Segmented Practice: Working with a Nurse Practitioner or Physician Assistant in Concierge Medicine

As a physician considering a conversion to a concierge practice, you may be concerned about how the transition will impact your patients. In these situations, a segmented practice may be the answer.

In this video, Dr. Joel Meshulam talks to us about his journey in becoming acquainted with SignatureMD and what set the segmented practice model apart.

As Joel describes, he was initially hesitant about converting to a concierge practice, until he came across SignatureMD:

I met with the folks at SignatureMD in an odd way. I’d been looking at concierge medicine for a while. The main model out there is a pay or go model: a patient either has the money or they have to find another doctor.

I work in a city practice; a lot of my patients are not wealthy.

In fact, I had gone through an analysis by another company, not SignatureMD, about five or six years ago, and when they came back with their fact-finding data, they said that I was the perfect doctor, my patients loved me, but the average income of my patients was just too low, and there was no way that it would be viable. I said, “Thank you very much,” and I got back on the hamster wheel, and that’s what I did for a while.


At some point I saw what I think might have been a magazine article or an email that talked about SignatureMD and that their model was a little different. They used something called a blended practice in which they promoted the use of a nurse practitioner or a physician’s assistant to retain your patients.

You wouldn’t necessarily have to kick your patients off to another doctor and you’d still be able to develop a concierge element.

Ethically that felt a lot better to me than kicking people to the curb if they didn’t have enough money, and it seemed to provide me with an option to continue to practice medicine, get some air back into my schedule, and be able to keep doing what I love to do.

If you are concerned about how converting to a concierge practice could impact your patients, get in touch. We would love the chance discuss about how a segmented model of personalized medicine can work for both you and your patients, as well as answer any questions you might have.

About SignatureMD:

SignatureMD (signaturemd.com), with offices in Los Angeles, California and Richmond, Virginia, is one of the nation’s largest providers of initial conversion and ongoing support services to concierge medicine physicians, with an expanding network of over 160 affiliated primary care physicians and specialists across 31 states.