Why OB/GYN Concierge medicine specialty is likely to succeed

By Michael Tetreault, Editor-In-Chief

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MARCH 4, 2013 | Like many American women, they aren’t seeing an internist or family physician for primary care needs but instead receiving her primary care from a gynecologist. A lot of women feel comfortable with this because for one, they’ve found that tests many times overlap … and being OBGYNs can be very thorough, women like that.

Under the law, women can select OB/GYNs as their primary care provider and cannot be required to seek a referral or prior authorization to see an in-network OB/GYN specialist. Parents can select a pediatrician as their child’s PCP.

Dr. Ira Mickelson of a Detroit, MI practice says the majority of his patients use him as their primary care doctor, “If we’re going to be good physicians we need to be aware of that and take care of all of their needs.” Dr. Mickelson continues to say the trend is toward using ob/gyns for primary care. Some medical schools are even preparing new doctors for this expanded role.

He explained, “Instead of just delivering your babies and pap smears and birth control, we’re now thinking more in the lines of total patient care.” So that means an EKG and chest x-ray when appropriate. And a full complement of lab tests, “We always take their blood pressure and we have discussions on quality of life which includes making life healthier.”

The cholesterol test Dr. Mickelson uses, the VAP, is even more complete than the one some internists call for, “It gives us a breakdown of the different types of LDL, different types of cholesterol.” If a woman is considering using her gynecologist for primary care, she needs to have a conversation about her expectations.

Dr. Mickelson recommends asking the doctor, “ ‘Are you going to be my primary care doctor, are you going to do my cardiovascular, the rest of my health care, or do i need to find someone else?’ I think that needs to be said.” Dorothy, a patient of Dr Mickelson is very happy with just seeing a gynecologist for her annual checkup…and she thinks other women would be too. “Its almost like going to the grocery store, one stop shopping and they like that and I think that’s why more women today do that.”

So, in answer to the question, can a OBGYN last more than three years in a hybrid concierge practice, I say confidently yes. It might be a different story if insurance was NOT involved or accepted in the practice as the majority of patients seeking out a concierge physician are concerned about:

  1. Insurance and/or Medicare participation;
  2. Price; and
  3. Location.

According to Scott MacStravic, PhD, he writes … ‘The initial concierge practices were all in primary care specialties–family practice, internal medicine, pediatrics–but there are a growing number that are in secondary specialties: 45+ by my count, including “addiction medicine,” cardiology, dermatology, general surgery, gynecology, and oncology just to name a few. These specialty practices usually offer the same immediate access, longer appointments, and a proactive health focus as primary care concierge practices. Some also offer home visits. Specialists usually limit their practices to a smaller number of patients–150-300 compared to the more typical 500-600 patients for primary–and they more often deal with patients who already have a chronic condition to be treated.’

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