Psychiatrist, Advocate for Patient Care

Chapter 12: The "Best" Patient-Physician Model

Skin in the Game for Physicians and Patients


​“In private practice, innovations can only succeed if they result in better patient outcomes and satisfied patients. If not, they are not repeated. There is no pressure to publish. The only incentive is better patient outcomes. The private practitioner’s focus is not constrained by what
the peer reviewers will say—only what his patients will say.” Gerold Gianoli, MD


There is no “best” model for direct-pay independent practice. There are many independent practice models that will serve to enhance the patient-physician relationship.


Like any consumer, I prefer some direct-pay business models to others. I strongly prefer those in which a patient directly pays a physician a fee at the time a service is performed. Some physicians, however, prefer a membership model – sometimes called concierge medicine. I
have conceptual problems with the concierge model, but if an independent physician prefers it, that is his or her free choice. I have some comments about this later in the chapter.


If we want to control or reduce the price of medical care while increasing quality; if we want patients to be full partners with their physicians, or better yet, have the power to hire and fire them; if we want the best chance of achieving patient-centered care, then practice models that ensure that a patient and his or her doctors both have “skin in the game” is a good starting point.

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