The shortfall of GPs will be replaced by nurse practitioners or other non MD medical roles. For a most people this will work just fine.
But for people who have ongoing chronic problems like kidney, gastro, skin, psychiatry, there’s no reason to pay a primary care doctor concierge fees. So if you don’t have problems that require a specialist, why are you seeing the primary care doctor enough to make concierge fees worthwhile?
My husband was considering joining a concierge program so he called his prospective PCP to discuss to the possibility. He was a really healthy guy but played a lot of sports and was proactive about his health. In the course of the conversation he mentioned that he had an appointment with his current PCP in a week or two to investigate some soreness he had in his armpit. The MD2 doc said that concerned him and offered to see him for a free initial consult/exam the next day. The soreness turned out to be lymphatic involvement from advanced melanoma, a very scary cancer. His new doctor smoothed every step of the way, from getting him rush appointments, to attending oncology consults and giving him a second explanation of results, to literally walking a biopsy sample through the system, without which we wouldn’t have been able to go on a long-planned and much needed vacation, to checking on both him and me post-surgery. He was literally a life saver.
He’s also provided less important but still very nice services, such as providing my husband with a comprehensive travel medicine kit. He has encouraged us to use the kit for other family members when we’re abroad with the caveat that we call him first for a [free] consult to determine the best course of medical treatment. We’ve texted him multiple times in the middle of the night not expecting a call until morning but have received a return call in less than five minutes.
Wow, @Sue22, what a great MD you guys have found. Has he become the MD for all of you and is there a discounted family plan?
So much depends on what the options in your environment are, how much you (and your family) use and are likely to use healthcare resources, affordability for you/your family, etc.
In our case, I really only see my internist 2x/year, my lung doc 2x/year, eye doc and allergist annually, and ob/gyn is going to be moving toward every 2 years after next year. See GI doc every 5-10 years.
With this general pattern of usage, i don’t see how a concierge MD would really help much.
@HImom, there is a discount for families but our older two aren’t at home and the youngest still sees our family’s trusted pediatrician. I didn’t join when my husband did because I was under the care of an oncology team and as a participant in a study was seeing them at least every 3 months. More medical exams seemed like overkill. I pretty much see my PCP once a year for a Pap smear, nothing else.
Having largely graduated from my oncologists’ care I am considering joining but strangely I’m a bit hesitant because I’ve gotten to know my husband’s doctor as a friend and having that professional distance broken makes me feel a bit uncomfortable about the prospect of using him for my full physicals.
It is a bit awkward figuring out what to do when you are friends with the person you see professionally for your health needs. I was a close personal friend of my allergist, but that didn’t interfere with her providing us with excellent care and that was a relationship that evolved over the decade plus that she treated all of us. My sister is the wife of an MD and has a tougher time finding MDs because they socialize with several other MDs and she feels awkward seeing the MDs professionally if they are friends.
When you see the MD only once a year (or even twice/year), it’s a bit tougher to justify paying for concierge service. I consider the MDs I see out of state for my lungs my concierge MDs, I guess since my appointments are about an hour apiece. I don’t have to pay concierge prices exactly, but I DO have to fly and pay all travel from HNL to where their medical centers are (SF and Denver). These MDs have resources not available in our state, so I like to keep my options open.
@ucbalumnus I envision it being a bit more like an expensive restaurant. If the quality (or perceived quality) is not there, it won’t stay in business long. It seems anyone can say they want to go concierge, but they need to have the following to pay for it. I doubt a doctor with a poor reputation would succeed as those spending money usually want quality with it in the same way a pricey place is (usually) better in quality of food and/or ambiance than the local burger joint.
Folks can choose the local diner or burger joint if that’s all they are looking for - and many of those ARE quite tasty, so well worth it - but for those who want/need more, it’s nice that there are options. Some people choose to spend their extra $$ on fancy cars, restaurants, travel, sports, home appliances, the perfect house, clothing, shoes, or a host of things. There’s nothing wrong with opting for a preferred better medical care too. It’s our differing choices of where our $$ go that keeps a good bit of the world running. Personally, I don’t condemn others for whatever they choose even if getting those oodles of pairs of shoes (or whatever) isn’t my choice. Someone is earning a living off making/selling those shoes.
Many people don’t have “extra” money. The ability to have your cancer diagnosed while it’s still treatable shouldn’t be available only to those who can pay a hefty monthly premium, yet that’s the situation we have. It’s not that people aren’t choosing to pay for the premium healthcare, they can’t pay for it. That’s a huge difference and has nothing at all to do with whether people prefer diners over fancy restaurants or how many pairs of shoes they buy.
^^^ It’s not only available to those with money to pay. I have a close relative who turned down buying health insurance from her job saying it was too expensive (even though she had extra money she spends on things most of us would consider wants, not needs - like multiple daily lottery tickets). Even without insurance, she’s having no problem getting appts and tests/treatments done - currently on her state’s system to pay for it. She doesn’t like her doctors, but it’s tough for me to have sympathy. She’s currently out of work (workman’s comp for a completely different issue) so low enough income to qualify for her state system the same as any other low income resident.
One can use the same argument to say expensive restaurants shouldn’t exist. There are people who can’t afford them and they NEED to eat (true statement). The expensive restaurants are taking away food that could be for sale in a market with supply and demand lowering the ultimate cost for all.
Do we need expensive clothing or should all material and sewing machines be used for just the basics? The latter would definitely help the poor - or maybe not since some jobs would disappear…
Then luxury or “above average” houses? How equal do we need to be to be “right?” Should we develop the society in “The Giver?” (book by Lois Lowry)
There’s a choice in medical care (at least in some places). There’s nothing wrong with options. If traditional places are having trouble filling voids, perhaps they’ll start paying doctors more of what they’re worth to fill them - or as others have said, NP’s and PA’s can (truthfully) fill in some of void.
Getting better care the way things used to be (more time, fewer patients, etc) is a worthy goal to promote. It might take money at this time to give it a push akin to organic small farm produce, but over time, it could become more of the norm. If more doctors went this route, supply and demand would lower the fees.
“Qu’ils mangent de la brioche”
After my primary care doctor went Concierge, I ran into a former nurse from her office at my new primary care. She said that many patients left the practice and those that remained were generally very high needs patients. So I’m not sure that it led to much higher income or fewer working hours. The nurse said it was difficult initially, but that their situation had improved as they made adjustments.
I’m curious if those totally against concierge medicine (in general - not meaning it’s simply not worth the cost to you in your situation) cut back to the pure basics on other necessities too (food, clothing, shelter) in order to keep everything fair and affordable to all. Then, of course, one has to wonder if only public schools are worthy (K-12 and college).
Or is it just this one topic you deem unfair because of the disparity in income? Should no one own an expensive restaurant due to folks not being able to afford to eat there or is it only doctors who can’t figure out a way to cut their work load to something more manageable (and enjoyable) while still earning a reasonable income?
The answer to 99% of all questions is “money.” We spend enough money on health care in this country to have concierge level service for everyone. We just have to consider it a public interest like roads and defense.
That high-level care that Sue’s husband got is the same high-level care that we get, and without a concierge fee. We just have an exceptional PCP who keeps her patient list small and is OK with the lower salary she earns. She left her old practice when they were changing to a concierge-light model, small monthly fee but $25 to answer a phone call and $35 to refill a prescription. The Dr. doesn’t become a better diagnostician just because you pay him more. A $60 injection is no better or worse than a $1600 one unless you count the mood lighting and cushier chair.
With what we have now, the PCP, the one actually doing the work, gets about 30% of collections or about 20% of billing. NPs and PAs get 2/3 of that. Just about every “reform” taken by insurance companies increases work by the PCP but decreases pay. They are also lobbying to lift the 20% limit on their profits. They have zero incentive to control costs but have 100% of the influence in health care legislation. We are told, repeatedly, this is the best system.
You can’t really compare fancy restaurants (totally optional) to basic healthcare (required in a functioning society). Like education, the way to improve it for an average person is not to funnel millions more to the Phillips Exeters of the world.
Concierge is an option.
Some employers offer multiple health care options…ahigh deductible HSA vs a POS or PPO plan. Heck. Even Medicare has options that can be considered…and the supplements or Medicare Advantage as well.
Even the exchanges have bronze, silver and gold plans at different price points with different benefits.
I view concierge doctors as another choice in medical care.
He does if he has more time to listen to you and consider your issues than if he is rushed because his office is triple booking patients in order to make ends meet.
I don’t know how to fix this but I have seen physicians who just don’t keep up with the latest in their field. My elder was referred to a medical device that is supposed to help his sleep apnea. I have spent the last few days trying to figure out how to reach the company that developed the device, so we can share the information with the dentist that the sleep doctor/lung doc recommended. We have a consultation tomorrow and I like knowing what we are walking into.
I had a long chat after multiple phone calls that had no answer and sent an email that had no one reply. The final answer is that the device that was recommended is no longer in manufacture because it simply didn’t work as promised and really didn’t help sleep apnea as it was supposed to, even though the successor company spent significant undisclosed sums on R&D.
I was able to get info from the successor company about the different options currently available, which we will discuss with dad, so see whether any of these might help him improve the quality of his sleep.
It really is a problem when the docs you see do not keep up with what is current, what is still available and what has been discontinued.
I also agree that when there isn’t enough reimbursement so the physicians don’t go to conferences, do CME, and attend sufficient training to keep up, that is also a problem. Rushed doctors can never do as great a job as ones that have more time to consider all issues and draw out patients who insist everything is “fine,” which happens quite often.
^^Reimbursement or no, in most states physicians must keep up with some legal minimum of CME or they cannot renew their licenses.
In our state, they don’t have to get a CME in their field—any field is fine! It’s upsetting (and can be dangerous) when they don’t keep up. Some are grandfathered in and don’t have to take periodic recertification exams either.
If the continuing education is similar to Civil Engineering PE “stuff,” H considers it almost totally a waste as he already keeps up on what he uses in everyday life. If he didn’t his work would suffer. He can complete his state requirements in a couple of days - not even full time days - and the courses certainly don’t have to be related to what he’s doing if he wanted to choose other options.
I think the fact that “if he didn’t his work would suffer” is what happens to doctors who are overworked. Do their continuing education requirements correct that? I’d have my doubts. It wouldn’t be enough for H with engineering to keep him current - not as “enough” as merely being able to keep up with his field on a regular basis does naturally…
Yes, I believe the continuing ed is mostly a salve for the regulating body and legislators that the professionals are “staying current.”
It is tougher to attend conferences when you’re a solo and have to make a lot of arrangements to attend conferences and no money is coming in while you are away. On an isolated state like HI, it’s harder to just drive over to attend things as well.
I have no idea what recertification exams are like but the specialists I know do seem to study for it quite a bit before taking it. Some are members of societies that meet and discuss cases, journal articles and issues; I think that’s very useful.