switching to concierge

[3bamboo]

I got a call the other night from my FP doc who was explaining to me that he would be switching to a concierge-style practice (~500 patients pay a yearly fee and have quick access to him whenever they need it). The reasons he gave for doing this were new to me. He said something along the lines that since millions and millions of people will soon be getting health insurance (via affordable care act) his office and other FP's all over the country are going to get swamped with people. The office is going to get so crowed he will have to start seeing patients in 10 minutes or less just to keep his schedule from being booked months in advance; and I would have to wait weeks and weeks for any appointment.

It seems to me he is getting out early and moving to a form of practice with less paperwork and more time. From what I understand, many other FP's are following suit to avoid this looming wave of new patients/all the paperwork that is associated with a large family practice. Although this new method may save current FP's it will do nothing for the millions of new patients that want to start regularly seeing a family doc. The FP's that remain behind will get even more crowed taking up the 3000 patients that each concierge doc will drop + all the new insured people. I can't imagine how difficult it is going to get for people looking for new primary care doctors.

Is this a realistic threat or just some paranoid move by a couple of family docs? If it is a threat, what should be done to encourage FP's to stay around, should we expect the salaries and perks to raise dramatically to encourage more primary care docs or something else? OR is this concierge service a potential FP savior and it could actually help convince new med students to pursue family medicine?

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[GUH]

I got a call the other night from my FP doc who was explaining to me that he would be switching to a concierge-style practice (~500 patients pay a yearly fee and have quick access to him whenever they need it). The reasons he gave for doing this were new to me. He said something along the lines that since millions and millions of people will soon be getting health insurance (via affordable care act) his office and other FP's all over the country are going to get swamped with people. The office is going to get so crowed he will have to start seeing patients in 10 minutes or less just to keep his schedule from being booked months in advance; and I would have to wait weeks and weeks for any appointment.

It seems to me he is getting out early and moving to a form of practice with less paperwork and more time. From what I understand, many other FP's are following suit to avoid this looming wave of new patients/all the paperwork that is associated with a large family practice. Although this new method may save current FP's it will do nothing for the millions of new patients that want to start regularly seeing a family doc. The FP's that remain behind will get even more crowed taking up the 3000 patients that each concierge doc will drop + all the new insured people. I can't imagine how difficult it is going to get for people looking for new primary care doctors.

Is this a realistic threat or just some paranoid move by a couple of family docs? If it is a threat, what should be done to encourage FP's to stay around, should we expect the salaries and perks to raise dramatically to encourage more primary care docs or something else? OR is this concierge service a potential FP savior and it could actually help convince new med students to pursue family medicine?

I don't know of any numbers but I've heard that an increasing portion of FP's are switching to concierge or direct practice models. If I ever go into FM it would be with an eye to eventually move to such a type of practice.

EDIT: http://www.beckershospitalreview.com/hospital-physician-relationships/survey-which-physicians-are-considering-concierge-medicine.html

 

[3bamboo]

I have to agree, It is very tempting to drop all the hassle of insurance and get right to one-on-one medicine. It would also be very good for the 400 or so patients signed up to you as you would be able to provide them with excellent care. After looking into it more I have realized its not just for the rich either. In fact, most are middle class families and the fee is between 40-100 a month.

The only problem is what happens to the thousands of patients who are dropped when their FP switches. There are not yet enough concierge docs to cover everyone and current FP's will get swamped. I think FP is going to have to change big time, it will be interesting to see what happens.

 

[Siggy]

The only problem is what happens to the thousands of patients who are dropped when their FP switches.

They'll go to the emergency department like they've always done. The thing the general population is about to learn is that insurance doesn't guarantee access.

 

[Didierdrogba]

I don't know of any numbers but I've heard that an increasing portion of FP's are switching to concierge or direct practice models. If I ever go into FM it would be with an eye to eventually move to such a type of practice.

EDIT: http://www.beckershospitalreview.com/hospital-physician-relationships/survey-which-physicians-are-considering-concierge-medicine.html

Perhaps, but this hasn't really happened a lot yet in countries with universal insurance. So it's probably not going to be that bad (from a pts point of view).

 

[GUH]

Perhaps, but this hasn't really happened a lot yet in countries with universal insurance. So it's probably not going to be that bad (from a pts point of view).

Remember - Obamacare does not bring universal coverage. It merely penalizes certain people who choose not to purchase coverage.

 

[SurgeDO]

I got a call the other night from my FP doc who was explaining to me that he would be switching to a concierge-style practice (~500 patients pay a yearly fee and have quick access to him whenever they need it). The reasons he gave for doing this were new to me. He said something along the lines that since millions and millions of people will soon be getting health insurance (via affordable care act) his office and other FP's all over the country are going to get swamped with people. The office is going to get so crowed he will have to start seeing patients in 10 minutes or less just to keep his schedule from being booked months in advance; and I would have to wait weeks and weeks for any appointment.

It seems to me he is getting out early and moving to a form of practice with less paperwork and more time. From what I understand, many other FP's are following suit to avoid this looming wave of new patients/all the paperwork that is associated with a large family practice. Although this new method may save current FP's it will do nothing for the millions of new patients that want to start regularly seeing a family doc. The FP's that remain behind will get even more crowed taking up the 3000 patients that each concierge doc will drop + all the new insured people. I can't imagine how difficult it is going to get for people looking for new primary care doctors.

Is this a realistic threat or just some paranoid move by a couple of family docs? If it is a threat, what should be done to encourage FP's to stay around, should we expect the salaries and perks to raise dramatically to encourage more primary care docs or something else? OR is this concierge service a potential FP savior and it could actually help convince new med students to pursue family medicine?

I have to agree, It is very tempting to drop all the hassle of insurance and get right to one-on-one medicine. It would also be very good for the 400 or so patients signed up to you as you would be able to provide them with excellent care. After looking into it more I have realized its not just for the rich either. In fact, most are middle class families and the fee is between 40-100 a month.

The only problem is what happens to the thousands of patients who are dropped when their FP switches. There are not yet enough concierge docs to cover everyone and current FP's will get swamped. I think FP is going to have to change big time, it will be interesting to see what happens.

500 patients x $100 a month = $50,000 a month

Makes primary care look a lot better for me.

 

[Didierdrogba]

Remember - Obamacare does not bring universal coverage. It merely penalizes certain people who choose not to purchase coverage.

OK, fair enough.

Frankly though, doesn't the lifestyle of concierge doctors seem horrible? It sounds like you are always on call...

 

[3bamboo]

for anyone interested this thread explains a lot about it. Turns out the hours and call aren't too bad at all, and most patients don't abuse the unlimited access.
http://forums.studentdoctor.net/showthread.php?t=997579

For me personally I would still like good insurance in case I have any very expensive long-term medical problems. I hate to think about how someone under this system would afford expensive cancer treatments or some other costly disease.

 

[GlowInTheDark]

for anyone interested this thread explains a lot about it. Turns out the hours and call aren't too bad at all, and most patients don't abuse the unlimited access.
http://forums.studentdoctor.net/showthread.php?t=997579

For me personally I would still like good insurance in case I have any very expensive long-term medical problems. I hate to think about how someone under this system would afford expensive cancer treatments or some other costly disease.

Many still maintain their insurance or may simply have high-deductible (aka catastrophic) coverage. The concierge or cash only doctors will sometimes provide you with the forms and you submitmyourown claims to insurance.

IMO, HSA+concierge/cash only+catastrophic= way to do it as a patient

 

[DrWBD]

I got a call the other night from my FP doc who was explaining to me that he would be switching to a concierge-style practice (~500 patients pay a yearly fee and have quick access to him whenever they need it). The reasons he gave for doing this were new to me. He said something along the lines that since millions and millions of people will soon be getting health insurance (via affordable care act) his office and other FP's all over the country are going to get swamped with people. The office is going to get so crowed he will have to start seeing patients in 10 minutes or less just to keep his schedule from being booked months in advance; and I would have to wait weeks and weeks for any appointment.

This is a dog whistle for the "get your government hands off my Medicare" crowd. The concierge practices use these folks' fear of all those "other" people who will be getting insurance to promote their business model. As of now, no physician in an ambulatory setting is obliged to provide non-emergency care to anyone, so the idea that any practice will get "swamped" with people involuntarily is ludicrous. If a doctor is spending 10 minutes seeing a patient or dumping you on a midlevel it's because that doctor made a business decision to overcome poor insurance reimbursements by increasing their patient volume and supersaturating their office capacity in order to sustain their practice overhead.

Concierge practices can and do fail. Some of you have the idea that you can finish residency, put up a sign advertising your exclusive practice, and start seeing patients right away. This is unlikely to work. The few concierge docs I know of that are doing well are the ones who have an already established panel that they cull patients from. Even then, the worry is that the "loyal" patients (there is no such thing in healthcare nowadays) will just leave you for a competing physician.

 

[LaughingMan]

A Pharmacist I know was telling me about her FP who went concierge.

She was extremely pleased with it. She said it was a bit pricey, but that she could get an appointment the same day when needed.