As medical costs have risen, insurance companies have taken steps to reduce their exposure, putting a cap on a physician's income.  At the same time, doctors have seen their costs rise without caps, i.e., rent, utilities, medical and office supplies, wages for office staff, and, of course, insurance costs, including malpractice.

It was only a few years ago my own doctor - I'm on my second one now, but I'll get to that - sent a letter to all his patients, me included, that he was leaving the practice of medicine.  He was tired of working day and night while watching his margins get thinner and thinner.  There just weren't any more hours in the day and it was no longer worth it to him.  He took an administrative position with a medical facility in another state.

His practice was taken over by my current physician who, on more than one occasion over the past several years, has confided to me the following:

• He works from 7 a.m. to almost 10 p.m. most days.
• He hasn't had dinner with his family in so long he can't remember the last time
• His children don't know him - I'm sure it's just a figure of speech, but it makes the point.

About six months ago, he flew a 'trial balloon' past me:  He was thinking his business model.  He could no longer continue working day and night trying to serve 1,000+ patients.  It's too hard to spend quality time with that many people for less and less money.  He wanted a business model that would allow him to reduce his patient load, increasing the time he could spend with each, and at the same time be able to make a decent living while getting back to a normal life style - who can blame him?

The model was simple:  Limit his patient load to 400-600 who are willing to pay an $1,800 annual retainer, which could be paid monthly, quarterly, or annually.   It doesn't affect any insurance or anything else; but, it does give the patient easier access for quality care - same day or next-day appointments, less-to-no waiting, more time with the physician, a pro-active wellness program instead of diagnose and treat, 24-hour physician access, personal client websites and easy access to health records, and more, including screenings, physicals, etc.

Last week, during a routine checkup, he announced he's making the change effective in October.  His membership practice is being coordinated by MDVIP, an organization that provides administrative, as well as additional medical resources support.

This is likely the trend we're about to see in the medical industry, as well as others.  Even many independent Registered Investment Advisory (RIA) practices across the U.S. have now instituted financial planning retainer programs to offset the reduced margins resulting from the fee compression pressures that have forced minimum account size requirements to move higher.

If your doctor hasn't said anything to you, yet, he soon might.  Thought you'd like to know.

Jim