Issue link: https://nebusinessmedia.uberflip.com/i/1547130
18 HARTFORDBUSINESS.COM | OCTOBER 19, 2026 Dr. Tiago Miguel (right) is the first physician at Private Medical's new Greenwich office, where adult memberships start at $45,000 a year and each doctor's patient load is capped at 100. Contributed Photo By Clarissa Garza cgarza@hartfordbusiness.com A new Greenwich medical practice charges adults at least $45,000 a year and limits each doctor to 100 patients. In South Windsor, another group charges adults about $100 a month for longer visits and same-day access through texting. Both practices offer what's known as membership medicine, in which patients pay a recurring fee for care and greater access to their physician. The model has been gaining ground nationally. A study published in Health Affairs in December 2025 found that locations offering concierge medicine or direct primary care — two forms of membership medicine — grew 83.1% between 2018 and 2023 in a national sample. "We think there's a real gap in the market, if you will, in the Fairfield-West- chester area, for something along the lines of what we offer," said Sanjay Banker, CEO of San Francisco-based Private Medical, which opened the Greenwich office on Oct. 1. For doctors, membership fees provide steady revenue and allow smaller patient loads, giving them more time for care and helping reduce burnout. For patients, the draw is longer visits, easier contact between appointments and a lasting relation- ship with a physician, experts said. Those benefits come at an added cost. Membership fees do not replace health insurance for hospital care, specialists and other outside services. And with primary care doctors already in short supply, limiting how many patients each sees could make care harder to find. What they offer Membership practices vary in what their fees cover and whether they bill insurance, according to the American Academy of Family Physi- cians. Concierge practices charge for enhanced access and services and may also bill insurance for medical care. Direct primary care practices cover routine primary care through member- ship fees without billing insurance. Private Medical, which describes its service as concierge medicine, operates a 3,000-square-foot Green- wich office, its first in Connecticut and seventh nationwide. The company also has a location in Midtown Manhattan. The practice caters to affluent patients, offering annual health assessments, ongoing primary and preventive care, coordination of outside care and support while trav- eling, according to the company. Private Medical does not bill insurance; outside services such as lab testing and specialist care are billed separately. Banker said the company already has members from Fairfield and Westchester counties who travel into Manhattan for care, which was the impetus for opening the Greenwich office. He said he expects most Greenwich members to be new to the company rather than transfers from Manhattan. The office opened with one physi- cian, Dr. Tiago Miguel, and has room for up to four doctors. An on-site clinical and operational team supports the practice, which also draws on the company's network of more than 4,000 physicians and specialists worldwide. Across seven offices, the company has "barely more than 2,000 members," Banker said, and annual renewal rates exceed 90%. In South Windsor, Dr. Vasanth Kainkaryam runs 4 Elements Direct Primary Care & Wellness Space, where adults pay about $95 to $115 a month in membership fees. Some large employers cover the fee for their employees, Kainkaryam said. He has about 450 patients, while his partner, Dr. Diana Rodriguez, has about 270. The practice covers routine primary Membership Medicine CT practices offer more time with doctors — for a fee care through monthly fees without billing insurance, which allows Kain- karyam to serve patients with or without coverage, he said. Patients get same-day texting and longer visits. Like Private Medical, Kainkaryam said his practice holds on to its members. Few patients leave, he said, and those who do usually cite a job loss or a move. Even then, some patients who relocate stay on through telemedicine; Kainkaryam said he holds over 20 state medical licenses. Why it's growing The number of clinicians working in membership practices grew 78.4% between 2018 and 2023, according to the Health Affairs study. John Brannelly, executive director of the Fairfield County Medical Association, which has more than 800 physician members, said the appeal for doctors is a smaller patient load. A physician in a traditional primary care practice typically cares for between 1,000 and 2,000 patients, he said. "Physician burnout is a real thing," Brannelly said, particularly since the pandemic. The association held a seminar on membership models last year that drew about two dozen physicians, he said, though members aren't "clam- oring" for it. Membership fees vary widely. At the low end, Brannelly pointed to Amazon's One Medical, which offers memberships to Prime subscribers for $99 a year. Scheduled office and video visits are billed separately to One Medical patients or their insurers. Brannelly said his in-laws paid $3,000 to $4,000 a year for a concierge program at an otherwise traditional practice, which afforded them house calls and their doctor's cell phone number. For patients, Kainkaryam said, the draw is keeping the same doctor. He said new patients often tell him about a physician who retired or left, followed by a string of replacements. "I think membership medicine guarantees that they've got the same doctor and they know them," he said. "So they're paying extra for the consistency, for the access, for that relationship that the traditional models don't afford you." Access concerns Smaller patient loads can have consequences for people outside membership practices, experts said. When a doctor switches to member- ship care and takes fewer patients, those who cannot stay must find another physician. "They have to be absorbed somewhere, and so that is one of the concerns of the movement to concierge," said Brannelly, who noted there is already a primary care physician shortage in Connecticut and nationally. Cost also limits who can participate. Although Fairfield County is wealthier than the rest of the state, its popu- lation is "incredibly diverse," Bran- nelly said, calling a $45,000 annual membership "absolutely one extreme" in terms of pricing. "Concierge handles one portion of the patient population, you know, but not the total population," he said. Banker said Private Medical is small by design. Even if the company exceeds its "wildest growth expec- tations," he said, it serves "a very focused, concentrated number of people." Kainkaryam said high-priced models reinforce the idea that membership medicine is only for the wealthy, and he often has to explain the difference to prospective patients. Even so, he expects more Connecticut physicians to open membership practices over the next few years. "We provide concierge-like services, but really for the average person, not the wealthy," he said.