Why More Doctors Are Switching to Membership Healthcare

The Shift Toward Concierge Medicine and Direct Primary Care

After practicing traditional primary care in Hinesburg for 24 years, nurse practitioner Holly Whitcomb opened Horizon Primary Care on Timber Lane in South Burlington. According to Whitcomb, her new practice utilizes a concierge model that combines a patient membership fee with insurance billing. She stated that the shift allows her to return to spending unhurried time with patients, getting to know their personal health goals, and directly answering phone calls and health questions.

This transition reflects a broader national trend. According to a Harvard study published less than a year ago, practices using concierge medicine—along with direct primary care models that bypass insurance entirely via membership fees—experienced an 83% surge nationally between 2019 and 2023.

Financial Pressures and Insurance Disparities in Private Practice

According to Susan Ridzon, executive director of Health First, membership models are primarily a response to payment systems that fail to adequately compensate private practices for their actual workload. Ridzon pointed out that insurance reimbursements vary widely based on the biller. While major healthcare networks like the University of Vermont leverage substantial bargaining power with insurers, smaller private offices often must accept whatever reimbursement rates are offered.

Furthermore, Medicare applies different fee schedules that favor hospital systems over independent practices for identical services. Ridzon described these reimbursement gaps as extreme, noting that much of the labor required for high-quality primary care—such as answering patient inquiries through online portals, taking phone calls, and coordinating treatment plans with medical specialists—goes completely unbilled under traditional insurance structures.

Alternative Models: Employer Partnerships in South Burlington

Other local medical providers have structured direct primary care to serve specific community segments. Nurse practitioner Beth Schiller, who owns Champlain Medical urgent care center in South Burlington, offers direct primary care through dedicated agreements with local employers rather than individual retail memberships.

According to Schiller, Champlain Medical has partnered with Engineers Construction Inc. (ECI) for years to manage workplace injuries and required employee physical exams. Under this arrangement, ECI incentivizes workers to utilize direct primary care covered entirely by the company. Schiller explained that a single annual primary care visit—which includes basic lab work, EKGs, and hearing tests—grants employees year-round access to the facility for urgent and primary care needs. Schiller noted that this arrangement recently enabled one patient to receive an EKG that promptly led to a cardiology referral, a stress test, and a triple bypass procedure.

Addressing Provider Burnout and State Workforce Shortages

The pivot toward membership-based healthcare arrives amid a shrinking pool of primary care clinicians in Vermont. Department of Health figures indicate there were 40 fewer primary care providers in the state in 2024 than in 2022, with nearly one-third of Vermont’s primary care physicians over the age of 60.

While those figures do not fully capture nurse practitioners like Whitcomb and Schiller, Ridzon stated that adopting membership models may help veteran doctors remain in practice longer. Rather than exiting the profession due to widespread administrative burnout, providers are establishing sustainable operational models to keep doors open, according to Ridzon.

Reflecting on her new practice, Whitcomb emphasized her primary motivation for the change. “I’m not doing this to make a gazillion dollars,” Whitcomb said. “I’m doing this to genuinely try to take better care of my patients in the way that I think they should be cared for.”

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