I’ve struggled with pricing more than almost any other decision in my practice.
The struggle isn’t strategic. It’s personal. James Clinic is, by design, a premium brand — premium experience, premium outcomes, premium investment. But the patients I want to serve, deep down, are people who look like my parents: hard-working, middle-class, the kind of folks who built things with their hands and never had access to the version of medicine I now know how to deliver. My mission, on the medical side, has always been to make this kind of care available to the people who need it.
The business side has had to learn that mission and pricing are not the same conversation.
If I’d priced JC for accessibility from the start, the practice would have closed inside three years. The mission would have died with it. Nobody would have been served. That’s the math underneath the discomfort, and it’s the math every physician with a serving heart eventually has to face. You cannot subsidize affordability through underpriced membership — you can only kill the practice trying.
So here’s what I’ve actually learned about pricing membership for a cash-pay practice — across multiple geographies, across multiple iterations, and through years of watching myself underprice the work I was doing. This is the post I wish someone had given me earlier.
The math problem under the mission
Let me name the underlying issue plainly, because most physicians I coach are tangled up in some version of it.
You believe medicine should be accessible. You went into this work to serve. You are uncomfortable charging high prices because high prices feel exclusionary. You worry that a premium price tag is incompatible with your values.
Here’s the structural truth: a practice that prices below its sustainability point doesn’t serve anyone — because it doesn’t survive. The practice that charges what it needs to charge in order to remain open serves more patients, in more years, more deeply, than the practice that closed trying to be affordable.
The solution to the mission-business tension isn’t lower prices. It’s different mechanisms. Scholarship slots, sliding-scale carve-outs, geographic differentiation, partnerships with FQHCs and free clinics, pro bono days, free educational content — all of those make the mission real without compromising the price. But the price itself has to do the structural job it was always going to need to do: keep the practice alive, profitable, and able to compound for decades.
You can serve patients you wish you could serve, or you can serve patients who can pay. The honest answer is that you have to do the second one in order to be in any position to do the first.
Pricing is positioning
Once you accept that, the next thing to internalize is that your price is the loudest signal your practice sends.
A patient who pays $99 a month does not believe they are receiving premium care. A patient who pays $400 a month does. The clinical work behind the scenes might be identical. The patient’s experience and outcomes will not be — because pricing shapes what the patient expects, how seriously they take the plan, and how much they trust the experience they’re inside of.
Underpriced practices attract the wrong patients. Price-sensitive shoppers, comparison-driven, low-trust, demanding. They expect premium service at commodity prices. They’re hard to satisfy and they refer other price-sensitive shoppers. The practice ends up overworked, underpaid, and full of patients who don’t fit the model the owner originally wanted to build.
Premium pricing selects for the patients who value the work. They’re easier to satisfy, more compliant with plans, more loyal, and more referring. The same effort at higher prices produces a better practice.
This is the part of pricing nobody told me when I started. Price isn’t just what you charge. It’s who you’ll serve, how seriously they’ll take the work, and what kind of practice you’ll have built five years from now.
The competitive audit (and what it revealed at JC)
When I finally sat down to do the work — the unglamorous, spreadsheet-driven work — I did what every practice owner should do at least annually. I built a competitive pricing audit.
It looked like this. List every cash-pay, concierge, integrative, and functional medicine practice in our market. For each one, document their pricing tier, what’s included at each tier, what’s excluded, and what they’re really differentiated on. Then put my own practice on the same grid.
The result was uncomfortable in the opposite direction from what I expected.
Practices in our market were charging up to twice what we were charging — and offering substantially less. We were including services in our membership that comparable practices didn’t include at all, or charged separately for at premium rates. Our patients were getting two to three times more value than the average local competitor, at a lower price point. We weren’t being affordable. We were being grossly underpriced.
I’ve watched the same thing play out for many of the physicians I coach. They believe they’re charging high because the number feels high to them personally — but in their actual market, they’re at the low end of comparable practices, and they’re delivering more. The discomfort of pricing isn’t usually about what the market will bear. It’s about the founder’s relationship with money, their imposter narrative, their belief that they shouldn’t be charging this much for what they do.
If you’ve never done a real competitive audit of your local market, do it before you make another pricing decision. The work itself will recalibrate you.
Heat-mapping your patients
The second exercise is geographic, and it tells you whether your pricing is actually reaching the population you intend to serve.
Pull a list of every active patient. Get their addresses. Drop them onto a map — even a rough one in Google Maps will work for a first pass. Then overlay it with community income data. Most online demographic tools will give you household income by zip code or census tract for free.
What you’re looking for: do your patient locations cluster where your target avatar actually lives? Or do they cluster somewhere unexpected?
This exercise produces one of three outcomes. Either you’re hitting the demographic you intended (good — pricing is calibrated), or your patients skew higher-income than you targeted (you may be underpricing for your actual buyer pool, or your marketing has selected up-market without your noticing), or your patients skew lower-income than you targeted (your marketing or your geography is mismatched, or you’ve priced into a market segment that can’t sustain it).
Each outcome implies a different next move. The data doesn’t lie. Where your patients actually live tells you who your practice is actually serving — and whether your pricing fits.
The overhead trap
Doctors universally underestimate their own overhead.
The estimate physicians give me for what their practice actually costs to run, on a percentage-of-revenue basis, is consistently 20–30% lower than what their P&L will show when we sit down and actually calculate it. The hidden lines add up: payment processing fees (3% of every credit card transaction), software stacks that creep up over years, malpractice escalations, professional fees, supply inflation, marketing that drifts higher than budgeted, the absorbed cost of bad debt and write-offs even in cash-pay practices, the unpaid hours of administrative time the owner doesn’t count.
Real overhead in a stabilized cash-pay practice is usually 35–45% of revenue. If you priced as if your overhead were 25%, you’ve quietly built a practice that can’t pay you what the work is worth — and you may not realize it until the second-location stretch or a slow quarter exposes the gap.
The implication for pricing is simple: your membership has to cover real overhead, plus reasonable owner compensation, plus reinvestment, plus a cushion for the unexpected. If the price doesn’t cover all four of those, the model is broken from the start. Solve it on the spreadsheet before the patients ever walk in.
The pricing psychology levers
Once the math is right, the psychology decides whether patients accept the price you’re charging.
A few principles worth knowing:
Anchor high. The first price a patient sees becomes their reference point for everything else. If you list à la carte rates first, the membership looks expensive. If you list a top-tier package first, the standard membership looks reasonable. Lead with the highest number you offer; everything below it benchmarks against it.
Use three tiers, not one. A single price gives the patient a binary decision: yes or no. Three tiers give the patient a choice: which one. Behavioral economics calls this the decoy effect. Most patients land on the middle option — not because it’s truly the right fit for everyone, but because the middle reads as the safe choice. Three tiers also let you serve different patient segments without cheapening the premium offering.
Lead with the value stack, not the price. A membership that lists 60-minute visits, direct physician access, advanced lab panels, hormone optimization protocols, dispensary discount, 24-hour message turnaround before the price activates value perception. The same membership that opens with $350/month immediately triggers price scrutiny. Order matters.
Compare to the unbundled cost. Most patients have no idea what an à la carte version of your services would cost. A simple line — At outside rates, this care would total $9,000+ per year. Membership delivers it for $4,200. — reframes the price as savings. Show the math.
Frame in the unit that fits. Monthly framing for memberships ($350/month) works better than annual ($4,200/year) for the buying decision. Annual framing works better when discussing total annual commitment or comparing to insurance costs. Use both, in the right context.
Loss-frame, not gain-frame. Without this, you’d still be paying for medications you don’t need, the wrong supplements, and visits that don’t fix the problem hits harder than Here’s what you get. Patients respond more strongly to what they avoid losing than to what they might gain.
Charge for access, not for encounters. Members pay for the relationship and the availability, not for visit count. This reframing matters because it’s structurally what membership is — and once a patient sees it that way, the price stops feeling like a per-visit calculation.
Geographic differentiation
This is the JC-specific piece, and the one most practices haven’t considered.
We operate in markets that span from communities that are 60% Medicare/Medicaid all the way to some of the most affluent zip codes in the country. The same brand. Different price points. Each location calibrated to its market — not to a national average that would either price us out of one community or leave money on the table in another.
A practice operating across multiple markets doesn’t have to charge the same in all of them. It probably shouldn’t. A pricing structure that works in Manhattan doesn’t fit Sioux Falls; one that works in Sioux Falls leaves substantial revenue uncaptured in Manhattan. Geographic differentiation lets the brand express the same values in different economic realities, and lets the practice serve more communities than a single national price ever could.
If you’re operating in only one market, this principle still applies in subtler forms — you can have membership tiers that map to different income segments, or specific carve-outs for the harder-working subset of your community whom you specifically want to serve.
Reconciling the mission
For me, the mission expresses itself in ways that don’t compromise the price:
- Lower-tier locations in markets where the affluent-tier price would exclude my parents’ demographic
- Scholarship slots within each location, funded by the practice’s profitability
- Pro bono days
- Free content — blog posts, podcasts, educational resources — that anyone can access regardless of whether they can pay
- Partnerships with FQHCs and free clinics, where I direct patients we can’t serve
None of these would be possible if the practice weren’t financially healthy. The mission is downstream of the math. The math is upstream of the mission.
That reconciliation took me years to arrive at, and I think it’s the single thing I’d want to give to physicians who are still tangled up where I once was.
Raising prices when it’s time
Most cash-pay practices are underpriced by 20–50% relative to what their market will support and what their work is actually worth. The discomfort of raising prices is psychological, not structural. The market will absorb a price increase from a practice that delivers value, almost every time.
A few rules I’ve followed:
- Raise prices at least every two years on existing members, with notice
- Raise prices for new members more frequently if competitive analysis supports it
- Never apologize for the increase. Communicate it as an investment in the practice that benefits members
- Expect a small percentage of members to leave at each increase. That’s healthy churn — they were the price-sensitive segment that wouldn’t have stayed long-term anyway
- Track retention through the increase. If departures are higher than 5–10%, the increase was too aggressive or the value perception isn’t there
The first price increase is the hardest. Every one after is easier. By the third or fourth, you’ve internalized the truth that pricing reflects value, not personal worth — and the practice gets healthier with every step up.
What I wish I’d known
The version of me who started JC undercharged for years because I conflated affordability with virtue. I thought charging less made me a better doctor. What it actually did was make me an exhausted, underpaid version of the doctor I could have been if I’d priced for sustainability.
The patients I served at low prices didn’t get more from me than they would have gotten at higher prices. They often got less, because I was working against the grain of what the practice could sustain. The mission I cared about wasn’t served by underpricing; it was served by building a practice strong enough to stay open and structured enough to express the mission in ways that didn’t kill the math.
If you’re reading this and your stomach tightens at the thought of charging what your work is actually worth, I see you. I was you. The discomfort is real and it’s also a signal — usually that you’re underpriced.
Charge for the practice you want to be running in ten years. Build the mission expressions into the structure. And let the price do the structural job it was always going to need to do.
— MJ
