Recently, a physician wrote about how access to a patient portal has turned his primary care practice into a reluctant concierge medicine practice, with patients asking questions and expecting quick responses day or night. I could relate. Modern technology is bringing a host of new, unexpected challenges to today’s physicians.

Patient portals may provide a level of ease and efficiency, but, as the physician rightly pointed out, they also create confusion, concern, and more questions. A portal is no substitute for a physician who knows you and your health history and who has the time to consult with you about your test results and the issues that matter to your health and well-being.

This kind of availability and support is concierge medicine, not a traditional medical practice in America today. But not every doctor wants to dismiss patients who may not be able to afford a membership. And not every patient needs this kind of personalized care. Yet, doctors can’t afford to provide this kind of time and attention to the patients who feel they do without receiving proper compensation. That is a simple fact.

That’s why I became convinced a hybrid concierge program is the solution to this problem. I launched my limited-membership program several years ago. Now, I  maintain my traditional practice, seeing all patients. No patients are dismissed or relocated. Yet, those patients who want more time and attention can have it by joining my concierge program. They get the support they want or feel they need, and I am properly compensated for providing that level of service and personalized, timely attention.

Do I wish I could provide extra time and attention to all my patients? Of course! But every health care provider today, or even any patient who’s ever had to wait in a waiting room or anticipated a call back from their doctor, knows that’s impossible. We have a physician shortage and an aging population. The need is great, and COVID-19 only highlighted that need. There are just so many hours in the day. And, let’s face it, with reimbursements constantly declining, I could be forced to shutter my practice altogether. Doctors like me, who are the “quarterback of care,” need options to remain stable and independent, seeing all patients—traditional and concierge. Rich or poor. Chronically ill or young and healthy. We want to remain in service to all.

So, when I have a patient who keeps contacting me for non-urgent matters and expects immediate responses, I suggest they join my concierge program. The mere suggestion either gets them to sign up or forces them to come to terms with the level of service they can and should expect.

“Sign up or wait” may sound cruel, but it’s not. After all, it’s not so much physician response rates that have changed. It’s often patient expectations. Prior to a portal, traditional patients had no way of emailing their physician for non-urgent matters. They had to call during office hours and have their questions triaged by the front desk staff. The doctor would then return calls based on priority and need. Chatting with a patient about a news article would have always been at the bottom of the callback list. Concierge medicine has nothing to do with that.

If you’re a physician who finds themselves in the same shoes, struggling with high demand for your time, or with patients who are increasingly annoyed by wait times for appointments or callbacks, I strongly encourage you to channel your frustration into meaningful change for your practice and your patients. Offering patients the option to secure the support and service they want without having to upend their entire practice is a good place to start. It’s a low-risk and—done properly—a no-cost solution. Your patients get more of you, and you get the financial buffer your practice needs. And who knows, with some free time, you might even enjoy discussing those news articles!

Anand P. Lothe is an internal medicine physician.