the ground up.
This is a conversation for any physician asking whether there's a better way to practice, and for any parent wondering what pediatric care could look like when the doctor picks up.
This episode is educational and informational. Nothing discussed should be considered medical, legal, or financial advice.
The day "Personalized" stopped working.
Tuesday, July 28, 2026 • Duration 43:02
Every concierge website on the internet says it. Your patients aren't looking for "personalized." They're looking for a specific person they can trust with their family's health. You ARE that person. The work is showing them — before the first phone call.
ABOUT OUR GUEST, GRAHAM KUHN, FOUNDER, FOCUS FILMS
I came to this work the long way. I studied opera in college but never became an opera singer — I moved to Atlanta after graduation to join a professional a cappella group, then spent twenty-plus years as a professional singer doing everything except opera.
Along the way I started working in music and video at churches, and discovered I liked telling visual stories more than performing them. The shift to personalized medicine wasn't a marketing decision. It was personal. My wife and I have always believed in medicine that uses pharmaceuticals when truly necessary and holistic, lifestyle, and integrative care when those actually move the needle.
What I've found doing this work is that direct care physicians are the doctors most willing to prescribe what actually helps the patient in front of them — not just what insurance will pay for. Those stories deserve to be told well.
I also know what these doctors are walking into when they leave the system. They didn't quit because they wanted to run businesses. They quit because they were burning out trying to practice medicine the way they were trained to. Now they're business owners anyway, and most of them weren't taught that part. The marketing, the systems, the strategy — none of that was in medical school. Our team's job is to handle the parts they weren't trained for so they can focus on the parts they were.
Based in Atlanta. Available for engagements across Georgia, with selective travel for the right practices nationwide.
Plot patients on those two questions, and four distinct groups appear, drawn from 561 patients who answered every question behind this model.
Level-Uppers, 29% of patients. These patients trust and like their current doctor (4.23 and 4.19 out of 5) but still want full independence from insurance (2.21 out of 5). They aren't fleeing a bad relationship. They're confidently reaching for something better before anything breaks. This group skews Baby Boomer and Gen X, with a meaningful Millennial presence, the youngest-skewing of the four.
Coverage Keepers, 27% of patients. The most loyal group in the data, with trust and like scores of 4.38 and 4.40, and the single highest insurance-importance score of any group we measured, 4.67. They aren't leaving anyone. They want the concierge experience added to a relationship they already trust, not traded away for it. The oldest-skewing group, heavily Baby Boomer.
Fresh-Starters, 27% of patients. Low trust and connection with their current doctor (2.65 and 2.56) and little interest in insurance compatibility (2.34). They're done compromising with the relationship and the system at the same time. This group spans every generation fairly evenly, and they are the most likely of the four to say, in their own words, that they're leaving because they feel like a number.
Careful Movers, 16% of patients, the smallest group. Unhappy with their current doctor (2.60 and 2.60) but still needing Medicare or insurance to work, 4.64, nearly the highest score in the entire dataset. This is a patient solving two problems at once: a doctor who isn't working, and a financial reality that has to keep working. That's a harder position than any other group faces, which is likely why they tend to be the most time-pressured to find a fit.
We didn't stop at finding this pattern once. We checked it against 1,149 patients across the full archive, 416 from the early years of our data (2013 to 2018) and 733 from the recent years (2019 to 2024), asking the exact same question both times: what matters most to you?
The answer: 74.3% in the early years. 74.5% in the recent years. Virtually unchanged.
For eleven straight years, roughly three out of every four patients who came looking for a concierge or membership doctor were looking for a relationship first, not a perk, not a discount. That was true a decade ago. It's true today. A separate, open-ended question tells the same story even more sharply: patients describing their search in their own words used relationship and trust language nearly three times as often in the recent years as in the early ones.
If you're marketing to "the ideal concierge patient" as though there's one of them, you're likely speaking clearly to one of these four groups and mumbling to the other three.
A few things worth doing with this, starting this week:
Tag your last twenty patient inquiries. How did they feel about their prior doctor? Did insurance come up, and how? Most practices find that one or two of these four types dominate their actual local market, not all four evenly.
Write different messages for different problems. A Coverage Keeper needs reassurance about continuity. A Fresh-Starter needs permission to start over. The same headline will not land with both of them, no matter how well it's written.
Track results by type going forward, not just by lead count. A year of that data becomes your own practice-level proof of where this model holds, and where your market looks different from the national picture.
We built a free tool that applies this exact research to your own practice. It's called the Patient Match Score, ten questions, about two minutes, and it tells you, from most to least likely, which of these four types your current positioning is actually attracting.
But, if the goal is sustainability, the tactic matters.
Let's zoom out for a moment.
A price war is what happens when competitors inside the same market repeatedly cut prices to undercut one another, creating a cycle where each side matches or beats the last cut. This "price-cutting momentum" pulls in competitors who feel forced to follow the initial price cut, and while it can create short-term benefits for the buyer, it erodes the profit margins of everyone competing.
Harvard Business School researchers Akshay Rao and Mark Bergen, writing in Harvard Business Review, built a career studying exactly this dynamic across industries. Their conclusion, echoed by strategists since, is blunt: most price wars are avoidable, and the businesses that start them or get pulled into them rarely come out ahead.
The Kinsta business blog, summarizing HBR's own internal analysis of the question, put it plainly: when businesses were asked whether they should engage in a price war, the overwhelming answer was "no." Instead, the research points toward differentiation as the more durable response to a low-cost competitor.
There is a second, quieter finding in that same research that some physicians should sit with. Price itself shapes how a buyer perceives value, and a price set too low signals that the product is cheap, in the way a price set too high can signal it is a ripoff. In other words, the discount that was supposed to win the patient can be the very thing that tells the patient your care is not worth much.
It's indeed, a delicate balance and it's different for every practice and every doctor. Why? Because of who you work for and serve: the patient. Every patient is different. Every practice is different. That makes this topic challenging but it's a conversation worth having because I want to see your practice thrive and more importantly, survive in your community.
Michael Porter, the Harvard strategist whose work still anchors most first-year MBA curricula, described three durable paths to competitive advantage: cost leadership, differentiation, or a focused niche strategy.
A company chooses to compete either through lower costs than its rivals or by differentiating itself along dimensions the customer actually values, in order to command a higher price. What Porter warned against was the position most panic-driven price cuts land a practice in.
Porter's phrase for it is "stuck in the middle," and it describes an organization trying to be all things to all people, with no distinct competitive advantage as a result. Businesses caught here typically perform the worst in their industry precisely because they never committed to one strength. A DPC practice that quietly lowers its price to compete on cost, while still trying to deliver same-day access, unhurried visits, and so-called affordable white-glove service, is not competing on cost leadership. It is trying to sell a premium product at a discount price, and the math does not hold.
Today, a medical practice or a company stuck in this position cannot beat a true cost leader on price, because it never built the operational discipline or scale to sustain that price, and it cannot beat a differentiator on the experience it promised, because the discipline required to deliver that experience costs money. Both promises erode at once.
This is not theoretical for DPC and low-cost membership medicine practices. It is visible in the industry's own numbers.
The 2026 State of DPC survey, distributed through the DPC Alliance and Hint Health's network, found a direct relationship between panel size and price. Practices with fewer than 200 patients averaged $105.93 per member per month, practices with 201 to 500 patients averaged $99.28, and practices with more than 500 patients averaged $77.74 per member per month. Read plainly, the larger the panel, the lower the average price charged per patient. That pattern is exactly what Porter's framework predicts happens to practices chasing volume without a differentiation strategy to protect price. It is worth noting this figure comes from Hint Health, a technology vendor with a commercial interest in DPC's growth, so it should be read as directional industry data rather than an independent audit. It is nonetheless the most comprehensive dataset the movement currently has.
At the same time, the broader market is not short on room to compete on value instead of price. More than half of private healthcare consumers rank the cost of care as the most dissatisfying part of their current healthcare experience, and DPC's growth has been driven in large part by employers and patients who are tired of opaque, escalating costs elsewhere in the system, not by DPC being the cheapest option on paper. Employers now fund the majority, roughly 60 percent, of active DPC memberships, according to Hint Health's 2026 trends report, which signals that the buyers filling panels today are increasingly sophisticated purchasers evaluating value, retention, and outcomes, not simply hunting for the lowest sticker price.
Regional pricing tells a similar story. Northeast DPC pricing rose 33 percent over five years, from $60 to $80 a month, even as national demand for the model accelerated. Practices in that region did not grow by discounting. They grew while raising price, in a market that was simultaneously expanding.
Here is the part of this conversation that is specific to medicine and does not show up in a typical business school case study on price wars.
Physicians are trained, deliberately and repeatedly, to put the patient's welfare ahead of their own. Medical professionalism itself is defined in the literature by principles of excellence, accountability, altruism, integrity, and humanism, all oriented around the patient relationship. That formation is not incidental. It is the point of medical education, and it is a genuine strength of the profession that should never be coached out of a physician.
But that same formation has a side effect worth naming honestly. A rigorous study out of the University of Cologne and University of Rennes, published in the Journal of Health Economics, measured patient-regarding altruism in 733 medical students at different stages of training. The researchers found that patient-regarding altruism is highest among freshmen, declines significantly through the middle years of medical study, and rises again in the final year as students begin assisting in clinical practice. Students with lower income expectations showed higher altruism scores overall.
Sit with that last finding.
The training that makes physicians excellent, trustworthy, patient-first clinicians also correlates with a documented discomfort around charging what care is actually worth. That discomfort is admirable in the exam room. It becomes a strategic liability in the business office, where it quietly nudges a physician toward the lowest defensible price rather than the price that reflects the value delivered, the access provided, and the sustainability required to keep serving that same patient for the next twenty years.
This is not a call to abandon altruism. It is a call to separate two different questions that get tangled together under stress: am I a good doctor and am I running a sustainable practice. A price built out of guilt is not more altruistic than a price built out of strategy. A closed practice serves no one.
Medicine is not the first field to face this exact temptation, and the businesses that raced to the bottom on price rarely tell a happy ending.
Rao and Bergen's HBR research spans industries from B2B and agribusiness to healthcare and the nonprofit sector, and the throughline in that body of work is consistent: firms that respond to a low-price competitor by cutting their own price usually shrink the whole market's profitability without gaining durable share, because the competitor simply cuts again. The winners in price wars, when there are any, tend to be the largest players with the deepest balance sheets, the ones who can absorb losses the longest. A solo or small-group physician practice is almost never that player, and should not try to be.
The lesson for low-cost DPC physicians is not abstract. It is Porter's choice, stated as a decision every practice has to make deliberately rather than by drift: compete on being demonstrably, operationally the lowest-cost, highest-efficiency provider in your market, which requires real scale and real systems, or compete on being demonstrably different in a way patients value enough to pay for. Trying to hold both at once is what leaves a practice, in Porter's words, stuck in the middle, with margins too thin to sustain the very things that made the practice worth choosing in the first place.
Circling back to my car guy roots, there is an automotive story worth every physician's attention here, because it is one of the clearest business case studies ever produced on the exact question this article is asking you if you're a DPC physician. It comes from Hagerty's "Revelations" series, hosted by Jason Cammisa, on the origin of the 1989 Lexus LS 400, and it has been retold in detail across automotive trade press and in Chester Dawson's book Lexus: The Relentless Pursuit.
The origin story matters as much as the engineering. Toyota's first American export, the Toyopet Crown, was a flop, selling only a few hundred units before Toyota pulled it from the market in the late 1950s. Twenty five years of steady rebuilding later, Toyota had become the largest importer of vehicles into the United States, and that success triggered a protectionist response. In the early 1980s, the U.S. government pressured Japan into so-called voluntary export restraints, capping Japanese auto imports at roughly 1.7 million vehicles a year. With volume capped by government policy, Toyota USA's Yukiyasu Togo pushed a different lever: if the company could not sell more cars, it needed to sell more profitable ones. That constraint, not ambition alone, is what pushed Toyota into the luxury segment.
In 1983, Toyota's then chairman Eiji Toyoda greenlit a secret effort known as Project F1, for Flagship One. Where a typical vehicle program of that era might use around 200 engineers and a few hundred million dollars, F1 was reportedly given no fixed budget and a development team of roughly 1,400 engineers, 60 designers, and thousands of additional technicians and support staff, spread across a six-year effort widely reported to have cost in the neighborhood of a billion dollars.
What that team actually did is the part physicians should study closely. Rather than guess at what luxury buyers wanted, a team of designers and engineers relocated to a rented house in Laguna Beach, California, and spent months directly observing affluent Americans: watching valet stands outside country clubs, studying the furniture in high-end homes, and even analyzing the leather scent inside Jaguar interiors closely enough to reverse-engineer the tanning process. They tested switchgear and steering wheel ergonomics against how women with long, manicured nails actually interact with a dashboard. This is the practice Toyota calls genchi genbutsu, going to see for yourself, rather than relying on assumptions about the customer.
Separately, Toyota's research uncovered something more specific and more useful than "people want a cheaper luxury car." Mercedes-Benz owners loved the prestige of their cars but consistently described the dealership experience itself, the pressure, the wait, the sense of being talked down to, as miserable. Lexus rebuilt the entire buying experience around that single insight. Sales moved from an elevated desk to a shared coffee table, removing the physical power imbalance of a traditional car sale. Only 80 of roughly 1,500 dealer applicants were approved to sell the car, each required to invest several million dollars and submit to ongoing customer satisfaction audits. The product and the experience of buying it were treated as a single, inseparable offer.
The engineering discipline underneath all of this was, by most independent accounts, extreme. Chief engineer Ichiro Suzuki pursued a drag coefficient of 0.29, well below the S-Class's 0.36 to 0.37, without relying on a rear spoiler, which he considered an inelegant shortcut. Interior noise was engineered down to roughly 58 decibels versus about 60 for the S-Class, and multiple road tests reported the LS 400 was as quiet at 125 miles per hour as its German rivals were at 95. Prototypes logged well over a million miles of testing, and engineers reportedly disassembled competitor vehicles to study exactly how they failed over years of use, then engineered around each weakness.
When the LS 400 launched in 1989, it was priced at roughly $35,000, commonly cited as about half the price, or as much as $30,000 less, than a comparably equipped Mercedes-Benz S-Class. The price gap was so large that BMW reportedly suggested Toyota was selling the car at a loss. Within two years, Lexus had overtaken Mercedes-Benz as the best-selling luxury import brand in the United States and topped J.D. Power's quality and service rankings, and Mercedes is reported to have lost roughly a quarter of its U.S. sales in the aftermath.
Here is the part physicians should sit with. The low price was not the strategy. It was the output of the strategy. Toyota did not set out to build a cheaper Mercedes and work backward. It spent six years and enormous resources removing the specific frustrations its own research showed were driving prestige-loving customers away, then engineered a manufacturing process disciplined enough to make that quality repeatable at scale, and only after that work was done did it set a price the market would reward. The aggressive price was possible because the operational excellence and the customer research underneath it were real, not because anyone at Toyota decided to compete by cutting corners.
This is the distinction that gets lost when a DPC or low-cost membership medicine practice drops its membership fee simply to fill a panel out of fear. Toyota's price was earned through relentless, well-funded engineering and firsthand study of exactly what its target customer resented about the existing options. A practice that lowers its price without first doing that same work, actually going to see for yourself what frustrates the patients you want to serve, and building a practice that removes those specific frustrations, is doing the opposite of what Lexus did. It is cutting the price before it has earned the right to.
The translatable lesson is not "charge less." It is this: find out, directly and specifically, what your patients are actually frustrated by in the healthcare experience they already have, build a practice that removes that frustration with real discipline, treat the entire patient experience, not just the clinical visit, as part of the product, and let price follow from that work rather than substitute for it. Toyota spent six years in the field before it touched the price tag. Most practices considering a discount have not spent six weeks asking patients what specifically is broken in the care they are currently getting.
None of this means price is fixed or that access should be reserved only for the wealthy. It means the starting question changes.
Instead of asking what is the lowest price that will fill my panel, the more durable question is what does my practice do that a patient cannot get anywhere else in this market, and does my price reflect that honestly. That might be same-day access. It might be visit length. It might be a specific clinical focus, a specific population, or a specific relationship to a local employer. Differentiation does not require the highest price in the market. It requires a clear, honest reason for the price you have chosen, one you can say out loud to a patient without flinching.
Panel growth built on discounting tends to attract patients who are price-shopping and will leave the moment a cheaper option appears next door. Panel growth built on a clear, differentiated value proposition tends to attract patients who stay, refer, and tolerate a price increase because they understand what they are paying for.
This article is intended for educational and informational purposes for physicians and healthcare leaders. It does not constitute financial, legal, accounting, or medical advice, and practice pricing decisions should be made in consultation with qualified financial and legal advisors familiar with your specific market and regulatory environment.
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Cammisa, Jason. "The Absurd Engineering Obsession Behind the 1989 Lexus LS 400." Hagerty Revelations, YouTube, youtu.be/i15Ii4yetLM
"How the Lexus LS400 Crashed the Luxury Party." Autoblog, October 2, 2025. autoblog.com/features/how-the-lexus-ls400-crashed-the-luxury-party
"How Lexus defeated 'the best car in the world.'" Motoring Research, July 25, 2024. motoringresearch.com/car-news/lexus-ls-400-review
"Lexus LS 400: 'the finest V8 engine in the world.'" Cult Classics, Adrian Flux, August 21, 2023. adrianflux.co.uk/cult-classics/lexus-ls-400-the-finest-v8-engine-in-the-world
Dawson, Chester. Lexus: The Relentless Pursuit. John Wiley & Sons, revised edition. Publisher synopsis via AbeBooks, abebooks.com/9780470828045
A detailed companion recap of the Hagerty Revelations episode, covering Project F1 staffing, the Laguna Beach research house, the coffee-table dealership model, and Suzuki's engineering targets, was supplied directly by the editor. Its original publisher and byline could not be independently confirmed at time of writing. Facts drawn from it (drag coefficient, price gap, engineer count, dealership vetting) were cross-checked against sources 11 through 15 above before inclusion, and the editor should confirm original attribution before publication.
Disclaimer: This article is for informational and editorial purposes. It does not constitute medical, legal, financial, or accounting advice, and it takes no position on the clinical use, safety, or efficacy of GLP-1 medications or any other prescription treatment. Concierge medicine as described here, is a healthcare membership business model. It is not a treatment, and it should not be marketed or described as an alternative or substitute for any medication a patient and their physician have determined is appropriate. Physicians and practices using any messaging from this article in their own marketing are responsible for ensuring compliance with FTC truth-in-advertising standards and their state medical board's advertising rules, including avoiding any claim, direct or implied, that concierge membership treats, replaces, or competes with a specific medication or clinical intervention. Figures labeled as estimates reflect Concierge Medicine Today's own analysis of published per-unit data and are identified as such throughout. Readers should consult a licensed physician, attorney, or financial advisor for guidance specific to their situation.
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