The best concierge doctors in San Francisco, and how to choose

What a concierge doctor offers

A concierge doctor, also called a retainer practice, charges a yearly fee and in return looks after fewer patients. A national survey in the Journal of General Internal Medicine found that retainer doctors cared for a mean of 898 patients, against 2,303 for doctors in ordinary practice [1]. House calls were offered by 63% of retainer doctors and 26% of the others, and direct access to the doctor at any hour by 91% against 40% [1].

The American Medical Association sets out what a retainer practice owes its patients. The terms must be presented clearly, joining must be voluntary, and a doctor who converts a practice must help any patient who does not join to move their care elsewhere [2]. The fee may pay for extra services and time, and the AMA asks doctors to take care not to imply that it buys more or better medical care [2].

When a hospital linked practice is the right answer

If you want your doctor inside a large health system, Sutter Health runs an adult concierge practice in San Francisco for patients aged 18 and over [3]. Its doctors keep a limited number of patients, offer same day or next day appointments, answer by phone or message on every day of the year, and can visit you at home or in hospital [3].

Visits typically last 30 to 60 minutes. Sutter charges a monthly membership fee, which it quotes on request, and it accepts insurance, including Medicare plans, for billable care [3]. For someone who wants their specialists and their hospital in the same system as their doctor, this is a sound choice.

When a small independent practice is the right answer

Private Medical has its San Francisco office in Pacific Heights, with 10 physicians who each care for a maximum of 100 members [4]. Members are seen in the office, by video, by text and email, and at home when it is necessary. The practice does not publish its fee [4].

A panel that small gives a doctor time to know every member of a family. MDVIP works differently, through a national network of affiliated doctors who charge an annual fee for a wellness programme of screenings that insurance does not usually cover [5]. That fee varies by place and by physician.

When an immediate care membership is the right answer

Sollis Health runs a flagship centre in San Francisco with walk-in urgent care, imaging and laboratory tests on site, open at every hour of every day [6]. Its clinicians are trained in emergency medicine, and Sollis describes its membership as a complement to your primary care doctor, who it keeps informed [7].

Sollis Platinum starts at $12,000 a year and adds 3 house calls a year for each member and advanced imaging when it is medically necessary [8]. The Platinum page does not say which centres sell the tier, so ask the San Francisco centre whether it is offered there. Sollis also says you may not see the same clinician at every visit [7].

This model suits a family that wants fast care for an injury or a sudden illness at any hour. It works best alongside a doctor who knows your history and keeps your longer term plan.

Questions to ask, and how to check a licence

The Medical Board of California publishes an Online License Search with a profile of every physician it licenses, and you can search by name or licence number [9]. It can also alert you when a doctor's practice status changes or enforcement documents are added. A doctor of osteopathic medicine is licensed by the Osteopathic Medical Board of California, so search there for a doctor with DO after their name [9].

These questions apply to every practice, including ours. Ask for the answers in writing before you sign.

• Is the practice taking new patients, and how many patients does each doctor look after?
• If I call in the morning, will a doctor see me that day?
• Which hospital does my doctor admit to, and will they visit me there?
• Who looks after me when my doctor is away?
• What does the fee cover, and what will be billed to my insurance?
• If I have Medicare, how does the practice keep the fee apart from covered care?

How our care in San Francisco will be different

We are building the clinic around one doctor for your whole family. Your doctor will know your history and your results, will see you on the day you ask and will bring blood tests, imaging and specialists into one place, so you never have to repeat your story.

Founding membership in San Francisco is from $13,000 a year. Children will be seen from three months old, with a parent or guardian in the room.