Concierge medicine: not the answer

Readers don’t usually realize it, but reporters rarely write their own headlines. Headline writers and/or editors write a headline that fits the space and captures the essence of the article, but the reporter usually gets the credit or the blame.
In This is Spinal Tap, David St. Hubbins (played by Michael McKean) says, “It’s such a fine line between stupid and clever.” It’s meant to be a ridiculous statement, but when it comes to headlines he’s actually correct.

A lot of what headline writers think is clever is really just cliched. For example, read an article about online doctor/patient messaging and you’re likely to see it headlined by some version of “Take Two Aspirins and Email Me in the Morning” or “The Doctor will Email You Now.”

What got me started on this subjct was another clever/stupid headline in the Atlanta Constitution:

Concierge medicine: Rx for stressed health care system?

(By the way, saying something is an “Rx” is also a classic headline writer’s device when talking about health care policy. It also has the advantage of being short.)

The only positive thing about the headline is the question mark. Concierge medicine helps individual doctors and patients but it’s definitely not good for the health care system. Physicians who convert to concierge practices reduce the supply of primary care, which is already constrained. That’s not an “Rx,” but perhaps a “prescribing error.”

To its credit, the article presents a balanced view. It even mentions one of my favorite observations about concierge practices: that there’s less demand for them than you’d expect. Concierge doctors aren’t even able to fill the limited number of patient slots they make available. As I’ve mentioned, I’m neither surprised nor disappointed about that.

November 9, 2007

5 thoughts on “Concierge medicine: not the answer”

  1. Lawrence R. Brownlee, MD – Tustin, Orange County, California. Started a concierge medicine practice at the request of some of his patients. All is well after three years.

    MD Elite, mdelite, MD VIP, MDVIP

  2. Well, still another non believer. As someone who has been following the burgeoning rise in the number of concierge practices, it is growing in number. And as I’ve always contested, it does not have to be a price retainer fee. New practices that charge as little as $25 per month are sprouting up.

    It is the best type of healthcare a patient can deliver. It should be what every citizen in this country should expect from their doctor (not NP, PA, etc).

    I would rather health insurers stop cutting reimbursements, keep up with inflation and loose the SGR – then there would be no need to cram more people into 1 hour slots.

    By the way, concierge medicine is better health care. That’s why it should exist. The trick is learning why it works and applying it to the “national health care” model.

    If you don’t want to reduce the number of PCPs, do the obvious – raise reimbursement, decrease paperwork and overhead.

    Forcing Americans to accept a lower standard of care just so it meets the needs of more people is not justified, nor fair.

    Concierge medicine is a revolution – the only kind that doctors have the power to create. We are not going to strike, we are not going to stop accepting insurance, we are not going to do anything the AMA polls say doctors will do.

  3. I think people who argue that concierge medicine will decrease access to heath care for the underserved are missing something. I agree with the above commenter that reasonably-priced concierge med practices make it feasible for regular folks to get this level of care.

    I would add that opponents seem to think that the supply of primary care docs is a fixed quantity. This is incorrect. The fact is that if primary care can be shown to be rewarding both personally and professionally (as it once was), we could see an increase in new primary care docs hitting the market in at most 3 years (the length of family practice, peds and internal medicine residencies). Of course, the fact is that many current internal medicine residents are in the process, right now today, of choosing a subspecialty over primary care. If they see this sea change happening, I am confident that some who may have gone the specialty route will change their minds and get in on the ground floor of this burgeoning field.

  4. I left a busy group practice in Fort Myers, Florida in 2005 to start my house-call based concierge practice. Originally I tried to deal with insurances but since none pay for house-calls, and Medicare only reimburses minimally, I couldn’t make it viable. In our area it’s not uncommon for me to drive 30-45min between visits and I typically spend 45-60min with a patient. Hence I was drawn to the concierge business model. I am still the ONLY concierge physician in South-West Florida exclusively making house-calls in Lee and Collier counties.
    No mistake, my services are a luxury item and convenience for most of my patients. I charge $2000-$6000 a year per person, depending on age, size of family, and location.
    I know it’s not the answer to our health care crisis, but I certainly love my job again! Besides I get to see my kids more.
    Two other key points for the lay-person to understand. Just because I charge above what insurance pays, doesn’t make me rich. I actually made less than our city pays bus drivers for the past 2 years, although admittedly the potential is significant. Also, even though most of my patients are the “rich and famous” of our area, doesn’t absolve me or any concierge physician of our responsibility to the community. In fact this is a responsibility of each of my patients as well.
    I continue to be an active office in the US Army Reserve, chair the Health Advisory Committee of the Lee County School District, volunteer as a Guardian ad Litem serving abused and neglected kids, teach Head Start program moms about child care, etc…
    No, concierge medicine isn’t for everyone, but it certainly has worked for me and my patients.

    Andrew Oakes-Lottridge, MD
    Personalized Health Care, Inc.

  5. Wayne M. Burr, MD
    Concierge Internal Medicine
    (239) 333-DR4U(3748)
    9407 Cypress Lake Dr., Ste. C
    Fort Myers, FL 33919

    Healthcare should be about choice and how one recieves their care. Concierge medicine gives the public another choice in how thier healthcare is delivered. Why should the public be forced into practices that demand more from physicians in less time? As more people learn about this practice model, more will understand the benefits of belonging to a concierge practice.

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