Find your starting point.
Your specialty, available hours, market, and goals shape the plan. Your own healthcare attorney reviews employment and practice restrictions before launch.
FOR PHYSICIANS READY FOR SOMETHING DIFFERENT
Build a membership practice around the medicine you want to practice—and the life you want to live.
Explore a remote start while keeping your current income, where your employment agreement and circumstances allow. Grow deliberately. Own what you build.
Physician-owned. Personally guided. Built at your pace.
CPA since 1973A lifetime understanding business
500+ physician clientsOver Keith’s accounting career
Two firms built and soldExperience on both sides of ownership
01 / A THOUGHTFUL TRANSITION
Start with your situation. Understand the constraints. Then build a practice that fits—one decision at a time.
Your specialty, available hours, market, and goals shape the plan. Your own healthcare attorney reviews employment and practice restrictions before launch.
Decide who you serve, what is included, when you are available, and how you coordinate care. Make the patient promise specific and sustainable.
Plan the budget, technology, website, and patient communication. Coordinate licensed professional work with the appropriate independent advisers.
Test your message with a focused audience. Track enrollment, retention, workload, and cash flow before deciding to expand or reduce employed hours.
WHAT WORKING TOGETHER MEANS
Engagements can combine practice-transition education, launch planning, and marketing content. The scope, deliverables, responsibilities, and fees are agreed in writing before work begins.
Clinical care remains yours. Legal, tax, accounting, and other licensed advice require separate professional arrangements.
Discuss the support you need ↗02 / MAKE THE NUMBERS VISIBLE
Move beyond revenue headlines. Adjust these illustrative assumptions to see what remains after operating expenses.
Operating costs should include marketing, malpractice, software, administration, and professional fees. Enter your own estimates; the defaults are hypothetical.
MONTHLY OPERATING SURPLUS
$7,200
Before owner compensation and taxes
*Expected cancellations, rounded up. This is a steady-state illustration, not a growth forecast. It excludes startup costs, financing, benefits replacement, owner pay, and taxes. Your time has a cost, too.
Before making a decision, model a slower start, the hours required to serve the panel, and the cash needed to reach your goal. No income or outcome is guaranteed.
03 / DESIGN THE DAY-TO-DAY
A membership works when both sides know what to expect. Set a service promise you can reliably keep alongside your other commitments.
This sample schedule illustrates 7½ hours a week. It does not establish how many patients you can safely serve.
Explore the practical questions ↗30 minutes each dayMessages, documentation, and coordination
6:00–8:00 p.m.Scheduled video appointments
1 hourAdministration and practice review
Define response times, vacation coverage, escalation, and in-person referrals before enrollment. Membership is not emergency care or health insurance.
04 / EXPERIENCE THAT TRAVELS WITH YOU
Adrian Keith Skane
Founder · CPA since 1973
A medical practice is also a business. You deserve someone who understands the responsibility of owning one.
Keith built two CPA firms over forty-eight years and worked with more than 500 physicians during his accounting career. He has lived the decisions about people, cash flow, growth, and when it is time for a change.
Concierge Medicine Alternative brings that perspective to physicians considering a membership practice. The aim is practical: help you understand the business, ask better questions, and build deliberately.
Start a conversation with Keith ↗Credentials describe Keith’s background. This service provides business education, transition support, and marketing; it does not create an accountant-client relationship.
05 / TAKE AN INFORMED LOOK
Explore the tools, hear from independent physicians, and consider the criticisms alongside the possibilities.
Stories, lessons, and critiques. These are independent examples, not testimonials for our services.
THE PRACTICAL TOOLKIT ↗Explore medical records, communications, and membership platforms. Confirm current terms with each provider.

Our distinctive voice for the people who care for others.
Resources open on our existing website in a new tab.
BEFORE YOU TAKE THE NEXT STEP
Your circumstances matter.
Here is where the conversation starts.
That depends on your employment agreement, available time, insurance coverage, and applicable rules. Begin with an independent healthcare attorney’s review of outside-work, confidentiality, and solicitation restrictions. A remote practice is not a way around those obligations.
A defined relationship and service package: for example, scheduled consultations, care coordination, and access within published hours. Specify inclusions, exclusions, fees, and response expectations in the membership agreement. The supplemental model here preserves the patient’s existing insurance and primary-care relationship.
Not necessarily. Direct primary care generally provides primary care through membership without billing insurance for those services. Concierge arrangements vary. This site emphasizes exploring a supplemental, remote membership; the appropriate structure depends on the actual services and your circumstances.
Start with a clearly defined audience and a specific reason to join. Develop educational content and a focused outreach plan, review it with appropriate counsel, and test demand on a limited budget. Track inquiries, enrollment, acquisition cost, and retention. Patient growth is not guaranteed.
Your patient agreement and care procedures must answer that before enrollment. Decide who covers absences, how urgent needs are directed to appropriate care, and what response times you can maintain. A membership should never imply emergency or round-the-clock access unless that service actually exists.
Each engagement is scoped individually. Start by discussing your goals and the help you need; requested services, deliverables, fees, and responsibilities should be confirmed in writing before you commit. There is no standard package price published here.
YOUR NEXT CHAPTER STARTS WITH A CONVERSATION
You don’t have to have the answer yet. Tell Keith where you are, what you want to change, and what is holding you back.
Speak directly with Keith
(813) 970-1967 ↗Email Keith ↗Email opens your email app. Include your specialty and a convenient time to talk. Please do not send patient information.
info@familydreammachine.com