Concierge medicine--what are your thoughts?

[v-tach]

I don't know how many of you have heard of "concierge" or "boutique" medicine (probably most of you), 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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[doc05]

who cares if it's elitist? it's a good option for the primary care doc who's frustrated with everything, wants to support his/her family, and cannot afford to go back and do another residency in a better field.

 

[Fantasy Sports]

It seems alright, I just dont understand the economics. The fees seem kind of low, so what if people with catastrophic health problems start preferring concierge to HMOs. It seems like then that concierge would have to start resembling HMOs in terms of trying to forge its client base.

If someone could explain that aspect of the economics to me, I would be very interested.

 

[doc05]

yes, except that in boutique medicine you select your patients. a poorly compliant, seriously ill patient wouldn't make the cut.

 

[efex101]

I think that concierge is on top of having your own HMO...meaning that this is your doc or whatnot but then the fees for procedures are billed to your HMO of choice.

"To a doctor fed up with trying to manage a medical practice, MDVIP offers a business model that is boldly counterintuitive: fewer patients, more money. Physicians' patient loads are limited to 600. Patients' annual fee of $1,500 covers a comprehensive annual physical and other preventive care, such as weight-loss and smoking-cessation counseling. (In Southern California and at the new hospital clinic in Boston, the fee is $1,800.) All other treatment for acute or chronic illness or disease is covered by a patient's private insurance or Medicare. MDVIP and the physician divide the fee; The company gets $500, the physician gets $1,000. If both parents are enrolled, coverage is free for their children under 25. Even with a patient load of only 600, a physician in the network will pull in an annual income of at least $600,000, and that doesn't include the reimbursements she earns performing medical procedures or treating ailments. That is four times the average annual income of a primary-care physician. "

Here is the link http://www.fortune.com/fortune/smallbusiness/articles/0,15114,654859,00.html

 

[subtle1epiphany]

v-tach, I agree with your concerns, here's my rationale...

"I'm not so sure about this one, I mean unless you could trace every penny that enters the coffers of teaching hospitals and residency programs around the country and assure me that it doesn't reach the program at which a specific "boutique" doctor trains, every physician has a responsibility to the public at large.

This is aside from the fact that as a physician I feel that I'm obligated to help those who need and can't get health care, for whatever reason.
This is the fact that residency training for a physician requires a huge sum of money, of which a small portion is paid to the resident on which to live. These funds come from the tax-payers (yes, the government) in return for the services of that doctor. Medical training, no matter from what angle you take, is heavily subsidized. Yes, by corporations, but more so by the public, and the public deserves access to that training. Unless these physicians are also providing care for those who are less fortunate, I think that a significant motivation is greed.

Granted, perhaps not the only one, increased time with patients is something that tugs at my heart as well, and trust me, with the loans I'll be paying back, I'd like a share of that money too. I just really feel, and very much want to feel, that a physician should not be concerned with the financial incentives past loan repayment and living comfortably."

Okay, if that statement above made any sense (and if so I know I'll be eating some of these words later), I'd like to say that having a practice like that would be awesome in so many ways, but for me, it wouldn't be honestly fulfilling.

 

[Southpawz]

I know for a fact that there are shortages of doctors in a lot of countries. It's because of this that many doctors get a large patient base. Now doctors moving to this 'concierge' method will just put more stress on the system, as the patients that he/she could have seen will move on to already overloaded clinics.

 

[MoosePilot]

Based on efex101's post that you can make 4x the amount of a normal primary care doc, you could take 1/4 of that, pay another doc to just provide treatment to the needy and still take home 3x your previous money.

 

[8744]

Based on efex101's post that you can make 4x the amount of a normal primary care doc, you could take 1/4 of that, pay another doc to just provide treatment to the needy and still take home 3x your previous money.

I think the longer you spend in Medical School or residency the less altruistic you become. While it is a privelage to treat patients and I certainly enjoy medical school, it is a lot of hard work for no pay whatsoever. Residency is even more work for less than you could make working the same hours at Wendy's. I will probably resent people trying to get their grubby paws on my money three years from now when I finally start making a good salary.

My point is let's avoid the temptation to count somebody else's chips. If a family practice doctor can gross $600,000 per year than we should be happy for him. If it is really that easy his salary will come down soon enough as more people try to exploit this business model and saturate the market with "concierge doctors."

 

[Energon]

The truth of the matter is that it is a lot more profitable to provide the "wants" as opposed to the "needs."

I dont know if this is because of a faulty system, or a misguided sense of entitlement from all of us entering this field.

Nonetheless, something has to be done about this.

 

[Shinken]

The truth of the matter is that it is a lot more profitable to provide the "wants" as opposed to the "needs."

I dont know if this is because of a faulty system, or a misguided sense of entitlement from all of us entering this field.

Nonetheless, something has to be done about this.

Watch out, you're going to get roasted for your comments!

You'll be called a communist or a socialist for even insinuating that the system is faulty. You'll be called unpatriotic because you're insinuating the US health system is not better than other countries' (even though health outcomes in this country are not even in the top 20 compared to other countries').

Don't even think of insinuating that health care should be accessible to all! After all, the only things that should be accessible to all are services offered by cyborgs or robots (in reference to the main argument someone offered me as to why health isn't a right but lawyers are a right: "How can a service provided by people be a right?" ... meaning that legal services are provided by cyborgs whereas medical services are provided by people. Although I do agree that sometimes lawyers don't seem to be human.)

I'm firmly against boutique medicine (in case you were wondering). Health disparities are bad enough as they are, we don't need to make them worse by opening boutique clinics.

 

[thewebthsp]

Ah duty vs. rights....

Well look, if you're a charitable person then do "regular" medicine.

Premium medicine is very very capitalistic. I could be comfortable doing both "concierge" and free clinic work, thereby satisfying a lifestyle (selfish) need and a duty (charitable) one.

 

[8744]

Watch out, you're going to get roasted for your comments!

You'll be called a communist or a socialist for even insinuating that the system is faulty. You'll be called unpatriotic because you're insinuating the US health system is not better than other countries' (even though health outcomes in this country are not even in the top 20 compared to other countries').

Don't even think of insinuating that health care should be accessible to all! After all, the only things that should be accessible to all are services offered by cyborgs or robots (in reference to the main argument someone offered me as to why health isn't a right but lawyers are a right: "How can a service provided by people be a right?" ... meaning that legal services are provided by cyborgs whereas medical services are provided by people. Although I do agree that sometimes lawyers don't seem to be human.)

I'm firmly against boutique medicine (in case you were wondering). Health disparities are bad enough as they are, we don't need to make them worse by opening boutique clinics.

I'm not going to flame anybody. How about we agree that those of you who want to save the world and see the practice of medicine as a "calling" feel free to work for nothing and give your services away.

Those of us who want to send our kids to private schools, take our wives on vacations to Italy, and generally make a good living will do so. Let's not count each other's chips. I don't know a single physician who doesn't do some pro bono work. Even rich plastic surgeons commonly devote a few weeks out of their year doing carity work. My church sends many physicians to the third world where many of them spend their vacation time treating the poor.

 

[Bo Hurley]

Geez, when will people get over the fact that it's OK for physicians to make a great income, and **gasp** be able to choose who they want to treat in a non-emergency. We're not 21 years old anymore and writing our lame personal statements to medical school. This is the real world. You want to travel to some 3rd world country and provide free healthcare, fine. You want to serve the poor in the inner-city ghettos, fine. You want to move to an affluent suburb and treat affluent people, fine.

Just don't try to impose what you want to do on others. Not every doctor wants to leave their family alone and travel to some unsafe 3rd world country to provide healthcare in order to compensate for some guilty conscience they may have about themselves being well-off. And not every doctor wants to move to some posh suburb to provide medical care to rich people. Live and let live. That's the great thing about American medicine, you can practice as you like as long as you're willing to work for it. This isn't China where you're simply assigned a medical specialty and an area of the country to work in by your medical school whether you like it or not (so I've heard). Why do you think so many doctors from other countries are desperate to come to the U.S.? Many even willing to do their ENTIRE residency all over again just so they can get licensed in the U.S. I'm talking about doctors who were chiefs of departments at hospitals in their native country who are willing to study for the USMLEs just so they can start residency from scratch in the U.S.

Not everybody has a "calling" to medicine and not every doctor feels like he has to "save the world". Many just want to have a secure job with a good income so they and their families can live a relatively comfortable life.

 

[8744]

Geez, when will people get over the fact that it's OK for physicians to make a great income, and **gasp** be able to choose who they want to treat in a non-emergency. We're not 21 years old anymore and writing our lame personal statements to medical school. This is the real world. You want to travel to some 3rd world country and provide free healthcare, fine. You want to serve the poor in the inner-city ghettos, fine. You want to move to an affluent suburb and treat affluent people, fine.

Just don't try to impose what you want to do on others. Not every doctor wants to leave their family alone and travel to some unsafe 3rd world country to provide healthcare in order to compensate for some guilty conscience they may have about themselves being well-off. And not every doctor wants to move to some posh suburb to provide medical care to rich people. Live and let live. That's the great thing about American medicine, you can practice as you like as long as you're willing to work for it. This isn't China where you're simply assigned a medical specialty and an area of the country to work in by your medical school whether you like it or not (so I've heard). Why do you think so many doctors from other countries are desperate to come to the U.S.? Many even willing to do their ENTIRE residency all over again just so they can get licensed in the U.S. I'm talking about doctors who were chiefs of departments at hospitals in their native country who are willing to study for the USMLEs just so they can start residency from scratch in the U.S.

Not everybody has a "calling" to medicine and not every doctor feels like he has to "save the world". Many just want to have a secure job with a good income so they and their families can live a relatively comfortable life.

Friggin-A, Bubba. I see we agree on a few things at least.

 

[Ross434]

Geez, when will people get over the fact that it's OK for physicians to make a great income, and **gasp** be able to choose who they want to treat in a non-emergency. We're not 21 years old anymore and writing our lame personal statements to medical school. This is the real world. You want to travel to some 3rd world country and provide free healthcare, fine. You want to serve the poor in the inner-city ghettos, fine. You want to move to an affluent suburb and treat affluent people, fine.

Not everybody has a "calling" to medicine and not every doctor feels like he has to "save the world". Many just want to have a secure job with a good income so they and their families can live a relatively comfortable life.

AMEN !

Boutique medicine gives me faith in the future of being able to run our own practices how we want and provide for who we want.. When the government starts telling me what to do, i'm moving to a more capitalistic country. Hopefully the US wont fail us.

 

[ddmo]

This sounds like a good system to me. If the physician wants to be altruistic they can take their extra time and spend it doing charity work.

I personally like the way plastics works because you can do the cosmetic stuff to earn a decent wage, and use it to finance the more gratifying cases of helping people with severe needs who can't afford health care. It's win/win.

 

[8744]

While it is true that I attend a state-supported medical school, implying that I therefore can be compelled to serve the needs of the state is a dangerous argument. By this reasoning, anybody who attends a public university should also owe some of their time and can be compelled to work wherever the state has a need for their talents. The Art Major, for example, who is looking for a lucrative job in advertising might be compelled to teach art in a crappy inner-city high school for a miniscule teacher's salary. A graduate of a state law school, as another exampe, should expect to be forced to practice as a low pay public defender.

I realize that some of you believe that government can create a utopia by coercion but this kind of thing never works.

Where would it end? And who in government is qualified to run your life?

How about people who have served in the military? Am I exempt from having my life dictated because I have paid, in spades, my debt to society. What about the taxes we all pay. I believe that close to 40 percent of the average paycheck is eaten up by sales, local, state, and federal taxes of one kind or another. Doesn't this count?

Freedom, baby. Isn't it something to strive for? There is no real freedom without economic freedom.

 

[Ross434]

While it is true that I attend a state-supported medical school, implying that I therefore can be compelled to serve the needs of the state is a dangerous argument. By this reasoning, anybody who attends a public university should also owe some of their time and can be compelled to work wherever the state has a need for their talents. The Art Major, for example, who is looking for a lucrative job in advertising might be compelled to teach art in a crappy inner-city high school for a miniscule teacher's salary. A graduate of a state law school, as another exampe, should expect to be forced to practice as a low pay public defender.

I realize that some of you believe that government can create a utopia by coercion but this kind of thing never works.

Where would it end? And who in government is qualified to run your life?

How about people who have served in the military? Am I exempt from having my life dictated because I have paid, in spades, my debt to society. What about the taxes we all pay. I believe that close to 40 percent of the average paycheck is eaten up by sales, local, state, and federal taxes of one kind or another. Doesn't this count?

Freedom, baby. Isn't it something to strive for? There is no real freedom without economic freedom.

Yeah, its one thing to owe an obligation to the military.. They're paying you... The government on the other hand, is taking your money (for school and taxes) We dont owe them anything.

 

[LADoc00]

Whats funny is how people are making a big deal of concierge medicine when i have to tell you, this is far from new. All medicine was concierge once.

The current quasi-socialist scheme controlled by big government in bed with big business WILL die and when it does, the goood times will roll.

 

[Perrin]

I feel that health care is not a right, it is a privilage. Therefore, neither the government nor anyone else should tell me what to do with my education. I am pursuing medicine to build a practice (read business) that provides a livelihood for myself and a tangible benefit to my community. How I chose to do this is none of your concern.

 

[SanDiegoSOD]

I feel that health care is not a right, it is a privilage. Therefore, neither the government nor anyone else should tell me what to do with my education. I am pursuing medicine to build a practice (read business) that provides a livelihood for myself and a tangible benefit to my community. How I chose to do this is none of your concern.

Strong words, but a principle I have to agree with. I don't see why so many pre-meds/medical students believe that a medical education commits an individual to a life of indentured servitude. Can't a physician also be a business person in the 21st century?