Blog | Sunday, December 13, 2009

Concierge medicine as a practice model

A significant percent of people do not know what "concierge medicine" is. Also known as "retainer" practice, concierge is a growing type of medical practice where the patient pays the physician an up-front fee (retainer) for services. The fee can range from $100 a month to $20,000 a year, depending upon the practice and the services offered. The fee usually covers all visits to the doctor, phone calls, more prompt service and e-mail access. Labs, tests, X-rays, specialist visits, and hospitalization are not included.

The concierge of Artus hotel, Saint Germain des pres, Paris by infostreetcafe via FlickrMore and more primary care physicians are forgoing the hassle of dealing with insurance companies and Medicare and are becoming concierge doctors. Because of the retainer, physicians can have a smaller practice and be more accessible to patients. The doctors that charge $20,000 a year have only 100 patients and provide "spa" service. (You do the math!) One of my colleagues has a long waiting list!!!

Patients who go to concierge doctors still carry health insurance for other health care. But they have easier access to their primary care doctor and both physicians and patients are generally happy with their arrangements. If the patient doesn't feel like it is worth it, they can always just drop out. Many physicians say if they hadn't switched to concierge practice, they would have just quit medicine all together.

Some of the criticism of concierge medicine is that with the shortage of physicians, it only exacerbates the access problem. It is called elitist and leaves out the people who can't afford the retainer. Other critics say patients are paying for service that many physicians already provide without a retainer.

Proponents of concierge say it is the free market at its best and it restores the doctor-patient relationship and contract. Tell me what you think about it.

Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.