Earlier than Dr. Walter Walthall switched to training at a membership-based medical clinic, he apprehensive he may burn out “in a wonderful blaze.”
The longtime San Antonio household medication physician just lately opened his personal membership-based clinic, a part of a rising care mannequin that costs sufferers a month-to-month or annual price and infrequently reduces reliance on insurance coverage billing.
Clinics working below the mannequin typically promote same- or next-day appointments, longer visits with physicians and an elevated emphasis on preventive care and wellness.
Although a small share of the general well being care system, these fashions are rising shortly. From 2018 to 2023, the variety of direct main care and concierge practices grew by 83%, and the variety of clinicians taking part in them elevated by 78%, in accordance with a 2025 research revealed in Well being Affairs.
In San Antonio, numerous membership-based clinics have opened over the previous twenty years. Some function independently, whereas others companion with nationwide corporations that present administrative and enterprise help.
Walthall practices below MDVIP, a nationwide community of greater than 1,400 physicians in 46 states and Washington, D.C. The corporate offers advertising, expertise and administrative help whereas physicians preserve possession of their practices.
With Walthall opening his observe in December, MDVIP now has 18 physicians in San Antonio and 141 in Texas, greater than it has in another state.
Quite a lot of different membership-based clinics might be discovered throughout the realm, together with clinics like Tailor-made MD and San Antonio Direct Main Care. UT Well being San Antonio additionally has its personal concierge clinic.
Sufferers at MDVIP-affiliated practices usually pay an annual membership price along with sustaining medical health insurance protection. In San Antonio, the price is about $2,500 per yr, in accordance with Walthall.
Prices for membership-based main care range broadly. Some direct main care clinics cost month-to-month charges of roughly $50 to $150, whereas concierge-style practices could price a number of thousand {dollars} yearly.
MDVIP’s price covers an annual examination as a part of their wellness program that features in-depth screenings adopted up by an individualized motion plan for sufferers.
Whereas supporters behind the mannequin say it permits for a extra personalised main care, some suppliers fear that smaller affected person panels, typically a couple of hundred sufferers in contrast with hundreds in conventional practices, may restrict entry to main care if the mannequin expands broadly.
The San Antonio Report visited Walthall at his clinic to debate why he switched from conventional main care and the way the membership-based mannequin works for physicians and sufferers.
The interview has been edited for size and readability.
The place have been you earlier than you opened this observe?
I used to be at North San Antonio Healthcare [Associates] for about 25 years, over there with six suppliers. It’s busy, it’s packed, it’s annoying. Typically [patients] can’t even discover a seat. I might see anyplace from 20 to 30 sufferers a day and have 15-minute appointment instances. You’ll be able to’t do appointments in quarter-hour. To me, there’s a lot extra to an individual.
I feel most individuals can no less than recognize that the present system we’ve got is just not optimum. We have to make some adjustments to it. I don’t place fault or blame on anybody. I feel there’s lots of locations the place we fall brief.
If I noticed [a patient], let’s say you had cellulitis in your arm, and I stated, come again in per week. Let me check out it. If you went to make an appointment, it will be three, 4 weeks out. My affected person then must go to a mid-level supplier, which is okay. The mid-level suppliers in North San Antonio are glorious. However I lose contact with the affected person, and for me, I like having that contact. I prefer to see and comply with by with sufferers.
I spent 30 years doing medication the best way that insurance coverage needed us to do it, and I saved up with it. However I feel at this cut-off date, what I’m discovering is that the calls for are extra. I can do it, however I don’t really feel like I’m giving my greatest to my sufferers.
I like tips, however I don’t like cookie-cutter medication. You’ve gotten to try individuals, not ailments, and it’s important to perceive that what could also be greatest for you might not be greatest for you and me. If you’ve bought a short while with the affected person, we find yourself going again to this cookie-cutter mannequin, as a result of it’s simply the trail of least resistance.
And so I had a choice I wanted to make originally of final yr. It was like, I can do that one other two or three years, and I’m going to burn out in a wonderful blaze, or I can discover a strategy to perhaps restructure this in order that I can do it one other 10 or 15 years and take my time with my sufferers.
How does this mannequin differ from a standard main care supplier?
We are going to see anyplace from six to 12 [patients] on common on any given day. The objective of this observe is to guarantee that sufferers might be seen on the identical day, if not the identical day, no less than by the following day. MDVIP caps out at 600 sufferers. That’s the utmost they might enable me to have. I needed to begin at a a lot smaller quantity and construct so I’ve set, over the following yr, a quantity that we wish to get to. Proper now I’m approaching 300 [patients].
By specializing in fewer sufferers, we’re capable of ship extra personalised care. Our motto is to place individuals over course of. We put relationships over rush. My sufferers have my telephone quantity. They’re not afraid to make use of it. I bought a name final evening at about 12 o’clock. Issues about blood strain.
What sorts of sufferers do you get right here? What are individuals’s causes for becoming a member of a observe like this?
The sufferers which are right here wish to be right here, and so they’re actively engaged in ensuring that they’re doing the easiest that they’ll for his or her well being.
What’s fascinating from a socioeconomic standing is you’d suppose, as I did once I was transferring over, that we’d see increased socioeconomic standing individuals coming over due to that fee. That might be a hurdle.
[But] my clinic mirrors what I had [at North San Antonio Healthcare], which I discover very fascinating and thrilling. All of us hopefully in our careers have more money to place to one thing. Some individuals put it into mannequin airplanes. There are those who put that more money and make investments it into their well being. These are the those who I see.
You’ll be able to say [people interested in] longevity, however I might say extra high quality of life is what individuals need. As we become old, we wish to have the ability to nonetheless be capable to do the issues we wish to do. It’s not nice if I lived to 95 however I’m bed-bound for the final 15 years.
Do you suppose extra practices like yours will open in San Antonio?
It comes again to provide and demand. If sufferers need this, then I do suppose you will notice extra of us. I need all of my [previous] sufferers over right here, if I can get them on board with taking a proactive method to their well being.
One of many greatest points that we’ve got is, how do you get medical college students to choose main care over a specialty? After I graduated medical faculty, we broke the document for the variety of med college students making use of to household observe residency packages, we had a giant uptrend, after which it began falling once more.
From a doctor’s standpoint, [the direct primary care model] permits us to truly implement all of the instruments we have been skilled with. I used to go away my workplace at 4:30 within the afternoon, burnt out and drained. Now I go away my workplace at 5:30 or 6, skipping to my automotive. I’m in an excellent temper.
