Most of the high-impact medicine in adult primary care is preventive. Blood pressure, cholesterol, diabetes, cancer screening, bone density, vascular disease. Almost all of these are treatable, often effectively, when caught early. Most are harder or impossible to reverse once they're advanced. Screening is the one tool that lets us see what's coming before it arrives.
TL;DR
- All adults: BP yearly, lipid panel every 4-6 years, A1C every 3 years (starting at 35), weight at every visit
- 40s: ASCVD risk calc + advanced lipid testing if family history; baseline eye exam at 40; colorectal screening at 45
- 50+: colonoscopy q10y; lung CT for eligible smokers; bone density (DEXA) for women at 65 / men at 70; one-time AAA screen for men 65-75 with smoking history
- Family history matters: a first-degree relative with early coronary disease or breast cancer changes everything
- In a concierge practice, the screening plan is built specific to you, not defaulted to a checklist
- To reach the practice: call 561-468-6981
Why preventive screenings matter
Most of the high-impact medicine in adult primary care is preventive. Blood pressure, cholesterol, diabetes, cancer screening, bone density, vascular disease. Almost all of these are treatable, often effectively, when caught early. Most are harder or impossible to reverse once they're advanced. Screening is the one tool that lets us see what's coming before it arrives.
What to screen for, by age
All adults
- Blood pressure at least annually, with home readings to confirm. (Five evidence-based lifestyle changes that lower BP if yours is elevated.)
- Lipid panel every 4 to 6 years, more frequently with risk factors or a family history
- Diabetes screening (A1C or fasting glucose) every 3 years starting at 35, earlier with risk factors. (How diabetes management works in concierge primary care.)
- Weight and body composition at every visit, plus waist circumference
Ages 40 to 49
- Comprehensive cardiovascular risk assessment, including ASCVD calculation and consideration of advanced lipid testing (ApoB, Lp(a), particle size) for patients with family history or ambiguous risk
- Baseline eye exam at 40
- Discussion of colorectal cancer screening options (current guidelines start at 45)
- Skin exam, especially if you have significant sun exposure or family history
Ages 50 and up
- Colonoscopy every 10 years starting at 45 to 50, or stool-based testing as an alternative for some patients
- Lung cancer screening with low-dose CT for eligible current or former heavy smokers
- Bone density (DEXA) for women at 65, men at 70, earlier with risk factors
- One-time abdominal aortic aneurysm screening for men 65 to 75 with a smoking history
- Continued age-appropriate cancer screening (mammography, cervical, prostate after a shared-decision conversation)
Family history matters
The above is a general framework. Your actual plan should be adjusted for family history, personal risk factors, and what's already known about you. A first-degree relative with early coronary disease changes your cardiovascular screening. A mother or sister with breast cancer changes your mammography timing. Good screening is specific to you, not formulaic.
How this works in my practice
In a rushed annual visit, screening usually becomes a defaulted checklist. Something gets ordered if it comes up; otherwise nothing happens. In my practice, the annual physical runs 60 to 90 minutes, and building a real screening plan is part of that visit. We actually calculate cardiovascular risk, review family history, and decide which tests make sense for your specific situation.
When results come back, I call you to review them. Not a portal message. If something needs follow-up, I coordinate it directly rather than sending you a referral slip and hoping the handoff works.
Frequently Asked Questions
Are these screenings covered by insurance?
Most are. The Affordable Care Act mandates first-dollar coverage for many preventive services on most commercial plans, and Medicare covers an extensive list of preventive screenings (the Medicare Annual Wellness Visit, mammography, colonoscopy, bone density, AAA screening for eligible men, lung CT for eligible smokers, etc.). Specific coverage depends on your plan; the front-line answer is "usually yes" but always verify with the order. (Full breakdown of Medicare + concierge for the senior-screening question specifically.)
Does Medicare cover the same preventive screenings?
Yes, mostly, with specific eligibility windows. The Medicare Annual Wellness Visit (codes G0438/G0439) is covered no-copay yearly. Mammography, colonoscopy, bone density, AAA screening, lung CT for eligible smokers, and most age-appropriate cancer screening are covered under Medicare Part B with standard cost-sharing. The frequency rules are specific; for example, screening colonoscopy is covered every 10 years (or every 24 months if you're at high risk).
Do you order genetic testing as part of preventive screening?
When it changes the plan, yes. BRCA1/2 testing for breast and ovarian cancer risk in patients with family history. Hereditary cardiovascular risk panels (familial hypercholesterolemia, Lp(a)) when warranted. Comprehensive multi-gene panels for patients with strong family history of multiple cancers. Genetic testing is most useful when there's a specific clinical question; routine 'wellness' genetic screening for healthy patients with no family history doesn't typically change management.
Is there such a thing as over-screening?
Yes. The harms of over-screening are real (false positives leading to unnecessary biopsies, anxiety, downstream procedures with their own risks). The right answer is screening calibrated to your specific risk profile, not maximalist screening of every possible marker. A physician with time can think about this; a 7-minute primary care visit usually defaults to either nothing or a generic checklist.
Can I get all my screenings done in one visit?
Mostly yes. The annual physical visit covers the history, exam, risk calculation, and lab orders. Most labs are completed at a separate lab draw same-day or within a week. Imaging studies (mammography, colonoscopy, DEXA, low-dose CT) are scheduled separately because they happen at different facilities. The point is that a single coordinated annual visit produces the plan; the individual studies happen on their own schedules.
How to evaluate any concierge practice for personalized screening
A concierge practice that delivers actual value builds the screening plan around your specific picture, not a checklist. The criterion is panel size: below 300 patients makes that level of attention possible; above 600 doesn't. (Full criteria for evaluating any concierge practice.)
About the Author
Dr. Ben Soffer, DO is a board-certified physician practicing concierge primary care in Boca Raton, Florida. He caps his practice at 50 patients, which is what makes the kind of personalized screening planning described above the actual operating model rather than a checklist.
If you want a serious, personalized look at your screening plan
A no-obligation conversation about your specific situation.
- Call: 561-468-6981
- Email: info@drbensoffer.com
- Or reach out through the contact form
