What is Concierge Medicine?

The Problem with Standard Medicine

Have you ever worried that you can't trust your doctor to give you the best advice, or that they simply don't have the time to help you make the best health decisions possible?

Let's face it: the standard medical system is not working. Patients get an average of 23 seconds^[1] before their doctor interrupts them, and the average office visit lasts about 11 minutes^[2]. Primary care doctors try to manage 2,500–3,000 patients, seeing 20–30 of them every day.

From a doctor's point of view, the situation is a disaster. Burnout rates are over 50%.^[3] Suicide rates among physicians are skyrocketing.^[4] They went to medical school to help people, but found themselves trapped in a system that forces them to act as data-entry clerks for insurance conglomerates.

But for you, the patient, it’s even worse.

The dirty secret of medicine is that your doctor isn't working for you. They are a subcontractor for your insurance company.^[5] As the southern saying goes,

Because the insurance company pays the bill, the doctor follows the insurance company's rules. This leads to "shoot-from-the-hip" diagnoses (misdiagnosis rates are near 1 in 20^[6]), rushed visits, and a reliance on "guideline-based medicine" that is often outdated or designed to save the system money rather than save your life.

The Landscape of "Concierge" Medicine

In response to this broken system, several new models have emerged. If you are looking for alternatives to standard insurance-based care, you will likely encounter these categories:

1. Membership-Based & Direct Primary Care (DPC)

• Examples: One Medical, MDVIP
• The Model: These practices charge a low annual or monthly fee to reduce the patient load slightly.
  • One Medical: Focuses on tech-enabled booking and nicer waiting rooms, but the medical model is largely standard.
  • MDVIP: A national franchise model that reduces patient panels to ~600 (vs 2,500), allowing for 30-minute visits and a basic annual physical.
• The Reality: While better than a 7-minute visit, these models typically still rely on standard insurance billing for visits and labs, meaning they are still tethered to the same insurance guidelines and "standard of care" limitations.

2. General Concierge Medicine

• Examples: Local independent practices (e.g., Westlake Concierge in Austin)
• The Model: This is the "White Glove" version of standard medicine. You pay for better access—cell phone numbers, same-day appointments, longer visits, and a doctor who will coordinate your care with specialists.
• The Reality: The service is excellent, but the medicine is often unchanged. They are effectively "super-managing" standard disease care. They address chief complaints, run standard labs, and follow the same guidelines as the doctor down the street—they just do it more politely and efficiently.

3. Elite / Ultra-Exclusive Concierge

• Examples: MD2
• The Model: Extreme exclusivity. Doctors may only see 50 families total. The focus is on absolute availability—your doctor will meet you at the airport or your home.
• The Reality: This is the pinnacle of the "service" model. It guarantees access, but like the general concierge model, it doesn't necessarily promise a different philosophical approach to health or longevity. It is standard medicine, perfected.

4. The "Biohacker" / Longevity Space ("Medicine 3.0")

• Examples: Peter Attia, various "Anti-Aging" clinics
• The Model: This model promotes itself as "advanced" medicine that goes beyond guidelines to optimize health. It relies heavily on extensive testing (genomics, continuous monitoring, liquid biopsies) and aggressive interventions to optimize surrogate markers.
• The Reality: This model is not "advanced"; it is epistemologically flawed. It relies on a fundamental misunderstanding of medical testing—ignoring pretest probability and measurement error—and confuses correlation with causation. By aggressively treating surrogate markers (like forcing lipids to physiologic zero) without outcome data, it falls victim to Goodhart's Law (when a measure becomes a target, it ceases to be a good measure) and Brandolini's Principle (bullshit is 10x easier to create than to destroy). It ignores the history of failed mechanistic hypotheses (e.g., CAST, torcetrapib, xygris) where treating the "number" killed the patient. It markets confidence, but delivers unproven and potentially harmful interventions based on ignorance of the scientific method.

The RiverRock Position: The Post-Longevity Era

RiverRock exists in a different category entirely.

We reject the anxiety-driven "Longevity Gold Rush" where patients are sold 500-biomarker panels and endless tracking devices with no data on whether they actually move the needle on longevity. This approach operates on the false premise that more data equals better health. It does not. We call this "Quantified Quackery."

We take a third path: MeaningSpan.

Beyond Lifespan

We recognize that extending the duration of life (Lifespan) is pointless without extending the depth of life. We focus on MeaningSpan—building the biological infrastructure to support your individual purpose.

We fix physiological problems with the skill of elite concierge medicine, focus only on longevity interventions that actually matter, and then pivot to the real work: enhancing your capacity to execute the mission of your life.

But to understand any of that, you first have to understand how we see the entire concept of health differently.

Read about our philosophy here: What is Health?

Go Deeper

This page discussed RiverRock's view of the concept of health. For those who want to explore further:

• Watch the lecture series – Dr. Z has recorded extensive discussions on longevity skepticism, Bayesian medicine, and MeaningSpan philosophy. Topics include:

  • Why homocysteine optimization is a biomarker bamboozle
  • Why testosterone supplementation doesn't improve longevity
  • Why full-body MRI screening generates more harm than benefit
  • Why massive lab panels on healthy people are "quantified quackery"

  Explore Lectures
• Read related essays – For more on the philosophy behind RiverRock:

  • What is Health?
  • The RiverRock Methodology
  • Dream-Driven, Data-Assisted Healthcare
  • Meaning & MeaningSpan

References & Footnotes