With changes in the marketplace, more physicians are considering concierge medicine – but even more have serious questions. Here are some of the most common.
I’ve always had physicians ask me about concierge, but increasingly questions are becoming much more direct. Most doctors now understand what concierge is; now they want to understand if and how it could work for them. I can tell that doctors have been really thinking about the implications of alternative practice models for themselves, the profession, and most importantly, patients.
I’ve started compiling some of the more frequently asked questions - here are a few - and we’ll be looking at other questions in future postings.
Q: I already do concierge care but do not get paid for it. Why would my patients want to join a hybrid program?
A: Patients join for many reasons. In a full model, the most frequent reason is about not having to leave their current physician. Some like the concept and are interested in the model that has fewer patients. In a hybrid program, patients join for various reasons. First, many have an appreciation for past services and satisfaction with the special relationship that they have with their physician. Next is anticipation of enhanced service offerings, knowing that they have options. Then there is a concern about managing their complex medical and personal needs. Concierge programs give people a sense of comfort that there is someone who is a part of their care team in a special way. For those whose time is very important to them, concierge programs offer more availability and less waiting time. Also access to a physician's cell phone - while not often used - is sometimes the determining factor. The most successful physicians in a concierge program are those who say, "I am already giving my patients concierge care."
Q: Since I hate being on-call, will giving out my cell number to members kill my private life?
A: When you are on-call now, often it is shared with others in a call group covering many patients at one time. The days or evenings that you cover may now generate a handful of calls. In a hybrid or even a full model of concierge, the number of patients is far less than in a traditional practice. Their need to reach you is reduced as they can do so more often during the day. When you do the math you'll realize that there could be a handful of calls over thousands of patients. How many do you think will call when there are a few hundred people who respect you more and think of the cell phone as a lifeline, and not a tether? In hybrid programs the call activity is usually one call every week or so. The patients who join a concierge program tend to show respect for you and your time as well.
Q: Will I have to invest in my office or my staff to do a concierge program?
A: If you use an outside firm or a consulting group, you may not have the upfront costs associated with the process. However, if you try to do it yourself, managing expenses such as marketing will require a great deal of planning and development. You may also need to re-contract with your employer if you are not self employed, and notify related providers of the changes.
Q: I am just out of residency and want to start a concierge practice. How do I do it?
A: Unless you are buying into an existing practice and are taking over the program of an existing concierge doctor, it is not advisable to start by "putting up a shingle and starting out cold" in a concierge practice. You would have to be independently wealthy to consider this approach as it may take years to become self-sustaining that way. Some day this approach may become a reality, but today it is not. You may be able to consider a hybrid earlier in your career, but usually it takes a few years "in the trenches" to get positioned for such a move.
Q: I am a specialist. Can I do this program?
A: In almost all cases, a full model cannot easily be done by a specialist. So we are talking mostly about hybrid models. All true concierge programs are built on patient-physician relationships that are ongoing and strong. Episodic physicians, or those whose relationships are for only a short period of time, are not well suited to this model. Some specialists have the characteristics for success like non-invasive cardiologists, gynecologists, and gastroenterologists while others do not.
If you have any questions or want to know more, feel free to e-mail me and I will be happy to answer or just look or more questions in my next blog post.