Martin C. Schulman, M.D.
Encinitas Personal Healthcare, Inc.



Why is there a practice membership fee?


Without this I’d need to charge much more for office visits or have many more patients

(and therefore not be able to provide the same level of responsive and personal service)


This fee includes services that are not typically covered by health plans and for which

some medical practices charge itemized fees.  This includes telephone and email

consultations, medication refills, and completion of medical forms.


Having a practice membership fee allows me to know exactly how many patients I have at

any time so that I can keep my practice to no more than 500 patients


Why are some concierge medical practices charging much higher annual fees?


Some of these practices include all visits with the physician, so they have to include the

potential costs of multiple visits per year for each patient even if they might not be



Some include an “executive physical” and possibly also multiple tests in the annual fee (see

related questions below). 


Some of these concierge physicians will accompany their patients to specialist visits or go

to a patient’s workplace to provide care, and this requires having a much more limited

number of patients so that a higher annual fee is required to make it financially viable

I will not do either of these things but will be very involved in discussing a patient’s care

with any specialist that may be involved.

Why is your medical practice cash only?

This allows me to get out from all insurance contracts, which have steadily forced lower

and lower reimbursements on physicians resulting in a need to increase patient volume in

order to maintain a certain income.


This allows me to get reimbursed the same by each patient so there is no need to charge a

higher per-service fee that allows for cash-paying patients to subsidize those patients

whose insurance plans pay much less than what is charged.


In summary, it means that I work for my patients instead of the insurance companies


Does “cash only” mean you don’t accept checks or credit cards?


Certainly not!  Checks and credit cards are welcome.  In fact, the practice membership

fee is typically paid in quarterly installments by either an automatic charge to a patient’s

credit card account.


Many Health Savings Accounts (HSAs) provide a debit card for payment of medical

expenses directly from a patient’s account.

Is my practice membership fee refundable?

Yes.  A patient can resign from my medical practice at any time and the fee for any

unused months will be refunded.


Is my practice membership fee reimbursable by my health insurance?



Are my office visit fees reimbursable by health insurance or HSA?


These fees are reimbursable by HSAs.

These fees are reimbursable at the non-preferred provider rate by fee-for-service


These fees are not reimbursable by capitated managed care health plans (HMOs).

These fees are not reimbursable by Medicare.


Why are none of the office fees reimbursed by Medicare?

I have chosen to opt out of Medicare.  Opting in to Medicare would require that I accept

the low Medicare rates and require that I bill Medicare for my services, which in turn

would raise my overhead and result in higher fees for my other patients.  Unfortunately,

opting out of Medicare means that my patients are not allowed to submit a bill to

Medicare for reimbursement of expenses paid to me (this is a federal government



Can I see you if I am covered by Medi-Cal?

No.  I am not contracted with Medi-Cal and physicians cannot collect cash payments from

Medi-Cal patients, even for services not covered by Medi-Cal.


Why doesn’t the practice membership fee cover an “annual physical exam” like some

concierge medicine practices?


Not everyone needs a physical exam or large panel of tests each year, so why have my

patient pay for something that might not be needed?  I follow published guidelines to

recommend what examination and tests, if any, are indicated each year, and together my

patients and I determine what tests are ordered


Carving out the physical exam allows for a patient’s payment for this to be reimbursed by

the patient’s health insurance company (HMOs and Medicare are the exception) as

practice membership fees (a.k.a. retainer fees) are typically not reimbursed by health

insurance companies.


Some concierge practices also include multiple tests such as screening blood tests,

electrocardiograms, stress tests, chest x-rays, and breathing tests as part of the

annual fee...why won’t you do that?


Some of these tests are not on the list of recommended screening tests put out by

various organizations, and others that are indicated certainly don’t need to be done

annually.  As noted above I choose to instead follow published guidelines for preventive

medicine care and therefore only recommend screening tests that are medically-indicated

according to these guidelines.


Also, in most cases you can get your tests done by a contracted lab, radiologist, or

specialist and have the charges for these services paid directly by your insurance

company or HSA. 


Why doesn’t the practice membership fee cover office visits?

For the same basic reasons as noted above for annual physical exam:


  • Why have a patient pay for more care than might be needed
  • Office visit fees are reimbursable by the right type of health insurance, whereas the practice membership fee is not, so these need to be separate items.


If I call or email for an appointment, do I have to describe all my symptoms in

order to schedule an appointment? In other words, do I have to prove that I am

sick in order to get a same-day or next-day appointment?


Absolutely not!  Just let me know that you want to come in and I’ll get you scheduled (and

I’ll see you on time!). 

This policy includes routine follow-up appointments in addition to acute illness



Do I still need health insurance if I’m paying you directly for your services?


I am happy to see patients who have no insurance (unfortunately there are too many in our

society in this situation), but if at all possible you should have insurance, even if it’s just

high-deductible insurance for potential medical catastrophe. 


Your insurance may reimburse you at least a portion of what you pay me (see below).


Insurance is needed to help with the cost of tests, specialist care, hospital care, etc.


If you have medical insurance and join my practice you may decide to switch from an

HMO plan or  a low-deductible PPO plan to a high-deductible PPO plan and use the savings

in insurance premium to help pay for the practice membership fee.  A high-deductible

insurance plan is truly for catastrophic healthcare, as insurance was originally meant to

be.  Compare this to automobile insurance, which you similarly hope to never need for the

car for which you pay separately as needed for routine servicing (equivalent to a

preventive care visit) and for mechanical problems (equivalent to an office visit for an

acute illness).   By not paying an HMO to manage your healthcare dollars you instead get

to decide how you want to spend (or NOT spend) your healthcare dollars.


Do you make house calls?

Yes, when medically indicated


Are you affiliated with any hospitals?


I have medical staff privileges at UCSD Thornton Hospital in La Jolla and UCSD Medical Center in Hillcrest.


I have medical staff privileges at Scripps Memorial Hospital in Encinitas.


This allows me to have online access to my patients' medical records at these hospitals.


Will you take care of me in the hospital?


My patients will be much better served by having the excellent hospitalists at the

above-noted hospitals manage their in-patient care.

(I guess that makes me an “officist”) 

I will be in frequent contact with these hospitalists so that I can have input as a member

of a patient’s healthcare team, and I will visit patients in the hospital as needed.


Are you really available 24/7 to your patients?

Yes, I am on-call for myself daily and will arrange coverage by a colleague only in very

limited circumstances such as illness or travel out of cell phone contact.


Aren’t you afraid that you’ll burn out by being on-call every day?


No!  There are several reasons for this…


  • The practice has a limited number of patients
  • Patients will know that they can easily reach me the next morning, so that may eliminate the need to call at night
  • Since opening my practice I’ve been awakened by a patient phone call only a few times


§ My medical practice is based on mutual trust and respect. 

  • I trust that my patients will know when to call 911 or to call me for a less urgent after-hours problem that can’t wait until the next morning, and if that’s the case I want my patients to feel comfortable calling me after hours. 
  • For those things that can wait my patients generally respect my time when I let them know by email that I will be at an event (for example, my weekly softball game or a child’s performance) and hold off on calling me until after the conclusion of the event. 
  • In return I strive to respect my patients by providing responsive and on-time service and earn their trust by providing the best possible medical care.


How can I learn more about this new style of medical practice?  takes you to the home page for the American Academy of Private

Physicians. I attended the second annual meeting of this organization in Dallas in May of

2005, and my heart was warmed by the universal message from the physicians who spoke

at the meeting: not only were they much happier, but their patients were also much more

satisfied and happy with the care that they receive. The good vibes continued when I

attended the fifth annual meeting in May of 2008.  The home page contains the

organization’s mission statement and tabs to information specifically aimed at

patients. The “find a physician” link takes you to a list of physicians across the country

that are using some sort of innovative medical practice design. Many of the physicians

listed have links to their websites, which will allow you to see details of various practice

models as well as the wide range of fees associated with these practices. Many of these

sites note desires similar to mine of wanting to return to the “good old days” of practicing

medicine before insurance companies got involved and changed things. Some invoke the

name of Marcus Welby, M.D., even though he was a fictitious character.

You can also find my practice as well as other “ideal medical practices” (IMPs; see on the IMP map at

Where can I read more about your medical practice?

In May, 2011 the San Diego Union-Tribune included me in a story about concierge medica

l practices.  You can read it at

In February, 2007 the local ABC affiliate 10News included me in a story about concierge

medical practices. You can view the story and read the transcript at

In February, 2006 the local CBS affiliate News8 included me in a story about concierge

medical practices. You can view the story and read the transcript at

The October, 2005 issue of San Diego Magazine had an article about concierge medicine

that discussed my medical practice. You can read it at

Can I meet you before deciding to join your medical practice?

Yes! You are most welcome to come in for a complimentary “meet the doctor” visit before

deciding that you want to join my medical practice.

How should I notify you of my interest in your medical practice?

You can call my office at 760-436-7464.

You can send an email to me at .

  • This email is not secure so please do not include anything in the email except name and contact information (do NOT include any medical information, credit card numbers, etc)

What other names did you consider for your medical practice?

These were considered VERY briefly:

  • “All Marty All The Time Family Medicine”

  • “Doc Around The Clock Family Medicine" (sing it Bill Haley: “one, two, three o’clock, four o’clock doc…”)

  • “All-In-The Family Medicine” (thank you Norman Lear)

  • “We-Are Family Medicine" (with regards to Sister Sledge)


Who should not sign up for my medical practice?

Someone who needs a physician who wears a tie…

  • Ties are uncomfortable
  • You don’t need me to wear one to know that I’m the physician

Someone who needs a physician who wears a white coat...

  • See above re: ties
  • I don’t need the extra pockets!

Someone who dislikes puns… sorry, I can’t help it.

Someone who is uncomfortable with paying a practice membership fee. 

  • If this is you please think about what you pay for cable or satellite television service, automobile club membership, shopping club membership such as Costco, or gym membership regardless of how much or how little you actually use these things
  • If you're still concerned about this, please call me and I'll be happy to discuss this with you
  • I waive the practice membership fee for the first quarter for new patients so you can try out the practice for just the cost of the office visit





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