Blog Wars: Concierge Medicine

Readers, today begins an occasional series in which Senior Editor/Blog Mistress Sara Michael and Editorial Director Bob Keaveney will take opposing views on some hot topic affecting physicians, then invite you all to join the fray.

The subject of our inuagural Blog War: Concierge Medicine: The Savior of Private Practice Medicine, or Evil Unethical Trend?

From Bob:
I’ve written about concierge medicine in the past. For background, a typical concierge (sometime called retainer or boutique) practice charges an annual or monthly "membership fee" directly to patients, who in return get a different level of access to the physician - usually longer and more frequent visits. They can usually get the doctor on the phone pretty quickly, and many offer e-mail communication, too. A concierge physician might have a few hundred patients rather than a few thousand. Concierge practices - the good ones, anyway - run the way primary practices are supposed to run: With doctors getting to know their patients, becoming truly part of their lives, and spending enough time with them to talk and listen.

That's not possible to do within the confines of the ordinary modern practice. The economics don’t work because primary healthcare today is about volume. Doctors have too many patients to spend more than 10 minutes or so with any one of them. Even when you do see 30 patients a day, in primary care you're way behind your specialist colleagues when it comes to income. That's why so few med students are opting for careers in primary care anymore.

So, for me, concierge medicine is a response to a dysfunctional economic climate that allows primary care doctors to do their jobs in the way they always dreamed - and in a way that's best for patients. Sara, what's your beef with that?

From Sara:
The trend of concierge medicine troubles me. I am not insensitive to the struggles many primary-care physicians face, but concierge medicine is far from being a solution to declining reimbursements and not enough time with patients. Instead, it’s a harbinger of what’s wrong with the system as a whole. The model flies in the face of any commitment to community and public health, which I think should be at the foundation of medical care.

Concierge medicine further divides our population into those can afford quality care, and those who can’t. What happens to the hundreds of other patients who decide they can’t afford the $1,500 to $3,000 (or more) annual fee? What about those who have had the same physician for years, and who may have trouble finding another primary-care physician? I think basic quality primary care should be afforded to every American and concierge medicine in many ways exacerbates the problem.