Two levers shape a membership practice more than any others: how many members you serve and what each one pays. They look independent, but they pull on each other constantly, and the combination that looks best on paper is not always the one that works best in the exam room or in the bank account. Running the numbers is the only way to know.
Consider two hypothetical versions of a practice. These are illustrations only, and in a network arrangement the fee and panel size may be shaped by your affiliation agreement, so treat this as a thinking tool rather than a recommendation.
Version A has 600 members paying $1,800 a year, for $1,080,000 in membership revenue. Version B has 450 members paying $2,400, which also totals $1,080,000. The topline is identical.
Now look at what sits underneath. If core costs such as rent, software, insurance, and base staffing are about $480,000 in either version, then both leave the same amount before additional costs. But the other pieces differ. Version A has more members to serve, which generally means more messages, more follow up, and more administrative work, which may require additional staff time. Version B has fewer members, so each one receives more attention, but a higher fee may also bring higher expectations and a greater risk that a few departures noticeably affect revenue.
Raising the fee increases revenue per member without adding workload, but it can affect retention and how members perceive value. Adding members raises revenue in direct proportion, but each one adds work, and eventually the service you promise gets harder to deliver. Lowering panel size does the opposite: it protects service, but every departure leaves a larger hole.
The question is not which version has the bigger number. It is which one gives you the best result after costs, with a retention risk and workload you can live with.
Start with revenue per member, cost per member, and what is left per member after direct costs. We describe how to estimate the cost side in a later post. Then track retention: how many members renew, and how many leave and why. A fee increase that loses a handful of members may still be positive, but only if you have done the math.
Also check your capacity. How many messages, calls, and same-day requests does the team handle in an average week? Are there weeks where service strains? That tells you whether adding members is realistic.
Remember that revenue is earned over time. As we explain in membership fees and deferred revenue, a fee paid at the start of the year is recognized across the months of service, so any change in pricing affects your income gradually rather than all at once. And keep in mind the assumptions we challenge in four myths about concierge practice profitability.
A simple best, base, and worst case model is a good way to see how sensitive the practice is. Base it on your actual retention and costs, then ask what happens if ten members leave, or if you raise the fee by 5 percent and lose five, or if costs rise by 8 percent. Seeing the range tends to make decisions clearer, and it is much better than finding out the hard way.
Fee and panel size are connected levers, and the best combination depends on your costs, your capacity, and your retention. Compare complete scenarios instead of single numbers, measure per-member economics, watch retention closely, and test changes on paper before making them real.
911 Bookkeepers works with cash-pay and membership-based medical practices across the Baton Rouge metro and surrounding parishes, modeling scenarios so physicians can see the numbers before they make the call.
MDVIP is a trademark of its respective owner. 911 Bookkeepers is an independent bookkeeping firm and is not affiliated with or endorsed by MDVIP. Nothing here is legal, tax, or compliance advice; confirm specifics with your own CPA, attorney, and affiliation agreement.
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