How to Start a Concierge Medical Practice: The Complete 2026 Guide

Most guides on starting a concierge medical practice are written by marketing consultants or practice management companies. They tell you to "find your niche" and "build your brand." That is fine advice, but it skips the decisions that actually determine whether your practice is profitable and tax-efficient from day one.

This guide is written from the financial and accounting side. I work with physician practices across South Florida — from solo concierge startups to multi-location radiology groups — and the structural mistakes made in the first 90 days are the ones that cost the most over the life of the practice. Wrong entity type, no payroll system, no retirement plan, no real-time accounting. These are not minor oversights. They are five- and six-figure mistakes that compound every year.

Here is how to start a concierge medical practice the right way, with the financial architecture built correctly from the beginning.

Why Concierge Medicine Is Growing

Concierge medicine is no longer a niche experiment. There are now over 12,000 concierge physicians practicing in the United States, roughly double the number from five years ago. The national market reached $7.35 billion in 2024 and is growing at over 10% annually.

MDVIP — founded in Boca Raton in 2000 — recently hit 100 consecutive quarters of growth. That is 25 years of uninterrupted expansion in a model that skeptics once dismissed as "medicine for the rich."

The growth is driven by patient demand, not physician supply. Patients are tired of 7-minute visits, 3-week wait times, and the feeling of being processed through a system optimized for insurance reimbursement rather than care. Concierge medicine offers the opposite: smaller panels, longer visits, same-day access, and a physician who actually knows your name.

South Florida sits at the epicenter of this movement. The tri-county area — Broward, Palm Beach, and Miami-Dade — has the highest concentration of concierge practices in the country. MDVIP headquarters is in Boca Raton. Baptist Health South Florida and UHealth Premier both operate concierge and executive health programs. The demographics (affluent retirees, executives, international patients) and the density of physicians exploring alternatives to insurance-based practice make this the most active concierge medicine market nationally.

If you are a physician considering the switch, you are not early. But you are not late either. The market is growing fast enough that well-structured practices launched today will reach profitability faster than those launched five years ago, simply because patient awareness and demand have matured.

Concierge vs DPC vs Hybrid: Which Model?

Before you do anything else, you need to decide which model you are building. The financial infrastructure, tax implications, and revenue projections are different for each.

Concierge charges a higher annual retainer and typically still bills insurance for covered services. This produces the highest gross revenue but retains some administrative complexity.

DPC eliminates insurance entirely. Lower per-patient revenue, but dramatically lower overhead and administrative burden. The math works with a larger panel and lower fees.

Hybrid uses a retainer for enhanced access and certain services while billing insurance for standard visits and procedures. This is the most common model for physicians converting an existing insurance-based practice, because it allows a gradual transition without losing all insurance revenue overnight.

Each model has different implications for entity structure, billing systems, and tax planning. Choose your model before you choose your office space. For a deeper comparison of the financial outcomes, see our concierge vs insurance practice comparison.

Step 1: Choose Your Practice Model and Set Your Fee

Your annual membership fee is the single most important financial decision you will make. It determines your revenue ceiling, your target patient demographic, and your marketing strategy.

Fee Ranges by Market (South Florida, 2026)

The math is straightforward: panel size x annual fee = gross membership revenue. A practice with 300 patients at $5,000 per year generates $1.5 million in membership revenue before any insurance billing.

South Florida supports fees at the higher end of national ranges. The concentration of affluent retirees, executives, and international patients — particularly in communities like Weston, Parkland, Coral Gables, and Palm Beach — means patients are accustomed to paying for premium services. Physicians in these markets commonly charge $5,000 to $10,000 annually.

Do not underprice. A fee that is too low attracts patients who are price-sensitive and creates a practice that requires a larger panel to be viable, which defeats the purpose of concierge medicine. For a full income analysis by market and model, see our concierge medicine income guide.

Step 2: Form Your Entity and Make the Right Tax Election

This is where most physicians make their most expensive mistake — and where the right guidance pays for itself many times over.

The Standard Structure: PLLC + S-Corp Election

For the majority of solo and small-group concierge practices in Florida, the optimal structure is:

1. Form a Florida PLLC (Professional Limited Liability Company). This is the required entity type for physician-owned practices in Florida. Filing cost is under $200 through Florida Sunbiz.

2. Elect S-Corporation tax treatment by filing IRS Form 2553. This election allows you to split income between a reasonable salary (subject to FICA/Medicare taxes) and distributions (not subject to self-employment tax).

3. Set up payroll from day one. The S-Corp election only saves money if you are actually running payroll and paying yourself a W-2 salary.

The Cost of Getting This Wrong

A concierge physician earning $500,000 in net income without an S-Corp election pays approximately $25,000 to $35,000 more per year in self-employment taxes than one with the proper structure. Over a 10-year career, that is $250,000 to $350,000 in unnecessary taxes.

The Form 2553 has a filing deadline — generally within 75 days of forming the entity or by March 15 for the current tax year. Miss it and you either wait until next year or file for late election relief, which is not guaranteed.

For a complete walkthrough of the S-Corp election process, timing, and reasonable compensation rules, read our S-Corp election guide.

Other Entity Considerations

• Multi-physician practices may benefit from a partnership structure (two PLLCs forming a partnership) depending on ownership and profit-sharing arrangements.
• Real estate ownership should be in a separate LLC, never inside the medical practice entity. If you are buying your office space, form a separate entity to hold the property and lease it to your practice.
• Malpractice and asset protection — Florida's LLC protections are strong, but your operating agreement needs to be properly drafted. This is not a DIY document.

Step 3: Build Your Financial Infrastructure

This is where Benefique lives. The financial infrastructure you build in the first 30 days determines whether you have real-time visibility into your practice's health or whether you are flying blind until tax season.

Accounting System

Set up QuickBooks Online (QBO) from day one — before you see your first patient, before you sign your lease. Your chart of accounts should be configured for a medical practice, not the generic QBO template. Key accounts include:

• Revenue: Membership fees, insurance reimbursements (if hybrid), ancillary services
• Cost of revenue: Medical supplies, lab costs, medication costs
• Operating expenses: Rent, payroll, technology, insurance, marketing
• Owner compensation: Salary (W-2), distributions, retirement contributions

Payroll

If you elected S-Corp status, payroll is not optional. You need a payroll provider (ADP, Gusto, or similar) processing at minimum monthly, ideally semi-monthly. Your salary must be "reasonable compensation" — meaning comparable to what you would earn as an employed physician in a similar role. For a concierge physician, $175,000 to $250,000 is typically defensible depending on specialty, location, and hours.

Business Banking

Open a dedicated business checking account and a business savings account (for tax reserves). Never commingle personal and business funds. In South Florida, we see physicians use CenterState (now ConnectOne), Centennial Bank, or national banks with strong business banking platforms.

Set aside 25-30% of net income for quarterly estimated taxes from the start. The number one cash flow crisis we see in new practices is a surprise tax bill in April because the physician treated all revenue as take-home pay.

Retirement Plan

This is one of the most powerful tax tools available to a new concierge practice, and most physicians do not set it up until year two or three — leaving tens of thousands of dollars in tax savings on the table.

A Solo 401(k) allows you to contribute up to $23,500 as an employee (2026 limit) plus up to 25% of your W-2 salary as an employer contribution. For a physician paying themselves $200,000 in W-2 salary, that is $23,500 + $50,000 = $73,500 sheltered from income tax in year one.

If you are over 50, catch-up contributions add another $7,500. If you are 60-63 in 2026, the new super catch-up adds $11,250 instead.

Set up the plan before December 31 of your first year to take advantage of these contributions. The employer contribution can be made until your tax filing deadline, but the plan itself must exist by year-end.

For more advanced wealth-building strategies including cash balance plans, real estate, and diversification, see our wealth-building guide for concierge physicians.

Step 4: Secure Your Space and Equipment

Concierge practices require significantly less space than insurance-based practices. You are seeing 8 to 12 patients per day, not 25 to 35. That means smaller space, lower rent, and a more comfortable patient experience.

South Florida Lease Benchmarks (2026)

A concierge practice needs 1,200 to 1,500 square feet — roughly two exam rooms, one consultation room, a reception area, and a small lab/supply area. Compare this to 3,000+ square feet for a traditional insurance practice seeing three times the patient volume.

Equipment Minimums

Budget $15,000 to $40,000 for initial medical equipment. Essentials include exam tables, diagnostic instruments (ophthalmoscope, otoscope, blood pressure monitors), a point-of-care lab system (optional but increasingly expected by concierge patients), and an EKG machine.

Do not overbuild. You can add equipment as your panel grows. The point-of-care lab, for example, can wait until you have 150+ patients to justify the supply costs.

For a complete cost breakdown including buildout, equipment, and first-year operating expenses, see our startup cost guide.

Step 5: Set Up Technology

Concierge practices spend far less on technology than insurance-based practices because they eliminate the billing and coding infrastructure that consumes 10-15% of revenue in traditional models.

Core Technology Stack

Compare this to an insurance-based practice spending $3,000 to $8,000 per month on billing software, clearinghouse fees, coding tools, denial management, and collections services. The technology savings alone can be $30,000 to $80,000 per year.

Choose an EHR designed for concierge or DPC practices. Systems like Elation and Atlas.md are built for longer visits, direct patient communication, and membership management. Do not try to retrofit an insurance-practice EHR — it will frustrate you and your patients.

Step 6: Staff Your Practice

One of the biggest financial advantages of concierge medicine is the lean staffing model. With 8 to 12 patients per day instead of 25 to 35, you need far fewer people.

Three Staffing Models

Model 1: Solo + Medical Assistant (lowest cost)

• One medical assistant handles vitals, labs, phone calls, and basic admin
• Physician handles patient communication, scheduling decisions
• Total staffing cost: $42,000 - $55,000/year (including payroll taxes)
• Best for: Practices under 200 patients

Model 2: MA + Part-Time Admin (most common at launch)

• Medical assistant handles clinical support
• Part-time administrator (20-25 hours) handles scheduling, billing, patient onboarding
• Total staffing cost: $60,000 - $80,000/year
• Best for: Practices at 200-350 patients

Model 3: MA + Full-Time Admin (mature practice)

• Full clinical and administrative support
• Total staffing cost: $80,000 - $110,000/year
• Best for: Practices over 350 patients or premium ($7,500+) fee models

South Florida Salary Benchmarks (2026)

Add 15-20% to base salary for employer payroll taxes (FICA, FUTA, SUTA), workers' comp, and any benefits you offer. A medical assistant earning $42,000 costs the practice approximately $48,000 to $50,000 fully loaded.

Step 7: Build Your Patient Panel

A concierge practice without patients is just an expensive office. Your panel-building strategy determines how quickly you reach profitability.

Two Launch Scenarios

Converting an existing panel: If you are transitioning from an insurance-based practice, you will typically retain 10-20% of your current patients as paying concierge members. A panel of 2,000 insurance patients might yield 200-400 concierge members. This is the fastest path to profitability because these patients already know and trust you.

Cold start (new practice): Building from zero is harder and slower. Budget 6-12 months to reach 150-200 patients. Marketing spend will be higher ($2,000 to $5,000/month in the first year), and you need operating capital to cover the ramp-up period.

The Corporate/Employer Play

This is the most underutilized growth strategy in concierge medicine. Companies are increasingly offering concierge medical access as an executive benefit. Amazon acquired One Medical. Crossover Health serves Fortune 500 companies. MDVIP has a formal employer program.

One corporate contract covering 20 executives at $5,000 per year generates $100,000 in annual revenue with essentially zero patient acquisition cost. The company pays, the executives show up, and you have a predictable revenue block that does not depend on individual patient marketing.

Target South Florida companies with 50+ employees, law firms, private equity firms, and family offices. Position concierge membership as a retention and productivity tool — their executives get same-day access, comprehensive annual physicals, and a physician who coordinates all their care.

Other Panel-Building Strategies

• Physician referral network: Specialists are excellent referral sources. They want their patients to have a responsive primary care physician.
• Real estate and wealth management partnerships: Financial advisors, estate attorneys, and luxury real estate agents serve the same demographic. Cross-referral relationships are natural.
• Community events: Health screenings, wellness talks at country clubs and HOAs, executive health presentations at corporate offices.
• Digital presence: Google Business Profile optimized for "[city] concierge doctor," targeted content marketing, patient testimonials.

Step 8: Launch and Monitor

The first 90 days are critical. You are simultaneously building your patient panel, dialing in operations, and establishing financial rhythms.

First 90 Days Financial Checklist

• Entity formed, EIN obtained, S-Corp election filed
• Business bank accounts open, credit card processing active
• QBO configured with proper chart of accounts
• Payroll provider set up, first payroll processed
• Retirement plan established (Solo 401(k) or SEP)
• Malpractice and business insurance policies active
• Quarterly estimated tax payments scheduled
• Monthly financial review process established
• Membership billing system tested and processing

KPIs to Track Monthly

If your membership growth rate is below 10 new patients per month after the first 90 days, something is wrong — either your marketing, your fee structure, or your market positioning. Diagnose it early.

The 12-Month Financial Timeline

Knowing what to expect financially reduces anxiety and helps you make better decisions. Here is what a typical solo concierge practice in South Florida looks like month by month.

Months 1-3: Investment Phase

• Revenue: $15,000 - $50,000/month (50-150 patients onboarding)
• Expenses: $25,000 - $40,000/month (rent, staff, technology, marketing)
• Cash flow: Negative. You are spending more than you are earning.
• Focus: Patient acquisition, operational systems, financial infrastructure
• Key risk: Undercapitalization. You should have 6 months of operating expenses in reserve.

Months 4-6: Building Phase

• Revenue: $40,000 - $80,000/month (150-250 patients)
• Expenses: $25,000 - $40,000/month (stabilizing)
• Cash flow: Approaching breakeven or slightly positive
• Focus: Refining operations, patient experience, beginning to reduce marketing spend
• Key milestone: Covering monthly operating expenses from membership revenue

Months 7-12: Acceleration Phase

• Revenue: $60,000 - $125,000/month (200-350 patients)
• Expenses: $30,000 - $45,000/month (may add staff as panel grows)
• Cash flow: Positive and growing
• Focus: Retention, annual renewal systems, tax planning, retirement contributions
• Key milestone: First owner distribution beyond salary, first retirement plan contribution

By month 12, a well-structured concierge practice in South Florida should be generating $750,000 to $1.5 million in annualized revenue with an overhead ratio of 35-45%. That translates to physician take-home compensation (salary + distributions + retirement) of $400,000 to $900,000 depending on fee level and panel size.

For detailed income projections by model and market, see our income potential guide.

Common Mistakes That Cost Physicians the Most

After working with physician practices at every stage, these are the mistakes I see repeatedly. Each one is avoidable with proper planning.

1. Wrong entity structure. Operating as a sole proprietor or single-member LLC without S-Corp election. Cost: $15,000 to $35,000 per year in excess self-employment taxes.

2. No accounting system. Using a personal bank account or a spreadsheet instead of QBO with a proper chart of accounts. Cost: inability to make data-driven decisions, surprise tax bills, and $5,000+ in accountant fees to reconstruct records at year-end.

3. Undercapitalization. Starting with 2-3 months of reserves instead of 6. Cost: panic-driven decisions, taking on debt at unfavorable terms, or giving up on the practice before it reaches profitability.

4. No retirement plan in year one. Waiting until year two or three to establish a Solo 401(k). Cost: $20,000 to $50,000 in lost tax-sheltered savings per year of delay.

5. Treating accounting as year-end compliance. Handing a shoebox of receipts to a tax preparer in March instead of having monthly financial visibility. Cost: every bad financial decision you make because you did not have the data to make a good one.

6. No tax planning until April. Quarterly estimated tax payments, retirement contributions, reasonable compensation analysis, and entity optimization should happen throughout the year, not at filing time.

For a complete cost analysis including how to avoid these mistakes, see our startup cost breakdown.

Frequently Asked Questions

How do I start a concierge medical practice?

Start with the financial structure: form a Florida PLLC, file for S-Corp election (Form 2553), set up QBO and payroll, establish a retirement plan, and open business banking. Then secure your space, choose concierge-focused technology (EHR, patient portal, membership billing), hire a medical assistant, and begin building your patient panel. The entire process from entity formation to first patient can be completed in 60-90 days if you work with advisors who specialize in physician practices. The biggest mistake physicians make is focusing on the clinical setup while neglecting the financial architecture.

How much does it cost to start a concierge practice?

Total startup costs range from $75,000 to $200,000 for a solo practice in South Florida, with most practices launching in the $100,000 to $175,000 range. This includes entity formation, office buildout, equipment, technology, initial marketing, and 3-6 months of operating reserves. Physicians converting an existing practice spend significantly less because they already have space, equipment, and an established patient base. See our complete cost breakdown for detailed numbers by category.

How do I set up a concierge medical practice in Florida?

Florida requires physicians to form a PLLC (Professional Limited Liability Company) for medical practice ownership. File through Florida Sunbiz, then elect S-Corp tax treatment with IRS Form 2553. Set up your financial infrastructure (QBO, payroll, retirement plan, business banking), secure medical office space, implement a concierge-focused EHR system, and begin patient enrollment. Florida has no state income tax, which makes the S-Corp reasonable compensation planning even more impactful for federal tax savings.

What are the requirements for a concierge medical practice?

The core requirements are: a valid Florida medical license, DEA registration, a properly formed PLLC with malpractice and business insurance, and compliance with the Florida Patient's Bill of Rights regarding fee disclosure. There is no special "concierge license." You also need a compliant patient membership agreement that clearly discloses what the retainer covers, what it does not, and the patient's right to cancel. From the financial side, you need an accounting system, payroll (if S-Corp), business insurance, and a documented billing process for membership fees.

How long does it take to build a concierge patient panel?

Physicians converting an existing insurance practice typically retain 10-20% of their panel as concierge members, reaching 200+ patients within 3-6 months. Cold starts (new practices) take longer — plan for 6-12 months to reach 200 patients. Corporate and employer contracts can accelerate this significantly. Most practices reach financial breakeven at 150-200 patients (depending on fee level), which takes 4-8 months for conversions and 8-14 months for cold starts.

Is starting a concierge practice worth it financially?

For most physicians, yes. A mature concierge practice in South Florida generates $750,000 to $2 million+ in annual revenue with overhead ratios of 35-45%, resulting in physician take-home compensation of $400,000 to $900,000+. Compare this to the average employed primary care physician salary of $260,000 to $300,000 or an insurance-based practice netting $200,000 to $400,000 after overhead. The financial advantage grows over time as your panel stabilizes and your overhead ratio drops. See our income potential analysis and financial comparison guide for detailed projections.

Related Articles

• The Real Cost of Starting a Concierge Medical Practice — Detailed startup and operating cost breakdown
• How Much Does a Concierge Medical Practice Make in South Florida? — Income projections by model and market
• Concierge Medicine vs Insurance Practice: Financial Comparison — Side-by-side financial analysis
• Tax Strategies for Concierge Physicians — Tax optimization specific to concierge practices
• How Concierge Physicians Build Wealth Beyond the Practice — Retirement plans, real estate, diversification
• Are Concierge Medical Fees Tax Deductible? — Patient-side tax deductibility guide
• S-Corp Election Guide for Medical Practices — Complete S-Corp walkthrough

Benefique Tax & Accounting provides full-service accounting, tax, and CFO advisory for physician practices across South Florida. If you are planning a concierge practice launch and want the financial structure built correctly from day one, contact us for a consultation.