We're Asking the Wrong Questions About Membership Medicine
- J. Lawlor, DO, MBA, FACOI
- Apr 20
- 3 min read
Two concerns surface very quickly when membership-based care is discussed:
“Are we creating access only for those who can afford it?”
This seems like the right question, but it misses the wider truth. Primary care has long carried a responsibility to remain broadly accessible, and any model that introduces a recurring fee naturally raises concern about exclusion.
But the framing needs more precision and less reflexive criticism.
Offering a spectrum of primary care models does not eliminate access. It expands the available options. Traditional fee-for-service remains foundational. Safety-net clinics remain essential. Value-based care continues to evolve. Membership-based models do not replace these structures. They sit alongside them.
The real issue is not whether different models exist. They already do. The issue is how they are used together.
Patient income does not reliably predict preference. Middle-ground membership models add a practical option with more moderate fees, helping bridge the gap between traditional care and fully concierge models. Financially secure patients may remain in traditional fee-for-service practices. Some middle-income families choose to spend discretionary dollars on better access and added features. Others do not. Choice exists across income levels.
Healthcare is not unique in this way. People regularly spend based on what they value. The presence of choice does not create inequity on its own. Poor system design does.
The more important focus is whether we continue down the current path of volume, strain, and burnout, while ignoring patient demand for these new delivery models and the new revenue streams that can help ease pressure on the system.
When done thoughtfully, membership-based revenue can stabilize primary care, support physician retention, and help fund broader community and system needs.
A single rigid structure does not guarantee equity. It often creates strain. A system with multiple options, if designed well, can protect access while allowing better relationships between patients and physicians.
There is another question that deserves equal attention:
“Is membership medicine contributing to the primary care physician shortage?”
This is a common question, and one I contemplate often. Most experts would say yes. Some would say no. The data would indicate yes when viewed in isolation.
If each physician is responsible for fewer patients, that does affect total capacity. We cannot deny that.
But that is only part of the story. The primary care workforce is already shrinking due to burnout, administrative burden, and loss of autonomy. Physicians may be leaving faster than they are being replaced.
The primary care physician shortage will continue to be a problem. However, if there is a concerted effort to improve the appeal of primary care, with less administrative burden, stronger income potential, more time to build meaningful patient relationships, and better work-life balance, we can begin to shift the trajectory.
In doing so, membership medicine can help tilt the table back toward trainees choosing primary care rather than continuing to move into other specialties. This may also require a shift in how we train future physicians, with greater emphasis on longitudinal relationships, continuity, and learning how to spend meaningful time with patients. In many ways, it is a return to what primary care once was.
These concerns are fair, but like most things in medicine, the answers are more nuanced than they first appear. Membership medicine professionals should view the current realities of modern healthcare as something we can and should influence, including both perception and reality. The primary goal is to improve care for individual patients, but we should also consider what we can do to strengthen the entire spectrum of primary care.
More to come in the coming weeks on how a committed group of membership medicine professionals and I plan to make inroads into these changes.
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