Concierge Medicine – The Future or the Past?

Health and Healthcare CategoryThe current US healthcare system is broken. Few would argue this point. Rising costs, decreasing reimbursements, more lawsuits, insurance hikes, and an aging population are just some of the difficulties that face both physicians and patients today, and the situation doesn’t seem to be improving.

One of the other major problems is the shortage of time. In order to make ends meet, doctors are being forced to see more and more patients in the same amount of time. For many physicians, what used to be an hour for new patients and half hour for established patients has been shrunk down to 20 minutes for a new patient and 10 minutes for an established one.

How could quality care possibly be carried out in such little time?

MannequinsThe recent advancements in medical technology and preventative medicine alone would take hours to adequately explain to a patient. Needless to say, accomplishing this feat is essentially impossible.

As a solution to this problem, an increasing number of physicians are turning to something known as “concierge medicine,” or “boutique medicine.” Under this system, patients are required to pay a yearly fee to the physician above and beyond the cost of their healthcare, which can range from $1,000 to $20,000. In return for this fee, they are granted a much higher level of access to their physician than one would expect. Doctors who participate in concierge medicine spend an hour with their patients on visits. They give out their personal cell phone numbers to be reached at all times. Many make house calls at no additional fee. Physicians guarantee that if you are sick and need to be seen, you can do so within 2 hours. Those long waits in the doctor’s office? Gone. Concierge physicians guarantee no wait in the waiting room.

Does this arrangement sound enticing to you? What would you do if you could spend an hour with your doctor on a visit, going through each of your problems in detail and really discussing the issues surrounding it? What if your doctor took the time to get a complete family history and perform all the latest cutting edge screening tools to assess your future risk for disease? Quality of care under this system would almost necessarily improve.

Of course, controversy stems from the fact that patients with lower income would likely not be able to afford these services. Also, if doctors are seeing fewer patients then we would need more of them to meet the demand. The system isn’t perfect by any means, but it’s a start in the right direction while we wait patiently for tangible universal healthcare. What do you think?

  • Dr. Surve is correct about the benefits of concierge medicine – benefits experienced by both the patient and the doctor. I opened one of the first concierge practices in this country 8 years ago. I’ve just written the first book to be published on the subject, “Concierge Medicine, A New System to Get the Best Healthcare” (Greenwood/Praeger, May 2008). Though there are controversies, concierge medicine is now available for the middle class and is quite affordable in many areas. Most of the arguments against concierge medicine fall apart under scrutiny. I have an entire chapter in my book devoted to this issue.

    Concierge medicine is driven by patient dissatisfaction over our present fast-food medical model of HMOs, PPOs and a failing Medicare system. Patients love the time they have with their concierge doctors. Doctors love having the time to do what they were trained to do. Unless primary care medicine becomes more attractive to young doctors, by implementing models such as concierge medicine, no one will opt for a career in internal medicine, family practice or pediatrics and the shortage of primary care doctors will only worsen.

    Steven D. Knope, M.D.

  • It is an interesting alternative or supplement to the idea of universal health care. I think that this is a logical extension of market segmentation, but I think when applied to health-care (and not airline tickets) it could be viewed as elitist. It’s an interesting idea, though, and worth a shot.

  • I use concierge medicine, as I have a quite rare, complex genetic condition. I’ve found that it is an invaluable investment for my situation.

    I think the elitist criticism is a real, serious concern. I would love to see some of the management companies taking the initiative to do their part to mitigate this issue. For instance, my doctor has limited his practice to 600 patients. I’d be willing to consider switching companies if there was one that limited the practice to 500 concierge patients and 100 patients who were unable to afford the service.

    Additionally, I believe that whatever the ultimate outcome, the emphasis being put on healthcare and the growing issues involved will have a positive impact on the current circumstances.

  • Diana

    Insurance companies worried about people with existing conditions and/or poor people not being covered? Family practitioners elitists? Good! Where’s there’s smoke there’s serious competition.

    CNN has an article on “Qliance” medical group in Seattle, Washington. It seems to me, we should let doctors choose how their monthly or yearly flat fees are invested to provide reliable income and invest in new medical technologies.

    The top down approach of insurance models usually insures the money stays at the top. Instead a truer free market approach would be, to let people choose their doctor then in-turn let doctors chose their investment company. For low income and complex cases the government could provide extra incentives or medical vouchers to offset cost.

    Why should doctors be at the mercy of bean counters? Doctors are the producers the providers. Insurance or investors should be catering to them. Why should I have to have a degree in medicine and business to understand my insurance or medical billing statement. How can a doctor treat you if they don’t even know you.

    Ten minutes isn’t enough time and doctors are continuously coming and going in our PPO. We spend 7,500 dollars out of pocket and our employer matches with another 7,000 for basic service. Imagine how a doctors group could invest this at 500 patients per year. Imagine the insurance administration cost this would save.

    I have lost trust in the medical field do to the increasing greed and influence of insurance companies and their profit margins over actual medical care. My only interest in a new business model is to bring back integrity and worth to the field of medicine.

  • sue

    hmm. it is an interesting idea, but as a middle class single parent, I currently pay about 2400 for employer health insurance coverage. This service is an add on, right? does not cover hospitalization, specialist visits, physical therapy, lab tests, etc, etc, correct.

    I would love to have this kind of coverage, but I think Dr knope is severely mistaken about what income level constitutes “middle class” If I were to pay $6k a year (assuming that is per-family), then I would be spending about 20% of my after tax income on medical care.. If you include inevitable incidental expenses.

    It’s a lovely idea, and not surprising with the general 30 year decline of middle class income levels, and increase of income levels for the super-rich that this would come about. But let’s not pretend anyone below the top 5% income level could afford this.

    Perhaps if doctors considered an “economy rate” concierge service (forget the house calls and 24 hour service, just give me a good intelligent physician who is willing to treat me like a human, actually thoroughly research my situation, recommend preventative measures and spend more than 5 minutes in an appointment) and I might consider.

    The other thing this leaves out of the equation is other health care professionals. I had a recent back problem, and some of the most compassionate, indepth, and ultimately helpful interaction came from a physical therapist who was deeply trained in some specific current research and methods for muscle training to help eliminate the problem – not just as a quick fix, but on a long term basis. What she gave me actually has helped, But when I tried to discuss what I had learned from her with my primary care physician, she had no idea what I was talking about.

    In my opinion a good physician is not enough.

  • Rocky

    This post is really amazing. i like it a lot.

  • Rocky

    this is a nice post

Sajid Surve, DO

Sajid Surve, DO, is a physiatrist, acupuncturist, and osteopath who specializes in musculoskeletal medicine and integrative medicine.

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