Inside A Practice

Concierge medicine can mean fewer patients and a higher salary

Concierge medicine can mean fewer patients and a higher salary

September 17, 2012 8:13 am by Stanley Goldis

The Patient Protection and Affordable Care Act is supposed to ensure that all Americans have access to quality, affordable health care and create the transformation within the health care system necessary to contain costs. With increasing numbers of physicians eschewing family medicine for specialties that will result in both higher income and fewer patient visits per week, how will access to affordable health care occur? While family practice and internal medicine physicians should serve as the quarterbacks of medical care, they are pressured to give less time to patients due to the low level of third-party reimbursements.

In a July 2012 PBS News Hour [2] report, Mark Murrison, MDVIP President, Marketing and Innovation, was quoted as stating that primary care doctors are “seeing 30 to 35 patients a day,” and “spending less and less time with their patients.” Murrison has become an increasing source of frustration to family medicine practitioners. An April 2011 survey [3] from the American Academy of Family Physicians shows the average number of patient encounters at approximately 25 per week.

Florida-based MDVIP [4] is a national network of more than 500 physicians serving more than 180,000 patients across the country. MDVIP-affiliated physicians see a maximum of 600 patients, with each patient receiving a minimum of 30 minutes with his or her physician per appointment. In contrast, according to MDVIP, a typical family practitioner has more than 2,500 patients with an average office visit of 8 minutes. Founded in 2000, MDVIP has experienced steady patient growth each year since its inception.

Last year, Accenture a global management consulting, technology services and outsourcing firm projected that by 2013 less than one-third of physicians will remain in private practice. A survey completed by the firm indicated that the rate of independent physicians being employed by health systems would grow 5 percent annually through 2014.

Clearly, many family practice and internal medicine physicians are shifting away from the traditional private practice partnership model in order to bolster income, reduce administrative burdens and better serve their patients. One option is to move to a hospital setting to reduce administrative burdens, while still maintaining a substantial caseload. Other doctors are becoming concierge physicians within the hospital environment to both reduce administrative time and earn more income. Still others are choosing to maintain solo doctor concierge practices. Each of these options has its pros and cons, which are beyond the scope of this post, however, some generalities can be made.

The solo concierge physicians who truly believe that their place in the medical world is to provide total, complete and continuous (24/7) medical care will likely have a less balanced work/life arrangement. I recently interviewed a dedicated concierge physician who (in practice for the past 10 years) stated that he had not taken a vacation in 14 months. As extreme as this may be, he has attempted to recruit other physicians into his practice; however the prospect of being available to patients 24/7 has dissuaded anyone from joining him. On the other hand, he is earning considerably more than he earned in his private practice and his administrative responsibilities have decreased since he no longer deals with the bureaucracy of Medicare or third-party insurers and their reductions in reimbursements.

Concierge physicians within the hospital environment may enjoy the best of both worlds. They see a reduced number of patients on a day-to-day basis while earning higher salaries and handling less administrative obligations than they would in a traditional private practice setting. Again, however, the work/life balance becomes difficult, as concierge patients demand more time and dedication from their physicians than traditional ones.

The hospital employee may still see 30 to 35 patients per day. This physician will also have reduced administrative burdens and avoid dealing with third-party reimbursements, while additionally enjoying more vacation time and fewer night and weekend calls. Compensation, however, is directly affected by the number of patients seen and the amount of reimbursements received. Typically, the hospital will be able to negotiate a better reimbursement rate and this may benefit the physician, but in reality the hospital will most likely get the lion’s share of the higher reimbursements.

Ultimately, the decision as to which practice model is appropriate will be determined not only by desired earnings, but more importantly by how one perceives the role of the physician and how that role will affect the physician’s work/life balance.

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[1] Image:

[2] July 2012 PBS News Hour:

[3] An April 2011 survey:

[4] MDVIP:

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