Concierge medicine, also known as retainer medicine, direct primary care or membership medicine, offers a physician’s services directly to patients for a standardized fee. It differs from traditional practices in that patients can have virtually unchecked access to their doctor, multiple visits aren’t charged as separate appointments and long wait times for appointments are eliminated.
As early as 1996, MD2 , the first concierge medicine practice, was established in the northwestern United States. With a limit of 50 families to one physician, it laid down the groundwork for future concierge medicine practices, emphasizing the high-quality care physicians can provide when not overwhelmed by a substantial volume of patients. Having such a reduced patient load eliminates “the rushed questions and assembly-line pace of even the best primary care practices,” and typically results in better health outcomes for concierge medicine patients. A recent surge in popularity has seen lower prices and an increase in accessibility for patients but for the average citizen needing medical care, concierge medicine is an unaffordable solution.
Doctors Love It
One of the biggest motivating factors behind moving into concierge medicine for doctors is the increase in pay. While a successful internist in New York or San Francisco might earn between $200,000 and $300,000 a year, The New York Times noted that a high-end, exclusive concierge medicine practice can net the right practitioner $500,000 to $700,000 per year. Such a significant amount would entice anyone to switch practices, especially when the heart of the business stays the same — providing quality care to patients.
Another benefit of concierge medicine for doctors is the reduction of operational costs; as they are smaller practices, they typically require less funding for promotion and marketing (many advertise solely through word of mouth or select references), support staff and other administrative and overhead expenses. Concierge medicine also lends itself to stronger doctor-patient relationships, built through more tailored care and time spent with individuals, that is more fulfilling for those burned out from the high volume of patients in traditional practices.
It’s Not for Everyone
Many doctors today are considering the switch from conventional to concierge medicine. Unfortunately, the benefits only follow if the customer base does, and not every long-time patient is eager or willing to change how they receive care. Despite the smaller patient load, concierge medicine can still result in burnout because of the constant and guaranteed access to doctors, with patients sending messages at their own convenience and treating doctors as their own personal paid staff. Another issue is the specialization of care: With less exposure to patients, doctors see a narrower range of medical ailments and lose certain skills as a result.
Patients Want It
Having unlimited access to a primary care physician is unsurprisingly the biggest benefit of paying for concierge medicine. With just a flat fee, patients can call or message doctors 24/7 and secure same-day or next-day appointments. Most concierge physicians see 400-600 patients compared to the 2,000-3,000 per physician in traditional practices, giving doctors more time to address individual patient needs and collect a full history. Concierge doctors also work with specialists for more cooperative care.
A referred-to specialist might not know what medications a patient is on and prescribe something that causes an adverse drug interaction, but by working with the initial primary care physician (in this case, the concierge doctor), this situation can be avoided. Service models also include tiered pricing, with higher fees resulting in more comprehensive care. A low fee model might include direct contact and quick appointment scheduling, while a higher fee model can score private rooms at hospitals, house calls and travel accompaniment.
The Real Cost of Concierge Medicine
Despite the potential benefits, the cost of concierge medicine acts as one of the strongest limiting factors for patients. While the more expensive, out-of-pocket “subscription” fee for access to concierge doctors covers most costs, it often does not cover specific medical services like hospitalizations and specialty referrals. Additionally, concierge physicians still tend to bill private insurance or Medicare for certain services, leaving patients to pay two fees: the concierge membership and their insurance.
Costs are spread out over a significant price range depending on the practice, type of access and age of the patient, with the average fee starting at $200 and going as high as $30,000 per month. Because lower fees equate to lower quality care or shortened time with physicians, this places a financial barrier on high-quality medical care — something every person has a right to, but not everyone can afford.
There are also ethical concerns surrounding concierge medicine, as it clearly highlights a barrier to quality health care for lower-income persons. Over 1 in 5 wealthy people pay an extra fee for direct access to their doctor, using resources that many do not have. With current models charging more for older patients, it also seems like the models are geared more toward business than positive health outcomes, even using the assumption that older patients need more care and therefore would pay more regardless of which practice they use. The biggest issue with concierge medicine is that it indicates a trend toward a two-tiered medical system based on economics.
With doctors flocking to concierge practices to avoid the current factory-line model of health care, the lower half of the economy is forced to submit to lesser-quality care. Given the current shortages in the primary care workforce, this only exacerbates problems such as shortened visits, long waiting times and a larger workload placed on already-strained physicians.
Conclusion
While both doctors and patients receive some benefits in concierge medicine, there are concerns and practices that inhibit its widespread use. This is partly because of uncertainty surrounding the level of care and performance measures, and because of the high financial barrier concierge medicine practices establish. With prices that are affected by age and the possibility of additional fees, patients can be wary of enrolling in such a program.
That being said, there is still merit in it, especially for those that might accrue substantial medical bills with numerous appointments or need extensive, more accessible care. Unfortunately, the high price tag alone makes concierge medicine a non-viable option for a large percentage of the population. It results in better care for wealthier patients, while lower-income families are forced to use whatever is left of a broken system.
