Call it boutique medicine. Retainer medicine. Platinum care. Evoking the pastoral image of a sturdy black doctor’s bag and spectacles, concierge medicine is a small but growing trend among over-worked and over-booked physicians. The practice essentially offers a limited number of patients the opportunity to pay a fixed annual fee in exchange for premium services and attention. Fees can range anywhere from $1,000 to $20,000. Concierge medicine has been dubiously received while transition necessitates limiting a physician’s patient base significantly. Imagine receiving a letter from your doctor of 30 years demanding an annual fee on top of the cost of your normal visits. Hurry your check, and you may be one of the lucky ten percent the practice will keep. Thousands of patients have been outraged to receive just this kind of letter from their family doctor.
I believe concierge medicine can indeed offer significant advantages if mixed with a dose of good, old-fashioned business practice. There exists a happy medium that allows physicians to spend increased time with patients without alienating long-term clients. In our practice, we demand no annual fee. We ask that Medicare patients pay out of pocket for their wellness visit; such payment is only covered when the patient turns 65. The patient can in turn be reimbursed on the insurance provider’s schedule.
If the patient is unable to pay, we will still provide the visit. In
considering a concierge practice, physicians should continue to accept
patients with Medicare or other third-party payers, but may ask for
payment directly before the patient files their own claim. The benefits
of a direct payment structure to physicians means a less bureaucratic
or “quota”-driven practice. The benefits to patients include same-day
appointments, complete and continuous physician access via cell phone,
on-site laboratories in clinics, and no anonymous hospitalists in the
event of a stay. Increased attention for patients leads to a much
higher rate of satisfaction and comfort.
Concierge medicine, from a doctor’s perspective, is a more
gratifying and fulfilling way to practice medicine. Today’s doctors
take on patient loads of up to 2,500 to 3,500 patients annually. Longer
appointments with concierge physicians means a thorough discussion of
patient questions and concerns. More time also translates into a real
ability to monitor wellness screens such as mammograms and
There exists the fear that concierge care will result in a
two-tiered medical system based upon economics. In the beginning, this
may have in fact been true. But as the practice has evolved over the
past decade, so have individualized billing plans. Ideally, physicians
should maintain long-standing relationships with patients regardless of
their ability to pay out of pocket. About 250 concierge physicians
exist in the United States today. Participating physicians report more
time to devote to patient care and advocacy, as well as continuing
medical education and family life. The result is a revolution in
preventative care and a return to a more personal relationship between
doctor and patient.