Picture this: You wake up one morning with a fever, a headache and body aches feeling like you didn’t sleep a wink. Recognizing these as flu symptoms, you call your doctor’s office to make an appointment. If you’re lucky, you’ll get through to the office on your first try and they’ll offer you an appointment… a week from now. If your doctor is part of a large practice, you’ll likely get routed to a call center where the person on the other end will ask you a million questions… and still offer you an appointment a week from now. Even though you insist you need to be seen today.
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Your options? You could just try to sleep it off (don’t do this). You could go to an urgent care center or the ER and wait in line for hours, only to be treated by a doctor you’ve never met. Or, you could cut out the middleman and long waits and text your primary care doctor, who promises to be available 24/7. Yes, that third choice could be a reality — but it comes at a cost.
In a world where you can pay someone to book your fitness classes and drive you to the gym, you can also now pay a doctor for more personalized care — but is it worth it?
What Is Concierge Medicine?
Good health care is going to cost you under a concierge plan. At Seattle-based MD² International, patients pay $13,000 to $20,000 per family for direct, around-the-clock access to their physician and more personalized care. In all concierge practices, patients pay a yearly or monthly fee, called a retainer. You can think of that retainer as paying a cover at a club; you’ll still need insurance to cover most services. And some concierge doctors don’t accept insurance at all.
“Concierge care is a contractual arrangement and not all those who buy it understand that it does not necessarily cover everything they may need such as hospitalization, blood tests, MRI and CT scans, et cetera,” says Pauline Vaillancourt Rosenau, Ph.D., of the University of Texas Health Science Center at Houston’s School of Public Health. “It is a ‘buyer beware’ situation, and in this case, individuals are well advised to read the fine print.”
While this all might sound like a “black market” for doctors, concierge medicine is actually pretty legit. The American Medical Association supports physicians’ and patients’ right to enter into private contracts and they’ve adopted a set of ethical guidelines for physicians who convert to retainer practices. The AMA helps regulate concierge medicine by ensuring contracts are fair. And they make sure that when a physician goes concierge, patients not willing to pay have ample time to find a new doctor.
“It brings back the benefits that are lost in more of the ‘factory style’ of medicine.”
While shows like USA’s Royal Pains might have you believing this type of healthcare is just for the Hamptons elite, lower-cost options, like MDVIP, Qliance and Concierge Choice Physicians charge about $50 to $150 per month for their services (that’s less than membership fees at some high-end gyms).
Physicians are drawn to the model because it allows them to spend more time with patients, while still making a profit, says Wayne Lipton, managing partner at Concierge Choice Physicians, which has transitioned over 300 doctors to concierge over the last 10 years. Under the traditional healthcare model, doctors are responsible for thousands of patients and often see 24 to 36 people in a single day, says Lipton. That’s because most doctors aren’t paid a salary, but are instead paid by insurance companies per patient seen or service provided, incentivizing them to squeeze tons of appointments into each day.
In fact, research shows that doctors are spending less time with patients than ever before, and it’s not uncommon for a doctor to spend just eight minutes with a patient. In concierge practices, physicians may only see around six patients per day. MD2 physicians, who care for about 50 families each, accompany patients to specialist visits and navigate their hospital stays, too, says the company’s marketing director Laurie Krisman.
On the other hand, some doctors and public health experts, like UT’s Rosenau, warn that concierge medicine could increase inequality and overall healthcare costs in the U.S.
“Doctors who do concierge care are not required to take on all who apply, or even all those who are willing to pay,” says Rosenau. “The question that research has not answered is this: Are concierge care doctors avoiding the sickest patients that require the most time and energy? If so, then it is the taxpayers who bear the cost because the poor and the very sick may well be eligible for subsidies when they purchase regular insurance in the market exchanges of the [Affordable Care Act].”
What’s In It for You?
Without the stress of having to see four to six patients an hour, concierge doctors can easily spend a half-hour or more with each patient. While some concierge doctors might offer blood tests or assessments that other primary care practices may or may not deem important or cost-effective, Lipton says that’s not what’s most beneficial to the patient. The doctors who have joined Concierge Choice Physicians all offer services outside your typical physical exam, such as nutrition and fitness counseling, physical therapy exams and stress management guidance using techniques like yoga and meditation.
Every year, MDVIP patients are given a wellness plan that addresses how they can reach their health goals over the year, offering services from disease prevention to emotional counseling and weight management. Some docs even teach their patients tai chi. And if you’re out of town and get sick, you’re guaranteed a same-day visit with any of the MDVIP physicians in the area.
“The actual core benefit…comes down to [doctors having] the time to do things they don’t normally do,” says Lipton. “It brings back the benefits that are lost in more of the ‘factory style’ of medicine.”
Extra time also translates to better communication. Compliance rates in medicine are historically around 50 percent, according to Lipton. That means patients understand what a doctor wants them to do, and follow through with the care prescribed, only about half of the time. “If you spend time with the doctor and they sell you on the idea of what you should do and help you understand the importance, answer all your questions and make it easy to have a strong relationship with them, you’re going to do what you need to do,” says Lipton.
Is Concierge Medicine the New Norm?
In 2013, just six percent of U.S. physicians were practicing under the concierge model, compared to four percent in 2012. But you can expect that number to grow: According to the 2014 Physicians Foundation Biennial Survey, which surveyed 20,000 American physicians about various health care trends, 13.3 percent said they plan on transitioning to this model partially or in full. Seventeen percent of docs age 45 and younger said they plan on making the switch.
And while Lipton says no studies have conclusively shown that patients with concierge doctors have better health outcomes, he says patient satisfaction is higher in the concierge model.
“There are hundreds and hundreds of thousands [of patients] who are enrolled,” says Lipton. “As that population grows, it will be a reflection of a move toward more private care. But not just private pay care: private care that gives time, convenience, more of a relationship with the doctor and more of an old-fashioned approach to care.”