By now you must know I married into a family of doctors. Bob’s father and his two uncles were doctors. He has a cousin on Long island who is an orthopedist, and one who was a practicing OB back in NJ. We have the MD gene and it runs deep. We would pack the kids up for the annual trip back to my MIL’s Seder each year, and one room was always devoted to a pick-up medical clinic – a Woody Allenesque review of sprained joints and aches and pains. So I’ve been hearing the disheartening rumbling with managed care for a long time now; but I’ve only recently heard about the Concierge or Boutique practice model.
Yesterday, a woman at the knitting circle mentioned her Cville doctor was turning his office into a Boutique practice and she was very willing to pay $1,600 a year for his time and attention. Now that’s just the fee to stay one of his patients, he’s whittling down the numbers from around 2,000 to only 500 patients. Some doctors will take medicare and insurance, others have given up completely and bill you, insisting the patient deal with the third party.This woman also said she thought that Proctor and Gamble owned the company that was going to run his new office. Look around, Family Practice and Internal Medicine docs are flocking to this model, officially called “retainer medicine.” This annual fee she felt would guarantee her access to the doctor, via email and phone, immediate appointments and even house calls!
I was surprised at my reaction. I said that’s too bad, because I see it as an ethical dilemma. In our great country, where the public option was taken off the table in the new Affordable Health Care reform act we barely managed to pass in order to appease insurance companies, a Concierge practice will only broaden the socio-economic gap between those who have so much, and those who are struggling to get by. The broad part of the middle class will become more fractured. I became slightly edgy, ranting about our fee-for-service medicine like I was some kind of, dare I say, socialist liberal. My knitting suffered. Intuitively, I just felt it was wrong. How can America be so alone in the world at not providing universal health care for its citizens? Here we are, with Africa…
Yet when I searched a popular physician website for “Concierge Medicine” there were 8,340 articles – all of them positive. They compared it to the choice of a private school over public, they said that while waiting for government to fix the system they decided to “…take matters into their own hands.” They reported about doctors going bankrupt! http://www.kevinmd.com/blog/2012/01/concierge-boutique-label-discredits-retainer-medicine.html They almost made me a believer. Almost. What do you think?
MountainMornings 
As a Patient, I often feel anonymous. I have known my Internist for more than twenty years, living in the same neighborhood, and sharing very personal information. Yet, he and I are essentially strangers. It is impossible to speak with him by phone. He only communicates with me if I agree to pay the $300 fee (on average) for the in-office consultation. When together, he asks me questions about my ailment, orders tests, writes me prescriptions and in passing, asks about my family. My test results are reported by his Nurse or more typically by his Receptionist. I recently received a form letter from his office indicating that he and his medical colleagues were affiliating with a management company to better serve his patients. I read this as greater difficulty in the future to have a timely and personal communication with my Doctor. In the same letter, an offer was made to participate in a new and improved practice of medicine as you describe in your Blog. I can be guaranteed a quicker, more personal form of medical care if I chose to “join” the club (my term) for the very reasonable fee of….I have chosen to forget the amount. The implication is forget about receiving timely and personal medical care if I don’t join the club. But it gets worse! Since I am sixty-five years old and have become a Medicare patient (with supplemental health insurance from my former employer, btw), I am informed that the Doctor’s Office is not accepting any new Medicare patients. Maybe if I join the club, the Doctor will accept my government insurance and try to fit me in…
This kind of treatment is unfortunately not unusual. I’m sorry you’ve had to experience it. Medicine is an art, not just a science full of numbers and scores on tests. Older GP and some OB physicians just gave up when it became clear they could no longer make a profit in their practice and they feared malpractice (which could be brought to court for a full 18 years after delivering a baby). Younger docs grew up in this environment – it’s those that are our age who have trouble adjusting to becoming “providers.” They have to see more and more patients in the same amount of time just to keep the door open. They are not trained in business management, and also they are not screened for social and emotional intelligence. When you find a good one, you want to keep that relationship. My brother got a letter from his family practice doc that he was “dropping” all medicare pts! I would ask your friends who they see, maybe check out a university hospital group of Internists – they are non-profit and will take the time to get to know you, and get your email, and bill medicare!