One of the members of my household recently enrolled in a “concierge service” physician practice – one of those practices where you pay a couple thousand dollars a year to choose one of their doctors as your primary care physician. That cost doesn’t actually cover seeing the doctor, of course; you’ve still got all of the normal insurance copays for office visits and treatment. That $2,000 a year just allows you to use the practice in the first place.
What you get for that extra money is a guarantee that on every visit you will see your actual doctor, not a nurse or physician assistant. They also guarantee that the doctor will spend at least 30 minutes with you and you get your doctor’s cell phone number and email address so you can contact them at any time. Plus some extras, like an MD on call 24/7, an hour-long physical each year and nutritional analysis and counseling.
I have some moral and financial heartburn about doing this. That’s a lot of money before you actually even see a doctor in the first place. And at a time when we spend so much time talking about the plight of the uninsured, this gold-star healthcare plan has a tinge of elitism that I’m not entirely comfortable with.
My relative had already brought these concerns up with the doctor herself. He had been her primary care physician for most of her adult life but two years ago, he left his practice to join this concierge service. What he told her then was that he had developed a citywide reputation specifically because he took so much time with his patients, kept up with research and put a lot of effort into figuring out the cause behind chronic problems and symptoms, rather than just treating them piecemeal. As his popularity grew, his practice had been pushing him to take more and more patients, bring in more money, cut corners on time with patients to fit in more of them and spend a little more time in the office. He said he finally realized he was shortchanging his patients and was starting to have trouble finding time for his children and wife.
So he left the practice to join this concierge service where he could practice as an old-school doctor, not an in-and-out-prescription writer.
That was two years ago and we didn’t follow him to his new concierge practice then. We’re going to try it now though, because my relative’s health is declining, perhaps due to the lack of a single, dedicated M.D. or maybe just because of age.
I mentioned all of this to my parents last week and they looked incredulous at the idea of paying a subscription fee for a doctor before you actually see the doctor.
I started trying to explain the benefits: that you get to see the actual doctor for long office visits and you get the doctor’s phone number …
They continued to look confused and I understood why. They live in a small town in rural Virginia. I grew up using the practice that they are currently at and it’s a different doctor now but the practice hasn’t changed. Of course your visit is with your actual doctor – who else would it be with? And 30 minutes? Back home, if you are sitting with the doctor for less than 45 it’s probably because you told her that you’re in a hurry. And the doctor’s number is in the phone book so if you need her after hours you just look it up and call her – everyone does.
It’s not just their practice – it’s all of them back home and in most of the small towns I’ve been in.
I told my mom about my experiences going to the doctor since I left for the big city. You probably sit in the waiting room for an hour after your appointment time. You probably see a nurse practitioner or a physician assistant, not a doctor. And whoever you see is probably only with you for five minutes and doesn’t remember your name from one visit to the next. It’s just the way it is in the city and I’ve gotten used to it.
She reminded me that I’ve been thrilled with my own city doctor and that’s true. I love her for the same reason that my relative loved hers: I got long office visits with someone who remembered me, spent time considering my overall health and following the new research in medicine. Of course I still sat in the waiting room for more than an hour, my doctor is really a nurse practitioner, and by “long” office visits, I mean she stayed with me for 10 minutes, not the regular 5. But after 20 years in the city, I’ve gotten used to in-and-out practices so 10 minutes with someone who knows my name seems downright luxurious.
It’s all in the past though – six months ago, my doctor left her practice to join a similar concierge service for the same reason: she’s tired of not seeing her family or her patients.
These concierge services have been a growing trend for the last two or three years and maybe this is just the way things will be now: that those who can pay extra will get personalized medical care and the rest of us will just end up getting used to long wait times and short service.
What about you? If you’re a doctor, do you feel the pressure of more patients and less time? And if you’re a patient, do you still have an old-school doctor or are you at an in-and-out practice?
And most importantly, is there any way to make general practice a profitable career while still providing personal service to everyone?
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