Concierge medicine is often pitched as the escape hatch for exhausted primary care doctors: fewer patients, longer appointments, more control over the schedule, better compensation, and considerably less of the clinical version of speed dating.
For many physicians, those advantages are real. Yet the career of internal medicine physician Annie Moore, MD, MBA, offers a fascinating counterpoint. After approximately 13 years working in concierge medicineand helping launch three concierge programs within academic health systemsMoore deliberately returned to a standard outpatient internal medicine practice.
That decision was not a rejection of concierge care. In fact, Moore has been remarkably candid about how much she valued the model. She enjoyed more time with patients, greater autonomy, schedule flexibility, higher compensation, and enough breathing room to research complicated medical problems. She has even suggested that those years may have helped extend her career in outpatient medicine.
So why leave?
The answer gets to the heart of a much larger debate about American primary care. A medical practice can offer doctors more time and money while still presenting trade-offs involving availability, professional purpose, patient access, and the simple human desire to occasionally turn off the phone.
Who Is Dr. Annie Moore?
Moore is a board-certified internal medicine physician whose career stretches back to the 1980s. She began practicing internal medicine in downtown Portland, Oregon, in January 1986, when she was 28.
Her early experience hardly resembled the rushed, tightly scheduled primary care environment many Americans know today. Her practice had a culture of hospital rounds and house calls, and she learned from senior physicians who emphasized the patient experience and long-term doctor-patient relationships.
The patient population was also unusually broad. Because of the practice’s reputation and downtown location, Moore treated people across the socioeconomic spectrumfrom wealthy Portland residents to people experiencing homelessness.
Those years established a theme that would follow her throughout her career: medicine was not merely about efficient transactions. It was about relationships.
How Moore Entered Concierge Medicine
Moore did not originally map out a career in membership-based medicine.
In 2005, while working at an academic medical center on the West Coast, she was asked to develop and lead what became, according to her account, the largest academic concierge practice in the United States at that time.
That assignment began what she later called her unplanned career as a concierge internist.
Her success opened additional doors. In 2011, another academic health system recruited her to establish a concierge primary care practice within an integrative medicine center.
Then life intervenedas life enjoys doing without checking Outlook first.
Following her second marriage, Moore moved professionally to Colorado in 2015. Within months, she was once again asked to build a concierge internal medicine clinic. It became her third concierge program across three academic health systems.
By almost any conventional measure, the model was working.
The clinic was successful. Moore was experienced. Patients valued the service. She knew how to make concierge medicine function inside sophisticated health organizations.
Then, at the end of 2017, she walked away from it.
What Concierge Medicine Actually Means
Before examining why, it helps to clarify an often-confused term.
Concierge medicine, sometimes called membership or retainer medicine, typically involves patients paying an annual or monthly fee in return for enhanced access and services. Depending on the practice, benefits may include longer appointments, same-day scheduling, direct physician communication, comprehensive preventive visits, and greater coordination of care.
Many concierge practices still participate in health insurance and bill insurers for covered medical services. The membership fee is generally separate.
Concierge Medicine Is Not Necessarily Direct Primary Care
Concierge medicine and direct primary care (DPC) are frequently thrown into the same conversational blender, but they are different models.
Direct primary care practices generally charge patients a lower monthly membership fee and do not bill insurance for routine primary care. The membership often covers office visits and other defined primary-care services.
Concierge practices may charge higher membership fees while continuing to bill insurance. There is enormous variation, however, so the label alone tells patients surprisingly little about what they are buying.
What both models commonly attempt to fix is the same problem: conventional primary care often asks physicians to do too much in too little time.
What Moore Loved About Concierge Medicine
Moore’s story is especially valuable because she does not portray concierge medicine as a villain. Quite the opposite.
1. More Time With Patients
One of the biggest advantages was simply having time.
A smaller patient panel can allow a physician to spend longer with each person, explore symptoms in greater depth, review lifestyle factors, discuss preventive care, coordinate specialists, and answer questions without constantly checking whether the next patient has been waiting 27 minutes and is preparing a Yelp review.
For an internist dealing with patients who may have diabetes, hypertension, cardiovascular risk, medication interactions, sleep problems, stress, and several specialists simultaneously, extra time is hardly a luxury. It can fundamentally change the clinical conversation.
2. Greater Schedule Flexibility
Moore also valued the work-life balance, autonomy, and scheduling flexibility concierge medicine provided.
Traditional fee-for-service primary care economics frequently encourage high patient volume. When each visit is another unit of reimbursable activity, reducing the number of appointments can create financial problems even if the physician believes longer visits would produce better care.
A membership model changes that equation. Predictable membership revenue can allow a smaller panel to support a physician economically.
3. Higher Compensation
Moore openly acknowledged another advantage that sometimes gets buried beneath phrases such as “relationship-based medicine”: she earned more.
When she returned to conventional outpatient medicine, she said her full-time compensation was roughly two-thirds of what she had earned during her concierge years.
That matters. Primary care physicians generally earn considerably less than many procedural specialists despite being expected to coordinate enormous amounts of increasingly complex care. Compensation is therefore part of the conversation about physician retention, whether anyone finds it romantic or not.
4. Time to Think About Difficult Cases
Moore also valued having enough time to investigate unusual diagnoses and medical questions.
Good medicine requires thinking. Unfortunately, thinking is difficult to enter into a billing system as a procedure.
A doctor who has additional time between appointments can review evidence, study prior records, speak with consultants, and connect clinical dots that might otherwise become tomorrow’s dots.
So Why Would a Physician Leave Concierge Medicine?
After all those advantages, Moore’s decision sounds surprising. Her explanation reveals that physician satisfaction cannot be reduced to one metric.
The Ability to Truly Disconnect Mattered
Concierge care frequently sells accessibility. Patients may receive direct telephone, email, text, or portal access to their physician. That closeness can be tremendously reassuring for patients.
But accessibility has another side.
Someone has to be accessible.
For physicians, especially those deeply committed to their patients, the psychological weight of being continuously reachable can follow them home, on vacation, during dinner, and into weekends.
Moore eventually found that being able to completely unplug tipped the balance in favor of the standard ambulatory model during the later phase of her career.
That distinction is important. Better work-life balance does not necessarily mean the same thing at age 40 that it means later in a physician’s career. At one stage, schedule autonomy may be everything. At another, being genuinely off duty may become more valuable.
Serving More Patients Also Mattered
Moore described another source of tension: the number of people she could serve.
The economics of concierge medicine work partly because physicians maintain smaller patient panels. A physician who formerly managed thousands of patients may care for only hundreds after converting to a membership practice.
For the members, that can produce extraordinary access.
For everyone who is not a member, the arithmetic is less comfortable.
Moore connected her decision with her professional values and her family roots in rural Oregon. Returning to conventional primary care allowed her to care for more people at a time when the United States was already struggling with primary-care access.
This does not make concierge physicians unethical. Nor does it mean doctors should sacrifice themselves on the altar of unlimited patient volume. It illustrates a genuine policy dilemma: a model that may make one physician’s career more sustainable can simultaneously reduce that physician’s total panel capacity.
Returning to Traditional Primary Care Was Not Easy
If Moore’s story ended with “and conventional medicine was wonderful,” it would make an inspiring movie and a terrible description of American health care.
She described significant difficulties after returning to standard outpatient internal medicine.
Among them were severe time pressure, difficulty finding enough time to telephone patients, a persistent sense that she could not accomplish everything patients needed, and long workdays spent completing electronic inbox tasks.
At the time of her original account, she described working days that could stretch roughly 12 to 14 hours because of the electronic workload.
She also reported lower compensation, frequent fatigue and stress, and frustration when patients could not obtain timely specialist appointments.
In other words, she did not leave concierge medicine because conventional primary care was easier.
She chose a different collection of trade-offs.
Why Her Story Matters Even More Today
The pressures that shaped Moore’s decision have not disappeared. If anything, they have become more visible.
Recent research on U.S. primary care continues to identify heavy administrative workloads, insufficient time, work-life dissatisfaction, and burnout as major challenges. Surveys have found that more than two in five American primary care physicians experience burnout, with administrative burden frequently cited as a leading cause.
At the same time, compensation remains an issue. Primary care physicians continue to earn substantially less on average than many specialists, even though strong primary care is associated with prevention, chronic disease management, coordination, and better population health.
No wonder membership-based practices are attractive.
Concierge medicine effectively says: what if physicians stopped trying to squeeze increasingly complex medicine into an industrial-volume business model?
That is a compelling question.
But Moore’s experience adds a second one: What happens after we solve the time problem?
The Ethical Question Behind Membership Medicine
The American Medical Association recognizes retainer practices as a legitimate approach to organizing care while also noting potential ethical concerns involving access, continuity, and fairness.
The point is not that paying for convenience is inherently wrong. Americans routinely pay more for convenience in almost every industry.
Healthcare, however, is not quite the same as getting priority boarding.
When a physician reduces a panel from thousands of patients to hundreds, people who cannot afford or choose not to pay the membership fee may need to find another doctor. In communities already struggling with shortages, that transition can be difficult.
Physicians therefore face an uncomfortable question: how much responsibility should an individual doctor bear for fixing a system whose business model may be making that doctor’s career unsustainable?
There is no tidy answer.
Concierge Medicine Can Still Be a Career-Saving Model
One of the most interesting parts of Moore’s perspective is that she did not consider her concierge years a mistake.
She believed those years may actually have extended the amount of time she remained in ambulatory internal medicine.
That observation deserves attention.
Suppose the alternatives for a burned-out primary care doctor are:
- remain in a high-volume practice and eventually leave outpatient medicine;
- reduce clinical hours substantially;
- retire earlier than planned; or
- move to a concierge or direct-care model and continue treating patients.
In that scenario, membership medicine might preserve physician supply rather than simply reduce it.
The impact depends on what would otherwise have happened.
Career Stage May Be the Missing Variable
Moore emphasized that physicians should not necessarily treat practice models as lifelong identities.
That may be the most practical lesson in her story.
A physician raising young children might prioritize schedule control. Another doctor dealing with educational debt may prioritize income. Someone approaching retirement might care more about reducing after-hours responsibility. A physician committed to underserved populations may place greater value on maintaining a large and diverse patient panel.
None of those choices automatically makes one physician more dedicated than another.
Medicine has a curious habit of asking doctors to choose a lane at age 30 and remain emotionally loyal to it forever. Real careers are messier.
Moore moved into concierge medicine, built programs successfully, benefited from the model, and later moved out again.
That is not inconsistency. It is career design.
What Happened After Moore Left Concierge Medicine?
Moore continued practicing internal medicine within the University of Colorado system. Her later work has increasingly focused on an issue that connects both sides of her career: patient experience.
In 2024, she became the inaugural holder of the Brown/Moore Endowed Chair for Excellence in the Patient Experience at the University of Colorado Department of Medicine.
Her work has included examining how healthcare organizations communicate with patients and how systems can better support different patient preferences rather than forcing everyone through the same pathway.
That trajectory makes sense.
The deeper issue in Moore’s career was never simply concierge versus non-concierge medicine. It was how to preserve the human relationship between doctor and patient inside systems that constantly place pressure on time, access, communication, and clinician energy.
Experiences and Practical Lessons for Physicians Considering Concierge Medicine
Experience 1: The 30-Minute Visit Feels WonderfulUntil the Phone Follows You Home
Imagine a primary care physician who currently sees 22 patients a day. Appointments frequently run behind. Lunch is partly dedicated to messages, prior authorizations, laboratory results, and prescription questions. Notes spill into the evening.
The physician converts to concierge medicine and suddenly sees eight or ten patients during a typical day.
The difference can feel astonishing.
There is enough time to discuss why a patient’s blood pressure changed instead of simply adjusting medication. A vague complaint can be investigated rather than postponed. Preventive care becomes part of the visit instead of something everyone promises to discuss “next time.”
Then Saturday morning arrives.
A patient sends a text asking about a new rash. Another wants to discuss a laboratory result. Someone traveling out of state needs a prescription sent to another pharmacy.
Individually, none of these requests is terrible. Collectively, they illustrate why concierge physicians need explicit boundaries, dependable coverage, and realistic patient expectations.
Small patient panels reduce volume. They do not automatically create psychological distance from work.
Experience 2: Smaller Panels Change the Relationship
One major advantage of a smaller practice is continuity.
When a doctor repeatedly sees the same few hundred patients, subtle changes become easier to recognize. A physician may remember that a patient normally dismisses pain but is suddenly worried, or that someone’s fatigue began shortly after a medication change.
Those details do not always fit nicely into structured electronic medical record fields. They are part of knowing a patient.
That relationship is one reason some physicians find membership medicine professionally satisfying. Instead of functioning primarily as a traffic controller who sends patients through referrals, tests, and portal messages, the doctor can again become the central coordinator of care.
Experience 3: Money Can Relieve Burnout, but It Does Not Answer Every Question
Predictable membership revenue may reduce dependence on rapid-fire insurance billing. Better economics can support fewer appointments and potentially allow a practice to hire enough staff.
Those advantages are meaningful.
But financial improvement does not automatically settle questions about purpose.
A physician who entered medicine partly to serve a broad community may eventually feel uncomfortable caring for a dramatically smaller population. Another may conclude that serving 500 people exceptionally well is more responsible than hurriedly managing 2,500.
Both perspectives can be sincerely held.
Moore’s experience demonstrates why practice design is ultimately personal. The spreadsheet matters, but it is not the only document in the room.
Experience 4: Leaving One Model Does Not Mean It Failed
This may be the most transferable lesson.
A physician can spend ten years in concierge medicine and later return to an employed practice. Another can spend 15 years in a hospital-owned clinic and eventually build a direct primary care office. Someone else may combine academic medicine, part-time clinical work, and leadership roles.
The goal should not be winning an argument about which practice model is morally or professionally superior.
The goal is creating conditions under which excellent physicians can continue practicing good medicine without being consumed by the machinery required to deliver it.
What Patients Should Ask Before Joining a Concierge Practice
Patients considering concierge care should look beyond promises of premium access and ask practical questions:
- What exactly does the membership fee cover?
- Does the physician still bill health insurance?
- How quickly can routine and urgent visits be scheduled?
- Who responds when the physician is unavailable?
- Are telephone, text, or video consultations included?
- How are hospitalizations and specialist referrals coordinated?
- What happens if the physician retires or the patient cancels membership?
The answers matter more than the word concierge on the website.
Conclusion: There Is No Perfect Practice Model
Dr. Annie Moore’s journey complicates the usual story about concierge medicine.
She experienced many of the model’s strongest advantages firsthand: more time with patients, better compensation, autonomy, flexibility, and room to think carefully about complex medical problems. She also helped build multiple successful concierge programs.
And then she left.
Her decision was shaped by factors that rarely fit into marketing brochurescareer stage, the desire to completely disconnect from clinical responsibility, the number of patients she wanted to serve, and her evolving sense of professional purpose.
At the same time, returning to conventional primary care exposed her again to long days, electronic inbox work, time pressure, lower compensation, and the frustrations familiar to physicians across the country.
That apparent contradiction is precisely why her experience matters.
Concierge medicine is neither the salvation nor the downfall of American primary care. It is one response to a healthcare system struggling to finance the time-intensive, relationship-based work that good primary care requires.
Moore’s career suggests that physicians should be allowed to move between models as their lives and priorities change. A practice structure that prevents burnout during one decade may become less attractive in another.
Perhaps the larger goal should be to create a healthcare system where doctors do not have to choose between adequate time with their patients, sustainable careers, reasonable compensation, genuine time off, and broad access to care.
That would be a truly luxurious version of medicineand ideally, nobody would need a membership card to get it.
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Note: This article is an independent, fully rewritten analysis based on Dr. Annie Moore’s publicly described career experience and broader U.S. medical guidance and reporting on concierge medicine, direct primary care, physician burnout, patient access, and primary-care practice models. It is intended for informational and editorial purposes and does not constitute medical, legal, or financial advice.
