Consider Concierge Medicine before Becoming Just another Employee

May 23, 2013

Traditionally, physicians have been self-employed, making their own practice-based decisions, but that is fading. Concierge medicine can help preserve self-employment.

You worked hard all of your life and found a degree of success at each stage. First, it was entrance to college and then medical school. Then residency and the decision to become a primary-care physician, where you could best meet the needs of patients and your chosen community. You then opened a traditional practice where you bore all the responsibilities and were supposed to enjoy the fruits of your efforts. But someone has come along and changed the rules of the game. The autonomy you planned on is becoming harder to find and sustain.

The media is now filled with stories of physicians at risk for bankruptcy. To avoid such a blemish, many physicians are accepting employment with either a hospital system or a large regional medical group. For the first time in their medical careers, these physicians are just another employee.

In the past, even if you were part of a small group, you were the one who received the "profits" of the practice. You worked harder and you earned more. Now, regardless of the compensation scheme, your employer views you as an expense against their profit.

It's a dramatic shift for many. No longer are you compensated for the relationship you have with long-time patients, the hours you spend studying a specific patient's illness, or the time you take to comfort and talk to family members; you are paid on the relative value unit (RVU) produced.               

What that means is despite the deal you may have negotiated with your employer, future efforts will be geared to control your compensation as a cost to the company since that expense goes against their profit. Further, any "new" work required, like all of that patient documentation, medical home management, transition of care, referral management - all the help you might expect from working with a large healthcare corporation - will simply be an additional cost for your employer. It's easier (and more profitable) for the corporation to layer that work on your already overburdened back since they don't have to compensate you more for that work.

Of course there are other issues physicians must deal with as well. As an employee, you may not get to select where you work, or who you work with. Unhappy with a rude front office staff or a nurse that makes you do a lot of the paperwork? Not much you can do. Doctor needed on the other side of town, a long commute for you? Doesn't matter; you go where assigned. As a result, physicians are treated, and see themselves, as another commodity. An offshoot of this reality is that physician recruitment is a booming business as doctors seek to find the best deal and move every few years to better their careers.

That represents a troubling shift. Most physicians I know chose their profession with the idea that they would settle in an area in which they wanted to raise their family, work hard caring for people, and develop a bond in that community. That's what medical professionals used to do. That was, until they were forced to work for somebody else.

Of course there are many physicians working for large, well-managed groups who are satisfied. But any physician today has been hearing more than a few stories of colleagues who simply aren't happy with the emerging physician-as-employee model.

The question is: Can't we come up with options that are good for all physicians and patients? Let those corporations who treat physicians and patients right flourish with models that strive to be patient-centric while respecting good physicians. Let those physicians who don't have that option in their community, or want to remain independent, keep their options open as well. I think concierge works very well for physicians in certain markets who were considering retiring, or who have young families, or who simply have very high demand for their services. I also think the hybrid concierge model (where just a small percentage of patients join the concierge program) can help to remove a lot of the headaches and uncertainty many physicians are facing today. It puts choice in the hands of physicians and patients - frankly, where it belongs.

So for those of you unhappy or unsure of the healthcare environment today, don't give up. Talk to physicians who have found options they like. Look at alternative practice models. Remain independent if that's what you want. Most importantly, find something that encourages and enables you to stay in medicine so you can continue to help patients and enjoy a rewarding career.