We agree with Dr Freedman’s assessment that disparate pressures have transformed medical practice, in which the notion of a traditional private medical practice is now an antiquated option. The modern paradigm finds that more physicians are employees rather than independent practitioners, administratively managed to achieve financial and other metrics. Loss of control, greater job dissatisfaction, and economic, bureaucratic, and other pressures on practicing physicians have trickled down to influence the career choices of medical students. Medical students consider lifestyle impact, a major criterion, when making ultimate career selections. The motivations that entice physicians to consider practicing concierge medicine have been well articulated in the accompanying Point debate, but the effect on patients and public health is largely unknown and not addressed.