Concierge practices fail to thrive: I'm neither surprised nor disappointed

Today's Boston Globe reports that "concierge practices" are not succeeding. The concept refers to primary care physicians who cut their panels from about 2000-2500 patients down to 300-600 patients, and charge each patient an extra $1500-4000/year in exchange for better access, longer appointments, and more personalized care.It's interesting that concierge medicine hasn't caught on. Why hasn't it?

• Many patients get good service from their existing doctors. When the first concierge practices were introduced a few years back, my primary care doctor wrote a letter to the Boston Globe suggesting that the answer was for physicians to work harder to provide excellent care to a regular sized panel of patients for regular reimbursement. (I've always gotten good service from him --including same-day responses to emails.) I'd rather have him as my doctor than pay extra to someone who is more concerned about his own lifestyle.
• Primary care isn't the bottleneck. A greater problem is access to specialists
• It's expensive

I never liked the idea of cutting a physician's capacity by 75 percent to address quality of care. That's not how quality is addressed in other industries, and it's a bad idea for healthcare too. Just think what would happen if every physician, including primary care docs, oncologists, and neurosurgeons reduced their patient loads by 75 percent.