Is Concierge Medicine Ethical?

For those of you too young to remember, Marcus Welby, M.D. was a TV show that began its seven-year run in 1969 and starred Robert Young as a family practitioner with a kind heart and superb bedside manner. The doctor epitomized the type of doctor that is now a thing of the past: the patient, unhurried professional who sat and talked to patients for as long as was necessary, not only to understand the patient's symptoms and complaints, but to understand the whole patient. The type of doctor who would come to you if you were too sick to go to the doctor. The type who could practically heal you with just a touch.

For many of us, this type of doctor wasn't a privilege—it was a right. This is the type of doctor we wish we had today.

Today's health care is a mess, but that description merely puts reams and reams of complicated information into just one word. After all, books have been written on the subject. Unfortunately, today's medical system rewards procedures rather than health; it does not reward prevention or watchful waiting.

Practicing medicine has gotten so thorny. And there are many reasons: the complexities of medicine; the soaring cost of malpractice; the growing options for treatments; the surging older population; the emergence of new illnesses and new strains of illnesses; and the basic economic inevitability of mounting costs.

It's easy to understand why more and more doctors are getting fed up with the system that gives them less time with patients and more time fighting with insurance companies to get paid and to make their own independent decisions. Family doctors, pediatricians and general internists are among the lowest-paid physicians. When they spend the bulk of their time on paperwork, phone calls and reviewing lab results—work that does not get reimbursed by insurance—is it any wonder that they pack as many patients into their days as possible? Often, burnout and dissatisfaction with the profession and the endless red tape follow.

Writer Jennifer Margulis tells of a top pediatrician, who is discontented with the demands of the medical system and abandons her profession to become a science teacher.

While not all physicians are driven from the profession, some are turning to concierge medicine.

The number of doctors in the United States switching to concierge medicine is somewhere around 5,000. These doctors charge their patients fees for premium service. Physicians practicing this type of medicine generally limit their total number of patients to around 600, from around 2,000 and up. They limit the number of patients they see each day to about 10 to 15. Some doctors charge an annual fee, while others offer a monthly fee, giving their patients the option of dropping the service if they please. Some doctors charge modest annual fees, though many can reach into the thousands of dollars. If their current patients are unwilling to make the switch, the patients may opt out and find a new doctor.  

In an August 2010 article in the New York Times titled "Can Concierge Medicine for the Few Benefit the Many?" Pauline W. Chen, MD, writes of a woman who is satisfied with the arrangement she has with her "boutique" doctor. She pays a fee of $350 per month for guaranteed around-the-clock access, appointments within 24 hours of calling, longer office visits and personalized attention and care coordination. The woman was saved from an unnecessary CT scan and subsequent hospital admission when her doctor intervened on her behalf. This woman's husband didn't like the idea of concierge medicine. He thought it was unfair to the people who could not afford to "buy" better care or a higher level of service. He visits a doctor in a traditional practice.

The solution to improving health care in America hasn't yet been found. I wonder if a one-size-fits-all approach will ever be reached. It is somewhat ironic that as patients' dissatisfaction with the health care system grows, so does concierge medicine. What's fueling the trend is not only the physician's desire for greater control over their health practices, but the patient's quest for that, as well.

What do you think? Would you be willing (and able) to pay extra to have greater access and/or care, more time with your doctor and less time in the waiting room? Is it ethical for doctors to switch to this type of care? Will concierge medicine bring back Dr. Welby?

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