CLINICAL INNOVATORS
Interview by
KATLYN NEMANI, MD
Creating a Robin Hood Model
for Concierge Care
An Interview with Deeb Salem, MD
D
eeb Salem, MD, is the chairman of
medicine at Tufts University School of
Medicine and the physician-in-chief at the
Tufts Medical Center, and has had a distinguished
career as an academic cardiologist. Dr. Salem has
been president of the New England Cardiovascular Society, and was the founding president of
the New England Affiliate of the American Heart
Association. His academic accomplishments include
more than 130 scientific publications, and he is
recognized as a national expert in coronary artery
disease and congestive heart failure. Dr. Salem
has repeatedly been listed in Boston Magazine as
one of “Boston’s Best” physicians, most recently in
November 2013. In 2004, Dr. Salem co-founded an
academic retainer practice at Tufts Medical Center,
offering a new model of concierge medicine.
“ I started thinking about
one of the key problems
in primary care—the
underpayment of
primary care doctors.
In order to survive, they
need to see several
patients in a day. Many
physicians are frustrated
with the demands
of caring for a lot of
patients.”
– Deeb Salem, MD
ACC.org/CSWN
Since the beginning of your career at Boston
University Medical School until now at
Tufts Medical Center, you have cared for an
economically diverse population. How has that
influenced your practice?
I was raised in Brooklyn in a very economically
diverse neighborhood. My parents were immigrants.
My grandmother was in this country for 50 years,
and she only knew two words of English. I came to
Boston to go to school and cared for a diverse community at Boston Medical Center, which I do here at
Tufts as well. At Tufts, we’re right in the middle of
Chinatown, and ever since I did my cardiology training here I’ve cared for non-English speaking patients
and patients from diverse economic backgrounds.
Tufts is the third oldest hospital in the country. We
were founded by Paul Revere. At the time when this
hospital was founded, people of means helped support
the care of people with no means. There was no such
thing as insurance. I thought that this tradition of those
more fortunate contributing to the care of the underserved could be an interesting model to carry forward.
How did you come up with the idea of a
“mission-driven” concierge practice?
About 15 years ago, there was a company called MDVIP that wanted to talk to me about a concierge service. Initially I told them that we weren’t interested
and didn’t think that there was a place for that at an
academic medical center. But then I started thinking
about one of the key problems in primary care—the
underpayment of primary care doctors. In order to
survive, they need to see several patients in a day.
Many physicians are frustrated with the demands of
caring for a lot of patients. That is the reality.
I started my career as an interventional cardiologist. In those days, the “cash cow” for cardiology was
doing interventional procedures. I thought it could be
interesting to create a “cash cow” for primary care.
We could start a practice in which a subset of patients
who did not want to be rushed through their visits
and wanted a slower pace could pay a fee, and that
money could be pooled in with the funds that we use
for paying our primary care doctors that do the usual
work. Patients in the traditional practice would not
be abandoned by their physicians, as their physicians
would only work part time in the concierge practice.
We started it as an experiment, and it worked. The
initial retainer practice started with MDVIP, but over
time we were able to run it ourselves.
How are the doctors in the program able to
afford the extra time to take care of patients
in the concierge practice while retaining the
patients in their traditional practice as well?
In the beginning we had three doctors who were
splitting their time between the two practices. Each
one had a day on the concierge side, and they would
cover for each other. They stopped taking new
patients in their traditional practice but were able
to maintain their old ones. Initially there weren’t
many concierge patients, so it wasn’t too difficult.
Over time (10–15 years), just by attrition of their
traditional patients, those physicians now spend just
about all of their time in the concierge practice.
What were some of the barriers you encountered
when starting the practice?
Some people took issue with the idea of patients getting
treated differently in the concierge practice. But what
often goes unsaid in academic medical centers is that if
you’re the president of a big company and a big donor
to the hospital, you will be treated differently by your
primary care doctor. The hospital makes sure of this.
We are just totally open about it. And people pay a
fee which goes towards improvin r6&Rf