"Concierge" medicine--what do you think?

[v-tach]

I don't know how many of you have heard of "concierge" or "boutique" medicine, but it seems there are some doctors who are converting their practices to this type of setup. Basically, for those who aren't familiar with this, the physician limits his/her practice to a relatively small number of patients, and charges these patients an annual fee for using the services of the practice. The idea is that it allows the doctor to provide more personalized care and spend more time with each individual patient--they often even make house calls, and give the patients 24-hour phone access. Another supposed benefit is that patients have drastically shorter waiting times at appointments etc. The physicians tend to earn quite a bit more money as well. The movement stems from frustration with the current healthcare system that can make it difficult to establish a close relationship with every patient. Now that I've explained the concept, here's my take on things. While I understand the frustration with certain aspects of managed care and a large patient load, and the desire to give all your patients the best possible care is obviously a noble one, I have an ethical problem with the concierge/boutique practice. The reason is that by limiting the number of patients you will take on, you are denying care to others who need it, as well as increasing the patient load of other doctors, whose patients may then suffer if the workload becomes unmanageable. Essentially, it doesn't solve the underlying problem; it just dumps it on someone else. Besides that, it strikes me as elitist. What do the rest of you think?

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[HrsNJ]

Something about it doesn't seem right to me either.

Do the doctor's work the annual fee out with insurance companies? Where is this method of medicine being used?

Have a good day!

 

[tinkerbelle]

I hadn't heard of this before you mentioned it, but I actually like it. And I can understand wanting to increase patient contact. Not only can you provide better care because you know your patient better, but I bet these boutique docs have a lower number of malpractice lawsuits. And as far as being elitest, doctors are not obligated to treat anybody unless it's an emergency (someone correct me if i am wrong). The workload is already unmanagable. I mean you see your patient for 10 minutes and then move on. It sucks. Doctors don't have the time to really see what is wrong with their patients and discover what outside factors may be contributing to the illness. It seems like doctors only treat the physical problem and I would like to see doctors consider the emotional, psychological, and financial burdens their patients face (which they could with more time). I think it would translate into better care for patients.

 

[Kazema]

Something about it doesn't seem right to me either.

Do the doctor's work the annual fee out with insurance companies? Where is this method of medicine being used?

Have a good day!

Insurance companies aren't involved I think. Only the very wealthy can afford this type of service. That's my complaint; I don't like this setup even a little bit but hey, if that's how someone wants to practice they have the right to do so.

 

[HrsNJ]

I think it would translate into better care for patients.

That's one possibility and definitely the ultimate goal of restructuring medicine, but I still see this type of medicine as causing more harm than good, primarily because there would be a huge portion of the population that would not get treated because of financial reasons. Also, let's say that the majority of doctors switched over to this type of care. There aren't enough doctors around, and then who would end up getting treatment? Probably, the people who could afford to pay the largest annual fees.

 

[tinkerbelle]

Insurance companies aren't involved I think. Only the very wealthy can afford this type of service. That's my complaint; I don't like this setup even a little bit but hey, if that's how someone wants to practice they have the right to do so.

why can't insurance companies be involved? I'm sure there's a way to make sure insurance pays for certain procedures. Otherwise how would you ever find enough patients to have a boutique setup?

 

[joy77]

Something about it doesn't seem right to me either.

Do the doctor's work the annual fee out with insurance companies? Where is this method of medicine being used?

Have a good day!

In the practices I've read about, the annual fee is an out-of-pocket cost for the patient. So it seems as though this model would work best in communities with a high-income patient base.

 

[vhawk]

The reason is that by limiting the number of patients you will take on, you are denying care to others who need it, as well as increasing the patient load of other doctors, whose patients may then suffer if the workload becomes unmanageable.

This is the scariest and most disturbing thing I have heard in almost a year of reading SDN.

 

[v-tach]

That's one possibility and definitely the ultimate goal of restructuring medicine, but I still see this type of medicine as causing more harm than good, primarily because there would be a huge portion of the population that would not get treated because of financial reasons. Also, let's say that the majority of doctors switched over to this type of care. There aren't enough doctors around, and then who would end up getting treatment? Probably, the people who could afford to pay the largest annual fees.

That's pretty much what I think. In other words, no one's denying that there's a problem with the current system as far as not having as much time to spend with each patient as would be ideal. However, concierge medicine won't solve the problem--it will be better for a few patients, but that will increase the number of patients who get insufficient or no care.

 

[ellia08]

I had heard of this.

My general feeling is that I personally wouldnt do it but that if a doctor feels fulfilled practicing this way then thats fine. Maybe he feels like he's giving a better quality of care. As for selfishness... maybe he also gives equal times to people who cannot pay, since he makes so much on housecalls and doesnt have to pay office overhead. Honestly, we cant really say based on this info who the doctor is treating--just that some of them must be wealthy enough to cover all the expenses (and maybe the expenses of other patients?).

To me it just sounds boring (capital B) not seeing a diverse collection of patients cause you arent going to see a lot of patients in general if you are at the continual beck and call of one (whatever their SES) but then, hey, thats just my outlook.

 

[dopaminophile]

This is basically ultra-small scale managed care. HMOs came about with doctors trying to replace the traditional fee-for-service structure. Patients would pay a flat rate, and all their health care would be covered by member doctors and hospitals. It sounds good until the management organization gets a life of its own and becomes increasingly cost-reduction oriented. I think the biggest problem with these boutique operations is that the doctor gets the best of both worlds, while the patient gets the financial worst of both worlds. They have to pay out of pocket for health maintenance and they have to keep insurance for anything outside of primary care. That's why only the wealthy can afford it.

My feeling is that the answers to our woes lie first in a handful of very serious reforms by both the medical community (read: better, harsher self-regulation) and by the public (read: tort and insurance reform). Then, a general transfer to large group practices like Mayo and the Cleveland Clinics will sooth some of the financial woes that medicine is facing.

 

[v-tach]

As for selfishness... maybe he also gives equal times to people who cannot pay, since he makes so much on housecalls and doesnt have to pay office overhead. Honestly, we cant really say based on this info who the doctor is treating--just that some of them must be wealthy enough to cover all the expenses (and maybe the expenses of other patients?).

You do bring up a good point there--it is certainly possible for someone who is doing this to then volunteer some of his/her time to treat the less fortunate. However, what if this doctor then can't deliver on his/her "promise" to be available to each of his/her regular patients 24/7? Or does, but consequently walks out on the clinic etc. where he/she is volunteering at the time? That is another ethical problem that can come up--it is certainly possible for multiple patients to need the doctor at the same time, and only one at a time can be attended to. This puts the others in the position of "getting shafted", if you will. Basically, it's not right to make promises one can't keep.

 

[efex101]

Some of the initial fees are not that much btw...google it.

 

[efex101]

I found one that charges $99 per month which IMHO is not a lot (although yes some folks cannot afford this) compared to what most folks spend eating out.

 

[JonnyG]

I fully plan on doing this when I open a family practice. The Philadelphia Inquirer ran an article on this about a year ago and interviewed several of the patients for one doctor. One thing they found is that many "poor" patients (particularlly the elderly) used the system because they had diseases that required alot of management from the docotr and perfered the care. There is nothing sinister with this. My motivation for doing it is I would like to know my patient and not rush them out the door. A standard fee is 500-1000 per person a year with discounts for families. You still bill insurance for any procedures or test you run. This is very similiar to the cash only system that has gained in popularity. Insurance is now somehtign for when you really get sick.

 

[TexasSnow]

At first I resented the "concierge" approach as I thought it was limited to the wealthy. But now that I realize virtually anyone can take advantage of it, I'm actually interested in the practice. Yet I still feel that there are some disadvantages I'm unaware of. Any ideas?

 

[efex101]

http://www.fortune.com/fortune/smallbusiness/articles/0,15114,654859,00.html

 

[Law2Doc]

I fully plan on doing this when I open a family practice.

An interesting concept, but I'm not so sure it will still be a career option by the time any of us finish up our schooling and residency training. With all the political rhetoric about the need for a single payor universal health care system, and the consensus in government that to enact such, all outside of the system healthcare options need to be eliminated (to avoid a multi-tier health system), you probably shouldn't get your heart too set on this.

 

[efex101]

The US will more than likely never come to that...(universal healthcare)

 

[Law2Doc]

The US will more than likely never come to that...(universal healthcare)

Perhaps not (although an awful lot of prominent people in government are pining for it). I just meant that the medical landscape will likely be very, very different by the time we finish up, so one probably shouldn't lock in on a particular form of practice just yet.

 

[JonnyG]

People will always pay for better care, even if the government will give them care for free. A doctor could choose not to contract with the government and work outside of that frame work. If anything healthcare may move more towards these type of fee based services. In fact this is how it use to be.

 

[Law2Doc]

People will always pay for better care, even if the government will give them care for free. A doctor could choose not to contract with the government and work outside of that frame work. If anything healthcare may move more towards these type of fee based services. In fact this is how it use to be.

Some of the proposed plans that have been floated in the past decade (esp. during the Clinton admin) would simply make it illegal for doctors to practice outside of the system. The fear in permitting outside framework physician practice is that we would rapidly end up with two systems, one for the poor and the rich, which most view as undesirable. I suspect in the face of ever rising healthcare costs we will see several more versions of universal single payor healthcare proposals brought to congressional vote between now and when we are practicing physicians. So keep your fingers crossed and prepare to be flexible as to the ultimate form of your future practice.

 

[dmoney41]

Some of the proposed plans that have been floated in the past decade (esp. during the Clinton admin) would simply make it illegal for doctors to practice outside of the system.

I guarantee even the hippiest socialist medicine supporter would never advocate a plan like this as their main target. Do you realize how easy it would be to demonize that as being communist (which is always the kiss of death for .. anything really in the US)?

 

[Law2Doc]

I guarantee even the hippiest socialist medicine supporter would never advocate a plan like this as their main target. Do you realize how easy it would be to demonize that as being communist (which is always the kiss of death for .. anything really in the US)?

Not as their main target, but it's a necessary element for universal coverage to work -- otherwise all the best doctors and richest patients tend to drop out of the system. BTW universal healthcare is usually demonized as socialist, not communist .The below link I found on Google and attached is somewhat of a rant/diatribe, but it does correctly describe and cite as to how the proposed Clinton Admin healthcare plan made it illegal and/or impossible to get outside of the system -- both as a patient and as a physician. It remains to be seen if future healthcare bills take the same tact.

http://www.geocities.com/Heartland/Meadows/2360/tracts/health.html

 

[tofurious]

An alternative is to secure a number of slots per day for your boutique patients such that patients who are self-pay get to see you quicker but you still see a set number of "regular" patients a day.

What no one has suggested, which I find viable, is with all the foreign doctors who want to come to the US and all the dissatisfaction of US doctors with the Medicare system, we could have a system where the foreign doctors can see the majority of Medicare/Medicaid patients. This way, US-trained physicians will not worry about foreign docs stealing their jobs, the foreign doctors will not worry about not getting a job after their training in the US, and more US medical graduates will enter primary care as it will be better rewarded with more self-pay patients and fewer can't-pay patients.

 

[Penelope1]

Not as their main target, but it's a necessary element for universal coverage to work -- otherwise all the best doctors and richest patients tend to drop out of the system.

All the best doctors will drop out anyway if something like this is enacted, but that's no protection against it, since most politicians couldn't care less what the consequences of their "good intentions" might be. I for one would never work under a system that doesn't recognize my right to choose the terms of my work, no matter how high my med school debt. I think the uncertainty over the future of medicine is one reason a lot of great people avoid medicine. (No offense intended to any of the great people here.)

But unfortunately, this seems to be where we're headed, since most people believe that healthcare is a right - which, sooner or later, inevitably leads to the idea that the government has to force doctors to provide it regardless of *their* rights.

 

[Ross434]

All the best doctors will drop out anyway if something like this is enacted, but that's no protection against it, since most politicians couldn't care less what the consequences of their "good intentions" might be. I for one would never work under a system that doesn't recognize my right to choose the terms of my work, no matter how high my med school debt. I think the uncertainty over the future of medicine is one reason a lot of great people avoid medicine. (No offense intended to any of the great people here.)

But unfortunately, this seems to be where we're headed, since most people believe that healthcare is a right - which, sooner or later, inevitably leads to the idea that the government has to force doctors to provide it regardless of *their* rights.

I agree with the idea that uncertainty is keeping good people out of medicine.. But i think its HIGHLY unlikely that we'll have socialized medicine in the US, given the impending conservative trend in US politics and the enormous leverage of the medical lobby in washington power circles.

 

[Law2Doc]

But unfortunately, this seems to be where we're headed, since most people believe that healthcare is a right - which, sooner or later, inevitably leads to the idea that the government has to force doctors to provide it regardless of *their* rights.

That's all I'm saying Just keep in mind that the landscape 6-10 years from now (i.e. when we begin post-residency practice) may be very different than today.

 

[Penelope1]

That's all I'm saying Just keep in mind that the landscape 6-10 years from now (i.e. when we begin post-residency practice) may be very different than today.

I didn't mean to sound combattive; I was agreeing with your main point , just noting that for some people socialized medicine with no loopholes for private arrangements would be a dealbreaker.

 

[vhawk]

All the best doctors will drop out anyway if something like this is enacted, but that's no protection against it, since most politicians couldn't care less what the consequences of their "good intentions" might be. I for one would never work under a system that doesn't recognize my right to choose the terms of my work, no matter how high my med school debt. I think the uncertainty over the future of medicine is one reason a lot of great people avoid medicine. (No offense intended to any of the great people here.)

But unfortunately, this seems to be where we're headed, since most people believe that healthcare is a right - which, sooner or later, inevitably leads to the idea that the government has to force doctors to provide it regardless of *their* rights.

A much better post than my earlier one, where I was shocked and alarmed to hear future docs talking about how unfair a system(boutique service) is that wouldnt be able to force doctors to see as many patients as they possibly could, regardless of ability to pay. Its also nice to hear people speak intelligently about this notion that healthcare is somehow a "right."

 

[45408]

I don't know that I would ever practice that kind of medicine, but I certainly wouldn't consider someone else to be selfish because they did choose it. We are entering a field that has an altruistic aura surrounding it, but I don't think we need to hold everyone to a higher standard necessarily. A medical practice still has to follow a lot of business rules too.