My 36 year old single daughter is suddenly faced by a set of medical problems that are painful and potentially lethal. She waited one month to see her primary care physician and was seen instead by a nurse and a nurse trainee. They gave her referrals to three specialist practices (no specific names) and told her to make the appointments. Waiting times ranged from one to six months, with no one concerned at all that the logic of seeing a surgeon before one had a diagnosis from a GI or GYN doctor. She is a working woman with basic health insurance and on her own would not be able to afford the $6000 that her hospital charges for concierge care. I can afford to help her but found your article very helpful in sorting out the issues involved. The bottom line: we just need help–someone to answer questions, to set up specialist appointments in a logical way, to set up diet and other wellness regimess that will get her through the very anxiety-provoking wait times that seem to be unavoidable. Retired people like us spend $6000 on a winter cruise. I would rather spend that much on seeing my daughter through this very scary time, and despite my fury that the American health care system is so poor and so expensive, I am very grateful that big hospitals are providing this service, because it is a badly needed antidote to the current problems.
Exactly what DPC and Concierge medicine are designed for….to allow options. My only concern is the incorporation into big business and institutions…the very same reason for current healthcare failure. Find a physician seperate from big business…one who CAN and will speak the truth concerning your care. Big business, including the hospitals, are much to blame for the current healthcare crisis as they are motivated by money.
I have been a concierge physician since 2005. We have a three physician practice. Our fees are relatively low, age adjusted and range from $800 per year to $2,600. We have many pro bono patients based on economic need. I am the chair of the American College of Private Physicians, a porfessional society for concierge and DPC doctors. A few years ago I was asked to write a textbook section on concierge medicine for a book on medical professionalism, “Professionalism in Medicine, A Case Based Guide for Medical Students” published by Jefferson Medical College, and though a bit dated it is still useful. There are several published papers demonstrating the great benefits of concierge medicine, most done by MDVIP which draws its data from over 800 of its concierge practices. These studies for example show up to 90% reductions in hospital admissions and better outcomes for members than for matched patients with conventional care. I am surprised the author did not find these studies as they are common knowledge in my circles. I would be happy to talk to the author of this article any time.
Pay less for something and get less of it and/or a lower quality of it. Pay more for something and get more of it and/or a higher quality of it. We’re not outraged by this in any other aspect of our lives. Why should medicine be different? I don’t currently have concierge medicine, but I sure as heck want it to be an option.
Great article! I was super interested in the paragraph that begins, “These arguments reflect pressing health care concerns across the United States, which has a well-documented health care gap that falls along socioeconomic lines” and goes on to elaborate on some then vs now comparisons. Do you have sources for those stats? I promise, I’m not digging for dirt or anything, I just genuinely found those statements interesting/terrifying/disheartening, etc. and would like to see the original articles. Thanks!
Steven King: in no way was I equating concierge medicine with direct pay, as you will see if you reread my note. And, yes, DPC is definitely a way to go for those lacking insurance, but can afford the monthly retainer. I know that my physician has a number of patients who fit that demographic.
We must evaluate this appropriately as I believe there are assumptions being delivered in this article. First of all we have an obligation to give “appropriate care”. That is to give care where there is” time” to listen, diagnosis and treat…..but most importantly prevent the illness. We talk about equality of care and what most people want is equality with the top 10% not the bottom 10%. CDC recently published in 2016 that the US health care system is the 3rd leading cause of death. I do not want to give people more access to this type of system of rushed hurried care. When delivered appropriately we can lead our patients out of that sinkhole. When the third party payers dictate care such as government and insurance companies and dictate how much time you have to give to keep your clinics open in order to see the volume sufficient to the cover the high overhead. Most people do not realize that physicians cannot keep their doors open anymore in the current model. Most of that overhead is going to admnisistrative bodies to run the system. Most primary care clinics owned by larger healthcare companies are run in the red and lean on specialty and hospital care to balance the sheets. There are areas in medicine that I am proud to still say we provide exceptional care, however, in primary care we cannot provide effective and appropriate care in the models that employ most providers and physicians. I would be happy to share the biometrics in my clinic compared with the standard clinic data or national data.
Remember if you pursue and want standard of care medicine for the patients in your areas, then , you should expect standard of care results as we have seen the CDC data above. People make value choices all the time of lifestyle choices, from vacations, to the vehicles we own, to cable TV bills, smoking cigarettes, eating meal at resturants, elective surgeries, fashion appearel etc… I think to pursue a level of care that is backed by evidence and improve health status, DPC and concierge models eliminate the third party disrupters and bring the physician/patient relationship back to a level that can deliver health and sick care as we all imagine it to be.
Please don’t confuse Direct Primary Care with Conciere Medicine. True DPC practices are a great value for patients. DPC practices typically charge a nominal fee of $50-75/month with unlimited visits and greatly discounted labs and generic medications.
Equating a DPC practice with a Concierge one is the same as saying water and vodka are the same drink…they both are clear and will get you wet if spilled.
I wrote my doctoral dissertation on concierge medicine in 2008 and I included the various spinoffs available then. The ethical aspects of it were dicey and still are but, as we all know, there are the haves, the have nots, and the have mores. At that time there were only some 200 concierge practices in place, and I ultimately concluded it was too early to place any bets on it becoming a thing, that it might ultimately be just a passing mention in the history of medicine.
The irony of it all is that I find myself a patient in a direct payment practice which, while not nearly as deluxe as a concierge practice, better suits my medical needs. It also better suits my physician’s needs/desires, since she goes to Haiti annually for a week to care the Haitian people, as well as heading up a free clinic for the homeless in town. She and her partner have been available to my husband and me 24/7 and, unfortunately, we’ve had to make use of that availability on occasion. That I could get through to my physician immediately amazed the EMTs who were present. Lest I sound like one of the have mores (although I am, to some degree), the cost for the two of us is $1900 per year. That’s the cost of a latte a day which many spend without a thought. Priorities, priorities.
I do believe public universities who receive government funding should not be dabbling in concierge’s medicine. Now they have a hand in both pots. However, as a physician but also a healthcare consumer, I want this option for me and my family. We are not yet a socialist society where everyone is condemned to the same inadequate and lacking systems of education, healthcare and housing that the government can provide. If the affordable healthcare act taught us anything, it taught us that they will fill the gaps in healthcare with subpar care to cover everyone. Midlevel providers (oops, I’m supposed to call them Advanced Practitioners this week) replace primary care and now even the waits to see them are climbing. Government supplied healthcare is NOT the healthcare that the upper echelon wants. They are now calling us physicians “providers” so why not treat it as the consumer based product it really is? If I am providing and charging for a service, my services that require increased work, time or convenience should cost more. If the healthcare consumer (who used to be called a patient) wants more, why should that not be available? I for one would love to see private pay healthcare take off and essentially strip the power from the insurance companies.
Thanks for writing this and exploring some of the issues associated with concierge medicine. As a pediatrician in a primary care practice that takes basically all insurances equally (we are about half Medicaid or CHIP) the ideas of concierge medicine and to some degree direct primary care have never sat well with me. I too would love vto hear about outcomes data, hopefully there is some research somewhere that is starting to look into this.
Thank you for a timely, important article. There’s a further angle that I think warrants discussion regarding concierge medicine and academic settings. Currently 60% of undergraduate teaching at US colleges and universities is done by adjuncts, who get no benefits or health insurance. Thus the academic world is now engaged in actively exacerbating social inequity, particularly regarding medicine. Many adjuncts I know cannot afford health insurance. Under Obama-care the ones who earn below $48,000 annually do qualify for assistance, though it must be stressed that if you earn more than about $40,000 annually you don’t get much assistance at all. On the individual health care market, if you are over 50 health insurance now routinely costs $700-$1000/month, and that is with very high deductibles. Thus it is increasingly the case that adjuncts and other self-employed people (writers, journalists, Uber drivers, gig economy workers, people with modest middle-class incomes) may be paying easily a quarter of their total pre-tax income in health care costs. It is utterly immoral that public universities, or any universities, who claim to care about social justice, are promoting concierge medicine to a small group of elite faculty at the same time that they are hiring ever-more adjuncts without any health insurance.
great article. I am a Michigan alum, taught here for twelve years and started using the medical system in 1960. I am totally opposed to two tiered delivery of health care, which we already have, given the stats on who lives longest, but this would make it worse.
Wow, this is such a well-written article. You really care about our community and without being editorial present the evidence in such a convincing way. Concierge medicine does not belong here.
I’m a concierge doctor. I can tell you there are some seriously thorny ethical issues involved. They are not easy to resolve in either direction.
This is complicated by the fact that the insurance model has become unethical, as well as intolerable on it’s own.
However, I think that concierge doctors need to own the reality of the ethical implications (problems) of this form of practice. And socially we need to decide whether we are willing to abandon capitalism in regards to healthcare, or not… And that’s *not* an easy or obvious decision.
My only concern to this article is the idea of looking for evidence. Concierge medicine is new. We’re still adjusting, innovating. It’s a bit absurd to think that definitive evidence could be generated this quickly. It’s like looking at the “evidence” for open heart surgery in 1960… Every single attempt had failed, for many many years.
Between 1950 and 1955, 18 attempts at cardiopulmonary bypass were published. 17 of those patients died.
And yet, despite “evidence” to the contrary, DeWall persisted in trying again. Ultimately successful, he ushered in a new era of cardiac surgery that is only possible because he continued to tinker with a process until it worked as hoped… And *then* there was evidence.
Any other approach devolves into a combination of stasis and industry-funded pseudoscience (since individual physicians would be cut out of the innovation process).
This systematic re-tinkering is far too new to think that reliable evidence would be available, especially in the domain of primary care, since we are looking for lifetime outcomes, which, to paraphrase Atul Gawande in his piece, “The Bell Curve”, often hinges on seeing, on a daily basis, the difference between 99.5% success and 99.95% success.
I would add that all such innovation begins as cost-ineffective solutions.
I’m happy to discuss further if interested.
Totally sounds like the two-class health system from Germany – “normally insured patients” who have long waits and have to pay for some care out of pocket and “privately insured patients” who recieve appointments faster and have more extensive coverage
When my primary care physician at Washington University in St. Louis moved to a concierge service he also physically moved from the city of St. Louis to a wealthy suburb. I liked him a lot but I refused to follow him on ethical grounds.
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