We recently received a letter from our primary care physician of some 17 years inviting us to "enroll" in his new program, a nontraditional upscale approach to health care variously referred to as retainer practice, boutique medicine or more commonly, concierge care.
According to the service with which he's affiliated, MDVIP, he will be the first primary care physician in the Tri-Cities making this change. I have the feeling he won't be the last.
Why is my doctor doing this, and how will his decision, and if I'm right, the coming wave of Washington primary care physicians following suit, affect our health care choices?
Primary care physicians, faced with discounted HMO and Medicare fees (as well as managed care limitations) reportedly boost their patient load to maintain a satisfactory income. This can result in a patient spending 10 minutes or less actually consulting with the doctor. Often, patients may see only a nurse or physician assistant. Physicians also are doing their own lab tests and operating weight loss clinics and "medical aesthetic services" in order to bring in extra dollars. All this takes away from the doctor's original reason for entering the profession.
According to the letter I received from my doctor, his primary motivation for making this change is enhanced patient wellness. Under the concierge care business model, my doctor's patients will pay a retainer fee of $1,650 annually and will receive "enhanced medical care," including an annual physical exam from which a "personal wellness plan" will be developed. Patients will receive same-day or next-day appointments that "start on time," unhurried office visits that "last as long as you need," and 24/7 access to the doctor. Office visits and consultations are not covered by the annual fee. Interestingly, this retainer-based medical practice model was pioneered in Seattle in 1996 by the former team doctor for the Seattle Supersonics.
How is my doctor able to provide this enhanced care? By drastically cutting his patient load -- by something like75 percent (from 2,500 to 600). And this is part of a doctor's motivation for making the change. Under the concierge care model, doctors feel they are able to spend more quality time with patients.
But concierge medicine has an added benefit for primary care physicians. They typically average about $175,000 per year; much lower than medical specialists. Working under MDVIP's concierge care model could boost my doctor's income by as much as $485,000 a year; a 277 percent increase.
What about the patients? How will they be affected by the change? Patients who can afford the retainer fee probably will feel better about their care. But those less well off, especially older patients on Medicare, and the poor, dependent on Medicaid, will find themselves looking for a different primary care physician, disrupting sometimes long-standing physician-patient relationships.
Medical ethicists and consumer advocates are concerned that the move to concierge care creates a two-class system of medicine, and with the growth of concierge practice, selective rationing of health care services and expanding class distinction. Fewer and fewer medical school students are choosing to become primary care physicians and projections are that by 2020 there will be a shortage of from 90,000 to 200,000 primary care doctors.
One can understand that long hours and lower expectations concerning reimbursement may be drivers for a changing medical practice model, but is concierge care the solution to this problem, or another symptom of a broken health care system?
-- Richard Badalamente retired from PNNL in 2003. He lives in Kennewick.