Here's a link to his piece, "Concierge Medicine: A Revolution In Primary Care" (PDF).
Dr Russak is a primary care doctor himself and recent switched to a concierge model for his own practice, both so that he could provide better care to his patients as well as to help sustain his economic viability.
He also addresses 3 common questions:
1) Is it too expensive?Here is his answer to question #3, "Is is ethical?":
2) Will this exacerbate the shortage of PCPs (primary care physicians)?
3) Is it ethical?
It is morally wrong to practice inferior care. As noted above, it is just not practical to provide good care to patients in the current reimbursement model without maintaining a full-time practice of nearly 2000 patients, which requires 10-15 minute appointments to see everyone. Good care requires time, and with the overhead of a primary care practice running $200K/year per physician, time and reimbursement are at odds with each other.(Read the full text of "Concierge Medicine: A Revolution In Primary Care".)
Because of this, one year ago, I took the leap of faith and decided to convert my personal practice to concierge. The PA’s and other less-busy physicians in our larger group practice were happy to take over the patients who preferred not to pay the retainer fee.
I now practice a much more rewarding style of Internal Medicine, where I have time for the vastly improved care that comes with longer appointments and following my own patients wherever needed, including the hospital, office, home or rehab. Being on call all the time is not easy, but with only 300 patients, there are very few calls and most are appropriate and timely. I truly believe this is a better way to practice primary care medicine.