Thursday, February 08, 2007

Concierge Doctors

Imagine a doctor who doesn't make you wait in the office but actually see you at the appointed time. Imagine a doctor who knows your name, knows why you're seeing him/her, and remembers why you saw him/her the last time. A doctor who makes house calls, comes to see you in the hospital, and calls you at home after you've been hospitalized. (Slight correction and clarification made.)

Such a doctor is available--for about $1,500 per year. Plus.

They're called concierge doctors. They have made a conscious decision to see fewer patients but to charge more. "Managed care" does not satisfy them--it's not why they chose to become doctors in the first place.

Some accept insurance for office visits, although most insurance carriers will not pay for the annual fee. Some feel that the insurance carriers are the problem--they don't enjoy being second-guessed by a "bean counter." Most want to do more for their patients and would rather see fewer patients and do a more thorough job of finding out what is wrong than Managed Care, Medicare, or Medicaid allow.

They also want to spend more time with their families and to come home relaxed, knowing they have done their best for each patient instead of worrying about what they might have missed.

Of course, the flip side is those who worry who will take care of those who can't afford to sign up for a concierge doctor. They worry that doctors are betraying some sort of ethical code by not treating all who are in need, that they are, in fact, building a two-tiered health care system between the have's and the have-nots.

(Don't we have that already, between those of us who are insured and those who aren't? Isn't that what "HillaryCare" is supposed to abolish?)

And this trend may exacerbate the growing shortage of physicians in the country.

(Wouldn't the answer to that be to open more medical schools and allow more candidates in? Aren't medical schools turning away qualified applicants because they have no space? Florida State University has the only medical school built since 1982, according to And Medicare has further distorted the market for doctors by subsidizing only 80,000 medical residents per year.

(Why is Medicare subsidizing medical students or residents? Does the AG Office subsidize lawyers?)

Of course, these new doctors are going to work in high-tech, high-paying fields, located in cities where they have the professional support these specialties require. Instead of simpler practices located in small towns and cities in the hinterland where they are needed.

(Which scenario is more likely to allow the new doctor to pay off his medical school loans within his/her lifetime?)

Some of these concierge doctors would not have remained in medical practice had they not rediscovered the joy of treating patients as patients rather than case loads. And, if the supply of doctors was not artificially restricted by the government and by the AMA, there would not be a shortage--or a potential shortage. Scarcity increases prices, which is why specialists charge more than generalists.

Competition for medical school is fierce, which has been justified as a means of ensuring that only the best will become doctors. However, a math or chemistry whiz is not necessarily the best doctor, House notwithstanding. Seeing 30-60 patients a day does not make for good medicine.

If "concierge" medicine keeps physicians practicing who otherwise would not be, then that's good. If their concerns are heard and addressed, perhaps "concierge" medicine will become available as the pool is expanded and patient load reduced. That should be the primary goal, IMHO, and not trying to play to "class warfare" fears.

After all, not all of us can afford to drive a BMW.