The last time you called your doctor’s office, how long did you wait for an answer? How long do you normally have to wait to get an appointment or wait for a call for a prescription? When you arrive at the office, how much time do you spend in the waiting room and how much time does the doctor spend with you?
Did you get answers to all your questions? How many seconds do you have at the beginning of your appointment to explain your symptoms before you are interrupted? Do the nurses and doctors seem more interested in your computers or charts than you?
If your experiences are like most people, your answers to these questions are not very flattering to the medical profession and the health care system in general. Most doctors don’t really want their practices to be like this, but they don’t have much of a choice. They must have a high volume of patients in order to make ends meet financially. The high volume makes the clinic a very crowded place and most patients do not feel they receive much attention.
In 1996 in Seattle, a doctor named Howard Moran thought there should be a better way to do this. He pioneered the concept of having a lower volume practice with highly attentive healthcare delivered as a service to patients for a retainer fee, just like many attorneys or accountants. This fee may be in addition to or in lieu of regular office fees billed to insurance companies. This concept allows the practice to remain financially solvent while providing better and more responsive medical service to its low volume of patients (generally keeping the patient count down to about one-tenth of the number in a typical traditional primary care practice).
Unfortunately, health insurance companies currently do not pay for this type of service, which means patients have to pay out of pocket, but if the service is good, it may be worth it. Patients joining these practices are encouraged to maintain their usual insurance that they will need for visits to other specialists, laboratory tests, radiological tests and/or hospital services if necessary.
Many concierge practices offer same-day or next-day appointments, no long waits for appointments or prescription refills, direct access to your personal physician day or night, home visits if needed, ongoing care if you are hospitalized , complete physical exams, audiometric screening tests, cardiovascular and cancer risk. screening, more attention to preventative care, unhurried appointments, all questions answered, family meetings if needed, coordination of care with specialists, provision of personal health records on CDs or flash drives, etc., etc.
Depending on the type and amount of services being provided, the retainer flat fee can vary widely from area to area, anywhere from $100-$20,000 per year, most likely averaging around $1500-3000 per year. There were only a few hundred of these doctors a few years ago, but now there are more than 5,000 of them across the country. Many, but not all, of them are listed on the main website of the American Academy of Private Physicians: http://www.aapp.org/. Patients can find a concierge doctor in their area on this site.
There has been some controversy surrounding some of these practices because some authorities believe that the growth of concierge medicine will lead to a two-tier medical system in this country: one for the rich and one for the not-so-rich. Additionally, with the current shortage of primary care physicians (PCPs), with an increasing number of concierge practices, the number of PCPs available to traditional practices will be even fewer, and access to care for patients served by those practices will be affected. On the other hand, more medical students may become interested in primary care if they have opportunities available in counseling medicine when they finish their residencies.
Some of these practices have been criticized by insurance companies who say concierge doctors are basically providing an insurance plan for their patients without having an insurance license to do so. Therefore, practices must be legally and financially structured in such a way as to avoid this criticism.
Overall, the concept of concierge medicine provides a good alternative to the currently unsatisfactory traditional model of medical practice. The fee may seem high to some, but in most cases, it probably won’t be much more than the cost of your local cable or phone bill, or the same as what a family would spend eating at a restaurant once a week. .