Concierge care has a new mascot, and her name is Dr. Sally Greenwald.
The Stanford assistant clinical professor recently found herself at the center of a media firestorm after The New Yorker profiled her thriving Silicon Valley practice that’s been cheekily dubbed the “Billionaires’ Vagina Club” by her patients. The nickname stuck, even if some of her billionaire clients reportedly found it unamusing.
Here’s the kicker: Annual memberships for Greenwald’s practice start at above $10,000 and over $30,000 for her highest tier of care. That buys you lengthy appointments, around-the-clock access, personalized treatment plans, and coordination with specialists. “Sexual health is health” is the motto that drives her business model.
Now, before you roll your eyes at yet another story about rich people throwing money at problems the rest of us can’t afford treatment for, hear me out. What’s happening in that Silicon Valley exam room isn’t just about the 1 percent. It’s a diagnostic tool; a $30,000-a-year per patient symptom that makes it crystal clear something is deeply broken in the American healthcare system. And if you’re paying attention, it tells you exactly where the real opportunity lies.
Let’s be clear about what’s happening inside the “Billionaires’ Vagina Club.” These women aren’t paying $30,000 for a Pap smear. They’re paying for personalized menopause care, hormone therapy, and sexual wellness treatments; services that traditional medicine has largely neglected, dismissed, or simply failed to provide.
In the U.S. healthcare system, where women with possible spinal CSF leaks report having their headaches dismissed because a neurologist said that “all women have headaches,” can we really expect our hormones to be taken seriously? Physicians tell women that our symptoms are “all in [our] heads,” yet may refuse even to order appropriate imaging to investigate what is actually happening inside our heads.
Furthermore, hormones are too often invoked as a convenient explanation for women’s symptoms without further investigation rather than treated as a legitimate clinical factor that should itself be evaluated and, when indicated, appropriately treated.
Greenwald’s approach goes beyond helping patients to extend their lifespans. She encourages patients to increase what she calls their “sexspan”—the number of years they remain sexually healthy and active. She argues that better sexual health can improve sleep, reduce stress, strengthen relationships, and boost overall health.
To put it differently, she views hormonal wellness as fundamental health—not as a secondary concern, not as an issue women must silently endure, and absolutely not as something that loses relevance as they age.
Her success shows that many women are desperate for this type of care. More specifically, women will pay for care that treats them as a whole human that combines clinical expertise with empathy.
I’ve seen it firsthand. In my work with disabled and chronically ill patients, I’ve watched people on fixed incomes shell out around $20,000 per year out-of-pocket for additional services such as chiropractic care for a variety of complaints, IV centers for Postural Orthostatic Tachycardia Syndrome (POTS) patients (which, frankly, are iffy because their baselines and fluids aren’t guaranteed to be monitored well, but the patients are desperate for relief), or functional medicine doctors for thyroid issues who might just give patients toxic-level iodine supplements that make them worse.
When a list circulated within Facebook’s chronic illness communities that revealed a primary care physician was charging several thousand dollars each month solely for care management, patients were genuinely shocked as the steep price tag offered very little visible value.
The screenshot was soon used to reinforce the sense of helplessness that often prevails in English-language chronic illness groups on social media. Comments followed along the lines of: “See? We cannot even afford basic care management from a physician who is supposedly one of the best in this area.”
The larger problem is not simply that one concierge physician charged an exceptionally high fee. It is that patients too readily accept that whoever has been most successfully marketed as the best must actually be the most knowledgeable or capable. Rather than critically evaluating a physician’s knowledge, reasoning, approach, or demonstrated value, patients may treat reputation, exclusivity, and price as evidence of expertise.
This reflects a broader healthcare marketing problem in the United States, namely that enormous resources are spent positioning physicians and healthcare companies as exceptional, while comparatively little attention is given to helping patients determine who genuinely possesses the knowledge and judgment their cases require.
So here’s the shocking comparison: The ultra-rich are paying $30,000 for concierge hormone therapy and sexual health support, which should be a basic part of women’s healthcare. Yet, what’s under-recognized is that chronically ill patients on fixed incomes are also often paying $20,000 or more out-of-pocket for wellness and healthcare services (some questionable) in an attempt to stay alive, to self-manage, and to cover the costs of medical negligence and care gaps.
According to a study by Harvard University professors and others, medical negligence and preventable medical errors add over $20 billion annually in direct excess healthcare costs in the United States. The total economic burden stretches to over $55 billion when factoring in liability insurance, administrative legal expenses, and "defensive medicine" or “fear-based medicine,” such as unnecessary tests ordered and unnecessary medications handed out to reduce liability risks. Disability due to unnecessary lumbar punctures as a part of defensive medicine is a major issue that I encounter in the patient population I talk to. Healthcare fraud costs the United States between $100 billion and $300 billion every year. Agencies like the Federal Bureau of Investigation (FBI) estimate that 3% to 10% of all annual healthcare spending is completely lost to fraudulent activity, waste, and abuse.
As a patient, I personally have seen physicians reading from emails where the front desk was coaching them on trying to sell me on double billing right before a necessary procedure, waiting until I was vulnerable. Double billing is when a healthcare provider charges multiple times for the exact same medical service, either by submitting duplicate claims to an insurer, billing both an insurer and a patient, or charging the government twice. In that particular instance, the physician was trying to push me to pay cash last-minute for a procedure that I knew was covered by my insurance. He attempted to say that the prior authorization fell through at the last minute. However, due to my intimate knowledge of insurance issues that I learned through having to learn CPT codes and even secure my own prior authorizations, I was well aware that that particular procedure did not require a prior authorization for my procedure. This is just one instance of many that I have experienced and successfully combatted. However, I saw in other Google reviews for the multi-location clinic that other patients had been scammed in these double-billing schemes where the patients’ insurance paid out, unaware that the patient had also paid the full amount in cash, being told falsely that their insurance hadn’t covered the bill.
In short, The New Yorker presented the ultra-rich paying more than $30,000 a year for women’s health services, ostensibly in an attempt to shock readers. Women’s health services should never be treated as a luxury. But the more revealing comparison is that many disabled and chronically ill patients in the lowest socioeconomic brackets may ultimately spend comparable amounts—not always for premium access, comfort, or highly personalized care but often simply to compensate for failures in the ordinary healthcare system.
These patients with fewer financial resources raise money through GoFundMe campaigns, drain their savings, take on debt, and set aside every available dollar for out-of-pocket medical and wellness services they may never have needed had their conditions been properly investigated and treated in the first place and had the appropriate regulatory bodies been more proactive in cracking down on fraud and poor clinician outcomes and behavior.
The wealthy are paying extraordinary prices to receive the attentive, individualized care that mainstream medicine withholds. Poorer patients are paying extraordinary prices merely to survive the consequences of neglect, fragmentation, and unresolved gaps in care.
[Related: Care Gaps: Why You Can't Find a Doctor and What's Really Causing It]
Let’s talk about why this gap exists, because it’s not an accident; it’s a design flaw.
Women’s health remains dramatically underfunded and under-researched. Between 2013 and 2023, a mere 8.8% of National Institutes of Health (NIH) research spending was dedicated to women’s health research. This disparity exists even though women make up over half of the U.S. population and manage 80% of healthcare decisions for their families. That funding has actually decreased as a share of overall NIH research during that period.
Several women philanthropists have attempted to tackle this issue. For example, Melinda French Gates has committed over $600 million through her organization, Pivotal, to address the chronic underfunding and systemic inequities in women's health. Her global initiatives tackle critical gaps at every stage of a woman's life.
The funding disparity is even more pronounced in the biopharma sector. Merely 7% of biopharma research and development (R&D) is dedicated to conditions that uniquely impact women, and under 1% of that fraction targets non-cancerous health issues. As a result, critical conditions like polycystic ovary syndrome (PCOS), endometriosis, and menopause receive next to nothing in funding.
The result is women being failed by the very system that’s supposed to care for them.
Consider menopause. Physically and emotionally, more than 85% of women navigate a multitude of symptoms spanning an average of seven years. These symptoms interfere with quality of life and daily activities, costing the healthcare system an estimated $24.8 billion and the workforce $1.8 billion annually.
Yet 73% of women do not receive any treatment during a medical visit for menopause symptoms. Partially, this is because only one-third of OB/GYN medical residents are trained in menopause care, according to a survey by The Menopause Society
Let that sink in: The doctors who treat women’s reproductive health aren’t being trained to treat menopause.
No wonder women in the U.S. are asking Google questions like, “Do you ever go back to normal after menopause?” They likely feel that they can’t ask their doctor this same query and receive a solid and empathetic answer. That’s the result of being left completely on your own to navigate your journey.
It is truly heartbreaking to consider the search query, “Do you ever go back to normal after menopause?” These women aren’t just looking up information about symptoms like hot flashes; they’re searching for answers about their identity. They are wondering if they will ever feel like themselves again, or if the woman they used to be has vanished forever.
Women patients may be navigating issues like fertility struggles, endometriosis, pregnancy loss, early surgical menopause, and the emotional drain of feeling dismissed or reduced to a checklist after menopause. Hormones affect far more than a woman’s sex life; they affect energy production, mood regulation, sense of self, and quality of life.
When women query "do you ever go back to normal after menopause?" they are not merely looking for medical treatments. They are searching for acompañamiento, a Spanish-language term present in Spanish and Latin American healthcare cultures to refer to a supportive presence to stand by them through moments of vulnerability even when the clinical answer is unknown.
Acompañamiento translates literally to accompaniment in English, but the word does not contain this nuance in Medical English as it does in Medical Spanish. As one Colombian physician told us, in Colombia, doctors are trained to remain with the patient despite the level of complexity and ambiguity and accompany the patients through their healthcare journeys. If the physicians have absolutely exhausted all potential resources to help the patients, they learn that simply being present with the patient is itself a valuable resource.
And that’s exactly what the traditional U.S. healthcare system doesn’t provide.
The “Billionaires’ Vagina Club” is part of a larger trend. Concierge care is booming, and for good reason: the healthcare system is broken, especially concerning women’s health.
The adoption of subscription-based and membership-based healthcare delivery models has experienced significant growth. From 2018 to 2023, studies show the number of medical practices implementing an annual fee nearly doubled. Currently, an estimated 3,000 to 4,000 physicians operate under this concierge framework, which now accounts for approximately 10 to 20% of all practices.
Why? Because primary care doctors are burned out. They see 25 patients a day, while dealing with declining insurance reimbursement rates. One in four U.S. doctors experiences “moral injury,” which is the psychological distress of knowing what patients need but not being able to provide it.
Consequently, physicians are embracing concierge primary care to rescue their practices. They charge patients a flat fee—often a couple thousand dollars a year, sometimes much more—and in exchange, they get to have fewer patients on their calendar and spend more time with them.
A major hurdle remains, though: within a few short months, many U.S. clinicians attempting the shift to subscription or cash-only models may encounter intense financial difficulties or failure. This struggle occurs because they overestimate the baseline value that their patients actually perceive. Consequently, they find themselves unexpectedly floundering in a short period of time after terminating their insurance agreements and opening their independent practices.
Why? Because they’re selling access, not value. And access alone isn’t enough.
These days, entrepreneurs across North America, Europe, and Asia are quickly stepping in with applications, digital clinics, and SaaS tools designed to improve access whenever gaps emerge in the U.S. healthcare market, which, along with our wellness sector, stands as the largest globally.
And look, these tools have value. They offer convenience and scale. But they often miss the deeper need.
Patients aren’t just looking for faster appointments or symptom trackers. They want acompañamiento, someone to truly be there with them during vulnerable times. They want to feel heard. They want to feel like they matter.
Women’s hormonal health isn’t generally something you can fix solely with an app. While an app may prove to be a useful tool in data collection, it neglects the mente-cuerpo (mind-body) integration aspect, such as women questioning their gender and sexual identity, their place in society, their relationships with significant others, and more as they undergo physical changes.
What’s missing is the patient narrative that accompanies that quantitative data and a human guide to help them as they turn the page for this new chapter. Hormonal issues aren’t a luxury item. These women are navigating identity, loss, fertility struggles, endometriosis, pregnancy loss, early surgical menopause, and the emotional weight of feeling dismissed.
Digital solutions may increase technical access, but they often still leave patients wanting the human connection they crave as part of the care experience.
Here’s where things get interesting.
Some South American countries have a powerful, undertapped opportunity. Colombia, for example, has a strong network of private-practice gynecologists, endocrinologists, and women’s health specialists who naturally excel at acompañamiento as a learned skill as part of their medical training. Acompañamiento refers to the compassionate presence, time, and interpersonal care that patients worldwide are missing.
Colombia’s top hospitals in cities like Bogotá, Medellín, and Cali provide advanced minimally invasive surgeries and comprehensive fertility treatments. With UK- and US-trained specialists and the latest technology, these facilities deliver care that equals or exceeds U.S. standards at only a fraction of the cost.
We’re talking 50% to 70% savings on major gynecological procedures compared to private treatment costs in the U.S., even after accounting for flights and accommodation. Colombia is home to numerous JCI-accredited hospitals, the global gold standard for quality and patient safety, ensuring care is on par with top U.S. medical centers.
A gynecology consultation in Colombia usually costs between 300,000 and 400,000 Colombian pesos—approximately $75 to $100 USD. In the U.S., that same consultation could easily cost ten times as much.
And the quality? Over 60% of senior reproductive endocrinologists practicing in Colombia’s premier international patient networks have completed extensive fellowship training in the United States, Spain, or the United Kingdom.
The U.S. market clearly shows people will pay premium prices when they finally feel heard and supported. Colombian practices and clinicians are uniquely positioned to meet this demand through in-person, hybrid, or well-designed international patient programs.
Beyond direct care, there’s strong potential for Colombian physicians to contribute to the global wellness market in providing patient education services within the field of hormonal health. These include (but are not limited to):
U.S. clinicians could learn a great deal from international approaches to healthcare. Successful private practices in other countries demonstrate that cash-only and hybrid models can thrive as the norm when they deliver clear relational value and clear positive clinical outcomes.
The “Billionaires’ Vagina Club” isn’t just a story about rich people. It’s a story about demand; massive, unmet demand for hormonal health care that traditional medicine has failed to provide.
The U.S. women’s health gap is real. It’s measurable. And it’s creating opportunities for practitioners who can deliver what patients actually want: acompañamiento, expertise, and real value.
The opportunity is unmistakable, whether you are a U.S. doctor striving to successfully pivot to a concierge model, a Colombian clinician aiming to bring in international patients, or an entrepreneur crafting the next wave of women’s health services.
At Medical Office Marketing, we help healthcare practitioners and organizations reach the patients who need them most. We can support you whether you are creating a telehealth platform, introducing a concierge practice, or scaling international patient programs. We can help:
The women searching “Do you ever go back to normal after menopause?” are looking for more than just answers. They’re looking for hope. They’re looking for someone who will actually listen. Be that person.
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