In Rural Massachusetts, Patients and Physicians Evaluate the Impact of Concierge Medicine

In the small city of Northampton, Massachusetts, Michele Andrews experienced firsthand the evolving landscape of primary healthcare. Having been a patient of her internist, Dr. Christine Baker, for a decade, she appreciated the quality of care but began to notice longer wait times for appointments, often weeks apart. The situation underscores a broader issue nationwide: the primary care physician shortage, especially acute in rural regions like western Massachusetts.

Recently, Andrews received a letter from Dr. Baker announcing the clinic's transition to a concierge membership model starting September 1, 2024. This model requires patients to pay an annual or monthly fee in addition to insurance costs. The fee for existing patients was set at $1,000 per year, with new patients paying $1,500 annually. Many doctors adopting this approach find that it alleviates the pressures of high patient volumes, allowing for more personalized and manageable care.

However, this shift has sparked controversy. Critics argue that concierge medicine predominantly benefits wealthier individuals, potentially limiting access for those with fewer financial resources and worsening existing shortages in community healthcare. Andrews and her husband faced a choice: pay the fee or seek another provider. They opted to leave, feeling that the additional expense contradicts the intent of insurance-based care.

Dr. Baker reported that fewer than half of her patients chose to maintain their relationship under the new model, reducing her patient list from 1,700 to about 800. Despite the stress, she acknowledged that some patients understood her decision and supported her, while others struggled with the new costs.

Some patients, like retired nurse Patty Healey, chose to stay, believing that concierge care might offer benefits like earlier appointments and longer consultations. This perspective exemplifies the debate surrounding personalized healthcare—while some see it as an advancement, others view it as an exclusivity issue.

Healthcare experts such as Michael Dill, from the Association of American Medical Colleges, warn that concierge practices could deepen physician shortages, especially in rural areas where access is already limited. The U.S. faces a projected shortage of up to 40,000 primary care physicians over the next decade. In Massachusetts, rural regions report lower rates of residents with a primary care provider, heightening concerns about health disparities.

Rebecca Starr, an internist specializing in geriatrics, recently started a concierge practice with a fee of $3,600 annually and a patient cap of 200. She believes this model allows her to provide better care and develop meaningful doctor-patient relationships. Similarly, Dr. Shayne Taylor offers a direct primary care service with a monthly fee, emphasizing that this approach can address inefficiencies in the traditional system.

Despite criticisms, some physicians argue that alternative models like concierge and direct primary care are necessary responses to systemic healthcare challenges. They believe such approaches enable providers to deliver higher-quality, personalized care without the burdens of insurance paperwork.

As the healthcare system evolves, the debate continues: balancing access, quality, and sustainability remains a complex challenge faced by both practitioners and patients amid ongoing shortages and disparities. Source: https://medicalxpress.com/news/2025-04-rural-massachusetts-patients-physicians-offs.html