By Cari Erickson | March 27, 2013 | As the ObamaCare law is phased in, health policy experts predict a growing physician shortage. Although ObamaCare did not create this shortage, it will worsen the problem.
Many doctors are responding to the new law by retiring early or reducing their hours in what the American Medical Association describes as a “silent exodus.” The Wall Street Journal reports an expected shortfall of 60,000 physicians in 2015 and 90,000 by 2020 (roughly 10-15% of practicing physicians), even as millions of newly-insured patients enter the system. As a result, patients will endure longer waits for doctor appointments. Meanwhile because of declining reimbursements, primary care physicians be forced see as many patients as possible each day in hurried 10-15 minute appointments, simply to make ends meet.
In response to this frustrating situation, more doctors are seeking an alternative practice model. They are establishing “concierge” or “direct pay” practices, where patients pay a monthly or annual fee for enhanced services, including same day appointments, 24/7 access to their doctor, e-mail consultations, and longer appointment times. Instead of the usual rushed 10-15 minute appointments, these doctors typically offer 45-60 minute visits allowing them to really delve into their patients’ problems and craft individualized treatment and prevention plans.
The Indianapolis Business Journal described how concierge medicine helped patient Dale Sventeck. Sventeck suffered from a “frozen shoulder” which severely limited his range of motion. Most doctors he saw simply wanted to schedule him for an MRI study and surgery. But concierge physician Kevin Logan was able to take the time to diagnose that Sventeck’s problem was caused by the mercury in his dental fillings. Dr. Logan advised Sventeck to remove the fillings. One month later, his shoulder was back to normal.
To make such time to see their patients, most concierge physicians carry a smaller patient load — typically 300-400 patients — rather than the usual 2000-2500 patients. Yet some patients have both practical and ethical concerns about the “direct pay” or concierge model. For patients interested in this option, here are a few key considerations:
1) Concierge medicine can be surprisingly affordable.
Although some of the early concierge services were targeted at the wealthy, nowadays the annual fee amounts to roughly $4-5 per day — the cost of a daily latte at Starbucks. This is within the means of many middle class families. Many middle class patients gladly choose to take more frugal vacations or drive less expensive cars in order to enjoy this service. The well-regarded One Medical Group (based in New York and San Francisco) is even more affordable, charging members only $200 per year.
2) Choice is good.
We regard it as perfectly acceptable that some people can afford to pay more to drive a nicer car or live in a larger house. Similarly, some parents choose to pay extra to send their kids to private schools over public schools. We should similarly respect the prerogative of those who wish to pay more for a more comprehensive doctor’s appointment. Patients have the right to spend their own money for their own medical benefit according to their best judgment.
3) Concierge medicine benefits both physicians and patients.
Concierge physicians routinely report greater job satisfaction, because they can practice the way they were trained — taking the time to really talk to their patients and use their skills to their fullest extent.
Dr. Floyd Russak, the head of my county medical society, explained his reasons for switching to a concierge practice:
It is morally wrong to practice inferior care… [I]t is just not practical to provide good care to patients in the current reimbursement model without maintaining a full-time practice of nearly 2000 patients, which requires 10-15 minute appointments to see everyone. Good care requires time, and with the overhead of a primary care practice running $200K/year per physician, time and reimbursement are at odds with each other…
I now practice a much more rewarding style of Internal Medicine, where I have time for the vastly improved care that comes with longer appointments and following my own patients wherever needed, including the hospital, office, home or rehab. Being on call all the time is not easy, but with only 300 patients, there are very few calls and most are appropriate and timely. I truly believe this is a better way to practice primary care medicine.
A recent study published by the concierge medical group MDVIP in the peer-reviewed American Journal of Managed Care showed that their approach to primary care saved $2,551 per patient due to decreased hospitalizations, and resulted in a 72-79% reduction in hospital readmissions for serious illnesses.
The number of concierge physicians is still relatively small (4,400 in 2012), but has increased 30% over the past year. As ObamaCare unfolds, Forbes’ Bruce Japsen reports that as many as 10% of physicians are considering switching to a concierge practice. Those physicians will be able to practice according to their best medical conscience, while being appropriately compensated. Their patients will receive high-quality care at a fair price. Both parties win.
Over the next decade, we will likely see the evolution of primary care delivery into two tracks. Some patients receive high-quality care from happy, motivated concierge doctors, whereas others will have to make do with rushed “assembly line” care from overworked providers trying to get their patients in and out the door as quickly as possible.
Which track do you want? If you don’t choose, the choice will be made for you. And you might not like what you’ll get.
Paul Hsieh, MD, is a physician and co-founder of Freedom and Individual Rights in Medicine (FIRM). He practices in the Denver area.