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Is Concierge Medicine Ethical?

By Sheryl Kraft

Created: 03/03/2011
Last Updated: 08/13/2012

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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. http://mothering.com/jennifermargulis/rejecting-modern-medicine/one-of-americas-top-pediatricians-leaves-pediatrics

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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Comments

I had not heard about concierge medicine. I would certainly pay more, and already do, to an alternative medicine doctor who succeeded in treating my Lyme when regular docs said I was fine, but I wasn't. The doctor who listens to patients is unfortunately hard to find these days.

It certainly seems as if many of us would love to have this type of individual care but it is costly and prohibitive. It would be nice to find some companies (and I believe some DO exist) who practice this model and are able to charge a lot less.

I think it is pointless to argue if this is ethical. Would it be better for these doctors to burn out entirely and leave medicine and years of training behind? I've burned out of allied medicine and left it. I know what it is like to be buried under piles of paperwork and endless waitlists of patients.

There will always be people who can afford better care than others. There will always be doctors who cater to those people. I wish I was one of the lucky few who could afford a golden ticket.

I don't know if it is "right" or not but if I could afford it, I would definitely do it.

Well, it depends. We already spend about $5,500 per year for a bare bones, high-deductible insurance policy for the two of us. Tack on our out of pocket expenses which can be another %5,000. If some of that money could go toward a concierge relationship, maybe. If not, then no way.

My fear is that it means only "rich" people will have access to "good" care, and the rest of us will still be stuck with a broken-but-still-expensive system.

I've heard about concierge medicine. In fact, one of my husband's pcps said he wasn't accepting insurance-based payments anymore and he was moving to this type of service. I'm not sure what to make of it, but I think about it every time I'm in the waiting room of a doc's office (which has thankfully been infrequent) and then I only have 5 minutes or so with the doc.

So true...we wait far longer for our appointments than do we actually have time WITH the doctor. Sad.

Well this is less than what I am paying for insurance right now. Maybe I should skip the health insurance and just buy out my doc? I don't think there are any clear answers. Right now--even without boutique care-- the rich get better health care than the poor. The poor in a capitalistic society get screwed every which way.

This doesn't take the place of regular insurance. You still need that, unfortunately. The fee merely covers access to the doctor's services but you still file with your insurance company for all services. Sometimes the fee will cover an "executive physical" which insurance companies will now; this includes an extensive panel of blood tests and perhaps other tests not covered normally by insurance.

Not only that, but from what I'm seeing, the fee really gets you access and covers that first exam. All of your office visits after that are charged at normal rates. Some of these docs are still in-network for insurance, but some won't deal with any insurance companies at all - so you're stuck with the retainer fee, your out of network deductible (meaning you're paying 100% for almost all medical services until that's met), plus the costs of insurance.

:( It seems crazy to me. I really want to find a good doc, I haven't had a checkup in the last several years, but who can afford all that?

I actually had a chance to do this, as the doctor I was going to (and whom I really liked) decided to switch to concierge service. He had some kind of other service handling the sales pitch for his patients and it all sounded really crass to me. We'll do this and this and this and this if you pay us a bundle, and if you don't want to pay, get lost. Can't afford it, so it was not a hard decision.

However, if I were rolling in dough and had a house in the Hamptons, I'd no doubt hire HankMed. Do you watch Royal Pains on TV??

A lot of docs have turned this over to marketing companies to coordinate/pitch for them, yes. And for those who can't afford it, it is not a hard decision at all.
No, I do not know the show Royal Pains - but now I'm curious. I'll have to look for it. I imagine there is something about this type of medicine in the show?

This is a very intriguing question. I hadn't realized this was a new phenomenon, but I can understand why some people would be very drawn to it. I find myself wishing very much that all Americans could have universal health care. It just seems the U.S. is such an outlier among developed countries on this issue.

Intriguing, yes...and so frustrating. Since there are no easy fixes, I wonder what the "best" way is. Unfortunately, I don't think there will be a workable solution in the near future.

Call me cynical but concierge medicine sounds like something for the very wealthy or something that, in practice, really only exists on TV.

I think we need a complete change in our health care system. We need to go to a European model where the system is nationalized and everyone gets good coverage. Then we need to regulate advertising and drugs and get the sugar out of our children's food and the Coke out of the schools. Our system is so messed up. And money driven. Thanks for the shout-out about my blog, Sheryl!

Will we ever get there? There are so many issues that it seems so unreachable sometimes, don't you think?

I don't know what the answer is. Yeah, if I had all the money in the world, I'd hire a private physician who took care of me and my family and no one else. Since I don't, I'm stuck in the mainstream health care system.

Many of us are stuck in that mainstream health care system. But there are definitely ways we can try to get it to work in our favor, by being proactive and prepared ahead of time. And realizing that the whole job is not just up to the doctor, it's up to us to be participants in our own care.

Having worked in healthcare for many years I found the whole concept fascinating, a little confusing and also, making the point that some docs, particularly the ones in general practice or other specialities that rely solely (pretty much) on insurance have had to find ways to keep their practice going. They still accept health insurance, of course. I'm not sure how it's all going to play out - I think the concept is still evolving.

Yes, sometimes it does come down to docs finding a way to stay afloat financially. It will be interesting to see how the whole thing evolves.

I think it was a concierge doc whose practice I inadvertently stumbled into in NYC and left with a $1,000 bill for a checkup. I'm still smarting from that one -- and from being denied any compensation by my greedy insurance company. It's so easy to get bitter about this, but I can't think of a less productive attitude. Still, what's the answer?

$1,000 for a check-up? Criminal. I wonder why they did not inform you of this ahead of time. And who would have thought to ask? That's outrageous. And it doesn't bring us closer to any solutions, I'm afraid.

Most concierge doctors total charge for a year is under $3000. I do housecalls for my patients 24/7 and my average patient spends less on me (before insurance reimbursement or tax breaks) than they would on a pack a day smoking habit. They spend more on their cell phone plans ( not to mention the cost of buying an iPhone) and spend over 10 times as much on private school. So I ask you, where is the public outrage of being elitist now? You want superior care and an hour with your doctor instead of a hurried office visit, then I think it's reasonable that you should pay more for it. Some people want a nicer car, and noone is shocked that a bmw costs more than a Honda. Some people want high quality organic food, so they pay more at whole foods that they would at path mark. Some people want a better education for their kids so they go to private reputable schools over state funded schools. I'll get off my pedestal when uncle Sam socializes medicine and pays my quarter of a million dollars of med school loans. This country cannot have things both ways, treating health care as a commodity, but making the providers of this important service work for peanuts. Don't force good doctors to see 50 patients a day to make ends meet and then complain about the wait time

I totally agree to the fact that today’s health care is a mess. A doctor who is kind hearted and who can heal us has become a dream now. The discussion on Concierge Medicine was interesting to read as it tells whether it is medicine ethics or not. ICD 10 Codes

Peace of mind is priceless. Often times providing that peace of mind requires extraordinary time and education. Insurance companies do not reimburse for that protracted time. More often than not, providing competent healthcare for an issue is relatively quick. Providing the time to educate the patient for the details associated with that issue is not. For example, diagnosing and treating an ear infection is not a complicated matter. Educating the patient about the associated fever, congestion, and pain is also not complicated but requires a lot of time. Provide that time and education, a healthcare provider will go broke, execute solvent friendly care and a patient is treated poorly and unsatisfied. The healthcare provider is stuck between a rock and a hard place.

Today, I received the official announcement with cutoff date, for when I won't be able to see my cardiologist anymore. Not because he is retiring, but because his practice is too large, and he is well off enough to cut his patient load. He is going from 1,700 patients, down to a select 600, who can afford a concierge fee. It took me a long time to find the doctors I trust and really like. And can talk to.

This doctor has expressed to me how badly he feels about missing his kids sports and other activities. I totally understand that. I was a stay at home mom for years.......giving up a nicer home etc. ........so I could be there for my kids.

I am older now tho, and have had a heart attack , and it's important for me to have this doctor by my side. At the same time, when I did have my HA, he was not on call, and, not being a surgeon, he did not perform the life saving procedure I needed. I saw him two days later, and for follow ups. He won't always be there, so, I hope I find someone just as nice and caring.

I had not heard about concierge medicine. I would certainly pay more, and already do, to an alternative medicine doctor who succeeded in treating my Lyme when regular docs said I was fine, but I wasn't. The doctor who listens to patients is unfortunately hard to find these days.

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