Patients want that personal relationship as well. People who grew up with house call doctor visits remember them fondly.
Dr. Michael Farzam is CEO of House Call Doctor Los Angeles. He’s been seeing patients in their homes for 13 years, and almost never has to make a referral. Part of the reason is he speaks with patients on the phone before making the trek in LA traffic to their home, but also, he says, “I can do everything in the home, essentially, a doctor’s office or a typical urgent care can do. So, we do x-rays and ultrasounds, we administer IV fluids.”
And there are advantages to seeing patients in their homes. Some cases can only be solved by a home visit, like the time he diagnosed a whole family with carbon monoxide poisoning from an old furnace.
An Increasingly Growing Movement?
It’s easy to get the impression that many doctors, fed up with traditional medicine, are about to switch to concierge medicine and direct primary care.
For example, a 2012 survey of some 14,000 physicians by Merritt Hawkins found that nearly 7% of practice owners planned to switch to a concierge practice in the next 1-3 years.
According to the Association of American Medical Colleges, there were 817,850 active physicians in the United States in 2012, the latest year for which statistics are available. How many of these doctors are in concierge or direct primary care practices?
“We believe — and this is after years of verifying doctors, talking with actual doctors, talking with business leaders, and talking with physicians who are influencers — that there are slightly less than 4000 physicians who are verifiably, actively practicing concierge medicine or direct primary care across the United States, with probably another 8000 practicing under the radar,” Michael Tetreault estimates.
Matthew Priddy, whose organization includes physicians in both groups, figures that there are about 5000 concierge and direct primary care physicians nationwide. But he also believes that a sizable number of concierge and direct primary care physicians don’t want to draw attention to themselves and keep a low profile.
Right now, far more traditional doctors are telling surveyors that they plan to switch than actually appear to be doing it.
“It’s just something you had to see visually in the home to be able to make that diagnosis. You know, if they had been in the house one more night, they probably all would have died. And that was a nice day. That makes the job very worthwhile.”
During our interview, Dr. Farzam took several calls from patients on his cell phone. It’s this personal care and the access his patients have that make them so satisfied. But this kind of service must be for the super-wealthy. Right? At around $400 a visit, Dr. Farzam says he does see the 1 percent here in LA – corporate executives and celebrities who want the privacy and convenience.
However: “But I’d say 95 percent of my patients are middle income people, who hold average jobs, and any way you look at it, our fee is less expensive than an emergency room visit, even if you have good insurance.”
The tech startup Medicast uses a house call model they call “Uber for healthcare”. Patients can hail a doctor 24/7 from a mobile app.
“It’s really as simple as just clicking a button when you’re not feeling well,” CEO Sam Zebarjadi says, “and we find a nearby on-call doctor who will come to your home, your office or hotel in under two hours.”
Patients can also summon a doctor from their website or by calling in to the call center. Medicast has been up and running in Miami and South Florida for almost a year and it launches in Los Angeles and Orange Counties in the beginning of June.
Of course, there was a reason house calls all but disappeared in the middle of last century. Medicine became more expensive, having medical insurance became necessary, and dealing with that ate into doctors’ profits.
“About 60 to 70 percent of the costs of healthcare are really in the overhead that come with traditional practices,” Zebarjadi says — and to make up for all that overhead, doctors might have to see 30 patients a day. “They spend about 6-8 minutes per patient…so it’s a very stressful experience.”
The Medicast model is a twist on a relatively new trend. It’s called private medicine and it’s growing by 25 percent a year. The idea is to eliminate some of the costs associated with billing insurance. That way, doctors can afford to spend more time with patients. These house call practices are a cash business – they don’t take insurance. They also don’t need nurses, receptionists… they don’t even need the office.
But still, these are doctors driving to your homes. How do the non-millionaire patients afford that? Zebarjadi says people are saving money on insurance by choosing policies with high deductibles.
“A lot of people are using healthcare for catastrophic events and actually looking elsewhere to services like ours for basic wellness and urgent care needs.”
So when you go to sleep with a high deductible insurance plan and wake up in the middle of the night with an alarming fever, you’re faced with a choice: a potential $3,000 in the Emergency Room, or $400 or so for a home visit. That house call might just be the frugal choice, as well as a lot more restful.