Concierge Healthcare

Margaret Atkins MunroLet's Talk About MoneyLeave a Comment

For most of us these days, visiting the doctor is a choreographed exercise frantically reminiscent of The Flight of the Bumblebee. You sign in, pay the required fee, have your vital signs checked, and then wait in a room barely big enough for the examination table and two chairs for the doctor to arrive. He or she then spends the few minutes allotted for this appointment, simultaneously asking questions while performing the examination, quickly jotting down the details of a new prescription, another test, or a follow-up visit before hurriedly flitting off to the next patient. Due to time constraints, there is little opportunity for discussion or questions; accordingly, only the most pressing concerns are ever addressed, or even heard.

If you’re a healthy individual, this assembly-line practice of medicine likely provides adequate care; if you suffer from anything more complex than the common cold, however, your needs are not being met.

This is the conclusion my husband and I have come to, eighteen months after his health began to decline. After dozens of physician consultations and myriad tests and treatments, he is no closer to a clinical endpoint today than he was at the beginning. What he does have to show for this expenditure of time and money is an overstuffed medical record which would put the Manhattan telephone directory to shame, and a file folder bulging with hundreds of expensive co-pay and insurance deductible receipts.

healthcareOur frustration is extreme; so, too, is that of his primary care physician. He is tired of being a slave to the insurance companies, primarily responsible for the health of their bottom line. Instead, he is taking steps to regain control, to practice medicine the way he knows he should. He has just announced that he will start offering concierge healthcare over the summer, reducing his patient load from a current level of over 2000 to as few as 200 individuals. Instead of only treating illness, he desires to promote wellness and health education, which cannot be shoehorned into a fifteen-minute appointment.

He is the first physician in Vermont to move in this direction, but he surely will not be the last; the level of physician frustration with the current system is stratospheric and growing. Combine the inability of hospitals and medical practices to attract adequate numbers of new primary care physicians with the ever-advancing age of those already here, and you have a system poised on the verge of collapse. As existing doctors move closer towards retirement, they will become more likely, not less, to reduce practice size by whatever means.

The move towards concierge medicine is not without substantial costs; in order to earn his living from a smaller cadre of patients, each patient this doctor accepts into this plan will pay a significant additional annual fee, one that insurance companies won’t cover. And, because so many of his current patients either can’t, or won’t, pay this added cost, these 1800 individuals will be forced to find new primary care physicians at a time when most internal medicine and family practice offices are closed to new patients.

From a purely selfish standpoint, I am delighted that my husband will be participating in this new model of medicine; he profoundly needs someone qualified to spend the time necessary to get to the bottom of what ails him.

At the same time, I have very real concerns about the viability of this model of medicine, not because individual doctors and patients may benefit from this more expansive type of practice, but because the vast majority will suffer. The stress cracks in our healthcare system will quickly widen into fissures if hundreds and thousands of additional primary care patients are thrown into an already overburdened system each time one physician opts to move to this personally saner model of practicing medicine.

I cannot fault my husband’s physician; he has reached a point where he either moves in the direction of more personalized, and better, care for a smaller group of patients, or he gives up the practice of medicine altogether. Remaining with the type of practice he currently has is no longer an option for him.

And I cannot fault us for grabbing at this life jacket; we’ve been incredibly patient up until now, but enough is enough. The constant worry doesn’t benefit the physical or mental health of any of the members of our family.

But I cannot help but wonder if this one doctor moving to concierge care will be the straw that breaks the healthcare system’s back. And if not this physician, what about the next one, or the one after that?

If we are not careful, and attentive to addressing the needs of the doctors who wish to practice medicine rather than insurance, we run the danger of creating a bifurcated system where, while health care must be accessible to all, for those who can’t afford the extra fee, there won’t be anyone left to provide it.