Spending 45 minutes with a doctor is a different clinical act from a 15-minute visit. In the standard visit, there is time to address the presenting complaint, refill the prescriptions and glance at last year's labs. In 45 minutes, there is time to read the full biomarker panel line by line, connect a thyroid number to a sleep complaint, adjust a protocol against four quarters of data and answer the questions the patient was too hurried to ask last time.
We built our practice around that second kind of visit and we want to be transparent about why it exists and what it costs, because most patients have never experienced it and therefore cannot be expected to know what they are comparing.
- The median primary care visit in the United States runs roughly 18 minutes, which is enough time for one complaint and a refill.
- Time changes what gets found: a clinician with 45 minutes reads the whole panel and the trend, not just the flag.
- Our membership is a flat $299 per month, two-month $598 start, cancel anytime after and it covers the doctor plus the quarterly Biomarker Audit.
- Medication is billed separately by the pharmacy at cost with zero markup, so the clinical conversation carries no prescription pressure.
What the standard 18 minutes cannot do
The 18-minute visit is not a character flaw of primary care doctors. It is the arithmetic of a fee-for-service schedule, where a practice must see a certain volume to survive. Given 18 minutes, a physician does the rational thing: they treat the loudest symptom, order the minimum panel and defer everything else.
The consequence is a specific pattern we see in nearly every patient who joins us. Labs that were drawn but never discussed in context. A thyroid value called normal that sat at the edge of the range for three consecutive years. A blood pressure trend that was never treated as a trend. None of this required bad medicine. It required more minutes than the schedule allowed.
What happens in our 45 minutes
A first visit in our practice runs about 45 minutes and a quarterly follow-up runs longer than the national average because the Biomarker Audit has to be read with you, not emailed to you. Here is the shape of it.
| Segment | What happens |
|---|---|
| History and systems review | The full picture, not the presenting complaint only |
| Biomarker Audit walkthrough | ApoB, Lp(a), hs-CRP, HbA1c, lipids, insulin markers, hormones and thyroid, read line by line against last quarter |
| Protocol adjustment | Medication, nutrition, training and sleep inputs adjusted against the data |
| Your questions | The ones that never fit into 18 minutes |
The walkthrough is the part patients tell us they did not know they were missing. A lab result emailed with a normal flag is information. The same result read against the previous three quarters, connected to a symptom and turned into a specific adjustment is clinical care.
Why the time is connected to the money
Fee-for-service pays per encounter, so minutes are the cost the practice is fighting. Our model pays differently. The Cardiometabolic Optimization Membership is a flat $299 per month, two-month commitment to start at $598, cancel anytime after. The fee covers the clinical relationship and the quarterly Biomarker Audit. Medication is billed directly by the pharmacy at cost with zero markup.
That structure removes the two pressures that squeeze the standard visit. There is no volume quota, because the membership carries the practice rather than the encounter count. And there is no prescription pressure, because the medicine never touches our margin. One flat fee for the doctor, zero markup on the medicine.
A real objection, named plainly: 'I can get a 30-minute concierge visit for a $3,000 annual fee elsewhere, why is this $299 a month?' Traditional concierge practices charge $2,500 to $5,000 or more per year for access and longer visits, commonly reported and most still bill insurance on top. We charge $3,588 for the first year and do not bill insurance at all. The difference is scope: we are a cardiometabolic practice, not a general-practice concierge clinic, so the membership buys depth in one system rather than breadth everywhere.
Who this is for
This model fits the patient who has outgrown the annual physical. You want clinical depth beyond normal range, you want the same physician reading your panel every 90 days and you want a clinician who will connect the hormonal panel to the metabolic one because in the body they are one system. If you have ever left a doctor's office with your questions unasked, the visit length was the reason and it is fixable.
A lab result with a normal flag is information. The same result read against three prior quarters and turned into a specific adjustment is clinical care.
Frequently asked questions
How long is a typical primary care visit in the US?
Most run about 18 minutes and a meaningful share of that goes to documentation in the chart rather than conversation with the patient. Appointment length varies by practice model, with concierge and direct primary care practices typically running 30 to 60 minutes because their economics do not depend on visit volume.
What actually happens in a 45-minute visit that does not happen in 20?
The clinician can read the complete biomarker panel against prior quarters, examine systems that were deferred, adjust the protocol across medication, nutrition, training and sleep and answer the questions that did not fit. The clinical difference is not longer small talk. It is the trend data and the connections between systems that only surface when there is time to look.
Does longer mean more expensive?
Per visit, no. Our flat $299 monthly membership includes the visits and the quarterly Biomarker Audit. Traditional concierge practices commonly charge $2,500 to $5,000 or more per year for similar access and most bill insurance separately on top. We do not bill insurance at all and medication is billed by the pharmacy at cost with zero markup.
Is this concierge medicine?
It is closer to direct primary care. Concierge practices typically charge a large membership fee and continue billing insurance for visits. Direct primary care charges one flat fee and does not bill insurance. Our practice is a DPC model scoped to cardiometabolic optimization, medical weight loss and hormone optimization rather than a general-practice clinic.
How often do I actually see the doctor?
At minimum once per quarter, when the Biomarker Audit is read with you. Between those visits, care is available asynchronously and the membership includes direct messaging with the clinical team. The quarterly cadence is a floor, not a ceiling, because some protocols need closer follow-up during titration.
Do you take insurance?
No. We are a cash-pay, membership-based practice and we do not bill insurance. The membership fee is HSA-compatible under the 2026 rules for direct primary care arrangements and prescriptions from the practice are generally reimbursable from an HSA as qualified medical expenses. We recommend confirming the details with your HSA administrator.
What if I need a specialist?
Then we refer, coordinate and stay involved. The membership covers the clinical relationship, not specialist care and a good primary care relationship is what makes specialist referrals targeted instead of shotgun. We help you choose the right specialist, send the labs that matter and follow the results back into your protocol.
Related guides
- Cardiometabolic Optimization: the definitive guide
- What a Biomarker Audit includes
- Direct primary care for cardiometabolic care
- Your HSA can pay for direct primary care starting in 2026
External reference: peer-reviewed work on primary care visit length in the United States documents the short-visit pattern described above.
References
- Direct Primary Care: Practice Distribution and Cost Across the Nation (J Am Board Fam Med). 2015. pubmed.ncbi.nlm.nih.gov/26546651/