Will Concierge Medicine or Direct Pay Models Thrive in a Small Town Environment?

by Maria K Todd, MHA PhD

 CEO and Founder
Mercury Healthcare International

Frequently, I receive inquiries from physicians interested in a change to their business model. But their greatest concern is that there may not be an adequate addressable market in the community where they are located. There isn't a standard formula by which to calculate success potential without setting a few targeted business and revenue (and lifestyle) objectives and a market analysis. If you've got a question about setting up a concierge membership model practice or 100% cash pay practice in a small town community, a rural setting, or even a larger city, let's start with a chat so you can get some answers.

When I help physicians considering a transition to concierge or direct practice business models, or to add new services, my first order of business is to determine their addressable market or "service area". Defining a service area is both art and science and it takes a fair amount of experience and expertise to get it right. Some of it is marketing and branding know how; medical business compliance and other considerations like your continued participation in managed care plans and government healthcare programs.

Often physicians define their service areas incorrectly out of ignorance. They were never trained to make these calculations or taught any guidelines. That's not a problem, really. It simply takes some basic explanations of the nuances involved.

Actually, there are several ways to accomplish this calculation. As part of "knowing your customer", you must know your practice make up, and who you serve, and determine the boundaries of your service area or relevant geographic market is a part of that. This includes, not only who you want to serve, but the geography you currently serve. I help many physicians to understand their local market through segmented demographics, spending data, traffic, and many other industry-leading insights. Sometimes that leads to an actual launch or transition to a concierge membership practice or cash only model, and other times it prevents a lot of heartache and unrealistic expectations and revenue projections. There may be more value in the latter than the former.

In these analyses, we must first consider percentage of addressable market share from the geography, but it should not be based solely on patient origin. That's the first factor. The second factor to overlay on the geographically relevant market is what you want or can reasonable expect to earn in terms of revenues within that geographically relevant market.

One service I provide is a comprehensive custom report and infographics set for which I charge $500 to prepare. It includes the following information:

Overview of Demographics
I provide access to over many fine-grained datasets to segment and find where your customers are located.  These reports can be created for 3- and 5-mile rings. I have access to 35+ insights and 3,700+ datasets ranging from detailed demographics to spending by business category, to crime index, traffic, and market void analyses that highlights doctors and medicine in your trade area, healthy lifestyle outlets such as gyms, natural food grocers, population trends by full-time residency, transient, seasonal and workforce metrics, and more.

Traffic Counts
This report shows accurate, up-to-date, 24/7 traffic counts, including data for both sides of the street
Hourly Traffic Volume for your practice address

Average Annual Daily Traffic Volumes
Daily Traffic Volumes
Hourly Traffic Volumes

Trip Range
For this report I interpret data to analyze where you fit in your shoppers’ daily errands using available data from mobile device tracking

This report provides insights about how much interest there is for what you sell, anywhere in the US.

Ancestry relative to Residential Population within a 3- or 5-mile ring and and county-wide

Ethnicity relative to Residential Population within a 3- or 5-mile ring and and county-wide

Language relative to Residential Population within a 3- or 5-mile ring and and county-wide

Educational Achievement relative to Residential Population within a 3- mile ring and and county-wide
Reported for 9 groups from elementary to doctorate.

Gender relative to Residential Population within a 3- to 5- mile ring and and county-wide for those who identify as male or female

Generations relative to Residential Population within a 3- to 5- mile ring and and county-wide

  • GenZ
  • Millennials
  • GenX
  • Boomers
  • Silent

Weekly Per-Capita Spending within a 3- to 5-mile ring from your business

  • Healthcare
  • Entertainment
  • Sports and Sporting equipment
  • Bicycles
  • Meals out
  • and more

Vehicles per Household relative to Total Households

Social Media and Online Reputation

No matter where you are located, social media is a business consideration. For physicians, every negative comment in your online reputation has an economic impact on your business. Some published reports estimate that each negative feedback can cost physicians as much as $2800.  Since about 92% of consumers rely on reviews to make their buying decisions, that's as bad as having a picket line against you walking like human billboards on the sidewalk in front of your door. And what's worse is that you cannot pay someone to filter out or have negative posts removed as easily as many "internet cleaners" would have you believe.

Also, opinions about your practice or of your competitors aren’t limited to star-ratings and official reviews. Unstructured reviews come from anywhere on the web where someone has mentioned a business without an explicit rating. For example, in tweets, blog posts and news articles.  Google data shows 97% of consumers, research businesses online. You need a system to comb through everything posted about you, your professional reputation, and your brand name or practice name reputation no matter where it exists online. We prepare physician summary reports each month for some of our clients while others choose quarterly reviews, semi-annual reviews or annual reviews. The choice is yours, the price is the same regardless of the frequency.

But after more than 10 years helping concierge and direct pay physicians plan, launch and build their practices, I'm no longer shocked by the number of physicians who have never examined their social media presence and online reputation for their practice, and public comments about their staff and business practices. Those without a website are sometimes amazed that they even have an online presence. Many directory listings upload your information from state and federal databases - just so that people can offer feedback and give star ratings about you whether you have a website or not.

You can’t afford to rely on guesswork when it comes to your reputation and online presence and you can't hide from the internet's impact on your bottom line.

For $55, I run a report that scours the internet for 48 hours to find every directory listing about you and your business, every comment posted, every mention or rating,  if your listings are complete and accurate, where you aren't listed but should be, which social media accounts have been opened in your name, a competitor analysis with your two key competitors (you determine who they are and tell us so that we can narrow down the search parameters). You get a 9-page, custom report with fresh insights and an overall score and along with highlighted areas for improvement.  This 9 page report is specific to your business and has many valuable points of information and action items.

We will prepare this report for you without further obligation. In fact, hundreds of physicians ask us to prepare these reports monthly and that's all they need from us. That's fine. We're happy to help you this way if that's all you want or need. There's never any pressure to buy more from us. It is such a popular service that we actually have a team just to run these reports each month for clients.

In a small town setting, your professional reputation can make or break your practice. People want to see you participate in the community and they want to like you and engage with you at multiple levels. We help you through public relations efforts, marketing, advertising, and community participation.  When you have a great online reputation, patients no longer feel as if you "sold" them a membership in your practice. Instead, they decide when and what to buy and come to you to complete the transaction.

Having an effective online presence in a small town leads to higher website traffic from mobile searches with the new "near me" oral search tools using Google.  It also leads to boosted search engine rankings and placement on the list of businesses returned in the search. This translates to free advertising you get from search engines and higher visibility to let people know about your business and your readiness to accept new patients, provide appointments without long waits, and get the help they need to maintain their health and vitality.

How you'll use this data

We help you improve patient acquisition from social marketing. According to Pew Research, 70% of Americans engage with Facebook daily, and 45% engage several times per day. If you don't have a staffer to help manage your social marketing and concierge or direct pay program, we'll assign an account manager at an hourly fee to make sure you have quality content posted regularly. Here are some things to think about when it comes to social marketing for your practice.

  • Understand that since Google determines your search engine ranking largely based on the completeness and correctness of your directory listings, this can really help boost your web traffic from ALL internet searches.
  • 96% of the Millennial Generation consume social media at a greater rate than all previous generations’ consumption of radio and tv combined.
  • 78% of consumers report that a company’s social media posts influence their decision to purchase.
  • People spend more time on social media than they do emailing, shopping, and online gaming combined.
  • 56% of US internet users age 65 and older use Facebook.
  • If you are no longer listed on managed care plan provider directories, how will your business be found? That discount you granted was in exchange for marketing you in the directory and steerage to your practice as a participating provider. If that's no longer happening, how will you get the word out?
  • Among Facebook users, the median number of Facebook friends is 155.  90% of small businesses have Facebook pages, but that almost one third of them have less than thirty-two fans. We help you build an engaged audience. If your page appears dormant, people don't remain engaged. Practices with successful social media accounts have one thing in common: they offer a steady stream of interesting content to information-hungry followers.  We use a variety of unique and differentiated content marketing strategies designed just for the concierge medical practice and direct pay physicians. Once we "know your customers and target market, we post content that is relevant to them, not just advertisements about your practice. And to position you at the "top of mind", posts are made on a regular basis and consistent.
  • In small towns, one of the most valuable market segments is new movers arriving in the community. One example of how valuable the our social marketing system works, is how it can help you target one of the most valuable market segments – new movers. Over 14% of American’s move per year. They actively seek services and products in their new area. Are you fully profiting from this prime market? Not if you aren't online. And... most people toss their yellow pages directories in the recycle bin within an hour of arrival. They expect to be able to find the same information online when they need it.
  • Get on the map(s). When we manage your social media marketing, we get you listed on all the maps so people can find their way to your door.

The #1 objective of a physician reputation management and online marketing system is to improve the PUBLIC reputation of you as a professional and your practice. We're Google-certified in digital marketing and we only accept healthcare business clients, so we end up focused and able to do a better job of this than our competitors.


Yes, concierge and cash-based medical practice models can thrive in small town settings.

We can't guarantee that your practice will thrive without an initial assessment, so start the discussion by engaging us to complete a market analysis  that includes a quantitative and qualitative assessment of where you are located or want to move. We'll apply our expertise to examine and analyze and interpret the size of your community both in terms of volume and in value, identify the various customer segments and buying patterns, your direct and indirect competitors, and the economic environment in terms of barriers to entry and regulation. When we do this in conjunction with an idea of your revenue goals and preferences, the output of the report will give you the specific information you need to decide next steps with confidence.