OP/ED: From S.C.: “Concierge medicine – a traditional doctor’s view”

February 27, 2013 – By MIKE SILVER — 

A local traditional internist believes all care, for everyone, should be “concierge.” And to that doctor that would include fast call backs, care in the hospital, cell phone access and useful websites.

Concierge medicine purports to give 24/7 access, faster appointments, little waiting time, heavy emphasis on preventive medicine, etc. But it comes at a cost, usually $1,500 to $1,800 as an annual fee and the physician still accepts your insurance. Some fees are much larger, in the thousands, and there are hybrid forms where practices take both concierge and traditional patients.

To many, it is a questionable practice, creating a two-tier system of medicine for the “haves and have nots.” It is growing to a degree. According to a CNBC website posting, there are about 4,400 concierge physicians in the U.S. The American Academy of Private Physicians (AAPP), a concierge trade group, reports 1,000 practices were opened in the past year.

A local internist responded to the CNBC report: “Concierge Medicine: Not For The Rich Anymore.”

In the report one of the writers said: “The growth is in response to rising demand … concierge practices are not likely to see a big bump as more people become insured under the Affordable Care Act …Most concierge patients have insurance. Concierge medicine is extra icing on the cake.”

The local doctor responded to some of the points in the report.

  • Report: Doctors (who contract with the major concierge practice management company) encourage emails and even texts because patients are given doctors’ cell phone numbers. Doctors can spend half an hour with patients. This improves communication.
  • Doctor: Every doctor should do this. I and many others do.
  • Report: In traditional health care, physicians and patients are on a conveyor line. So there is no clear follow up.
  • Doctor: This statement instills fear, uncertainty and doubt. It’s a big sales pitch that’s used.
  • Report: But those in the business say the regular exams, additional testing and other preventative care offered by concierge-style medicine are its greatest assets.
  • Doctor: All evidence does not support this statement. In fact excess testing, not indicated, is harmful. Understand, many tests are not covered by Medicare and rightly so. Many of the tests billed have no evidence of need. As to time, a well run practice can turn a 15-minute visit into a 7-minute visit if a physician/patient relationship exists. On the other hand, a 15-minute visit can become a 40-minute visit, if that is what is needed.
  • Report: Because concierge doctors can be reached by email and cell phone, travelers can benefit from this style of medicine.
  • Doctor: All doctors should be available and give patients all the communicative tools whenever and wherever they get sick.
  • Report: Concierge care is suited to the chronically ill, particularly ailing seniors. Some older people may want house calls or three-way conversations.
  • Doctor: Totally wrong. Ninety percent of concierge physicians do not have hospital privileges. That is what the chronically ill need as their primary physician in the hospital can stop medical errors.

The doctor had a lot more to say. He does agree with one advantage concierge physicians have and that is time. After all they limit their practices to 350–600 patients and make up the revenue with annual fees.

The executive director of AAPP in the same report states, “There’s a wind in the sails of concierge doctor supply and demand.” Perhaps, but there is also lots of air coming through the holes of people’s pocketbooks who pay these fees, often unwillingly, because they love their doctor.

The biggest flaw in concierge medicine is simply this: How can you call yourself a concierge physician and not care for your patient in the hospital when he or she really needs you, especially in smaller hospitals? At that time you don’t care about 24/7, quick appointment scheduling, email capability or the like. With all due respect to hospitalists, your own primary doctor truly knows you as a patient, knows your history, knows your family situation and is perfectly capable of caring for you or getting the right specialist for your care, if needed.

Although social visits by concierge doctors may be comforting to the patient, its clinical efficacy is questioned by many since most have no hospital privileges. In our area most traditional primary doctors leave their patients’ care to the hospitalists. They also do not have privileges. The doctor mentioned above sees his patients in the hospital.

Patients have to judge for themselves the value of concierge medicine. There are many physicians who give high-quality clinical care, provide patients all the services as best he or she can, without extra fees. Let’s face it, some people simply cannot afford $1,500 every year; they can hardly pay for their insurance premiums. As I have said, something is wrong with our entire health care delivery system and its costs. We deserve better.

Columnist Mike Silver lives in Pinecrest and may be reached by email at michaelsilver@hargray.com or by calling 843-815-3894.

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