An apple a day plus $2,000 a year — for another year

About a year ago, I wrote about my wife’s decision to join a “concierge service” physician practice where you pay a couple thousand dollars a year to choose one of their doctors as your primary care physician.

Tara Courtland

Communications Director Tara Courtland

It was a difficult decision because that $2,000 a year doesn’t cover actual trips to the doctor — we still have to pay all of the normal insurance copays for office visits and treatment. The $2,000 is for the privilege of using the practice at all.

Last week it was time to decide whether to re-enroll for the coming year so we spent a few minutes considering whether it had been worth it in the previous year.

In the last year, the number of trips to the doctor has dropped dramatically because she doesn’t actually have to GO to the doctor. She calls him. She emails him. He answers his cell phone, gives advice over the phone, answers her questions, and sometimes even calls in prescriptions.

This is somewhat of a godsend for a minor hypochondriac with a limited amount of sick leave available for doctor’s appointments. She doesn’t need to go in for every single issue – 95 percent of them are resolved by hearing a doctor she trusts reassuring her over the phone that it’s fine, or calling in the medicine she needs, or just setting up a referral to a specialist.

A few weekends ago, for instance, she thought her fingernails looked funny. She was concerned that perhaps it was a sign of some type of infection or a critical problem with her internal organs.

She emailed him a picture on a Saturday afternoon and he wrote back within an hour to say that fingernails sometimes do funny things for no reason, but in looking at her chart, he saw that she’s due for her annual bloodwork soon anyway. He set her up an appointment to have bloodwork done on Monday and included some type of fingernail-assessment in the bloodwork request. Because it was just a blood draw, she didn’t need a copay for the visit. And miraculously, her splitting fingernails turned out not to be a sign of bubonic plague. So that was a relief.

There have been a number of interactions like that over the course of the year. I don’t think we’ve saved $2,000 in copays, but the copays we haven’t had (from all the times she would otherwise have gone in to have something checked), combined with the amount of time she’d have had to take off work to do it have about evened it out. Adding to that her peace of mind from being able to talk to a doctor any time she wants … it ended up being an easy decision to renew for another year.

I remain troubled, however, by the need to do this. There are social and political ramifications that come from good doctors opting out of the general population to do high-end care only. And there are ramifications that come from the people who are smart and engaged and socially conscious making a decision to just throw money at their own personal medical problems, rather than demanding better care and better results from the healthcare system as a whole.

These things trouble me as a citizen and as a person who wants the entire healthcare system to be more affordable, more fair, more accessible and less burdensome on practitioners. On the other hand, I also like it when the answer to the question “My shoulder hurts. Do you think it could be cancer? Should I go to the ER just in case?” is “No. Email your doctor and then go back to sleep.”

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About Tara Courtland

Tara Courtland is the communications director at NEMT.
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