What are your thoughts on the emerging trend of "Concierge" or "boutique" medicine?
In this new emerging trend, doctors are reducing the size of their practice so that they may spend more quality time with their patients and their families. The physicians are reducing their practice by charging an annual fee to patients that is in addition, in most cases, to their health insurance. Companies like https://www.mdvip.com/Corporate/index.aspx have created a new specialty called "personalized" or "boutique" medicine. This is a more personal and somewhat more proactive form of medicine. Who stands to benefit from this emerging trend?
Wealthier patients benefit while the typical http://www.medicare.gov/ patient or the typical senior on a limited budget , can probably only afford a http://www.medicarehmo.com/ or may have problems finding a non HMO doctor willing to take them on as new patients.
How does this new trend affect you ? Write to us and let us know from either the patient or the physician perspective? Is this better medicine? Why do you think this new trend has emerged? Do you think that this trend has a negative or a positive impact on health care?
Friday, September 15, 2006
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2 comments:
anyone wants to learn about medicare HMO's should visit
http://www.medicarehmo.com/
In my practice...on several occasions..I have been told, somewhat, frustratingly by my medicare patients..(patients that remind me of my grandparents) that they have been given the "boot" by their primary md. ...I am not sure what to tell them when they ask me ... "who would I refer them to now that their doctor of the last 20 years has left them and has asked them to pay $1500 to join their http://www.mdvip.com practice "...or how to help them find some one else... it poses a significant problem because in the city of http://www.ci.boca-raton.fl.us/ , (Boca Raton, Florida) many of the primary doctors are switching to http://www.cbsnews.com/stories/2006/07/20/earlyshow/contributors/emilysenay/main1820059.shtml
Primary doctors are setting up concierge or boutique medicine practices for the wealthier patients only... As a result we are running out of good doctors to recommend to these patients... I feel terrible for them...It is like your grandmother telling you she cannot afford to see the doctor who has been taking care of her for the last 20 years.
What would you say to her? Most elderly patients cannot relate to this type of decision by their doctor because they still think of the doctor as "holier than thou", the elderly still give the doctors the respect that doctors claim that they do not receive from the younger patients..Obviously , the move to concierge medicine doesnt help their image.
But, this is happening all over the country, and I am guessing it is a problem that will need to be dealt with. If a patient no longer can afford their doctor.. then where do they go?? Inevitably, they will end up on the wrong end of the "healthcare" totem pole...think about it.. if every http://www.aarp.org patient or every http://www.medicare.gov
patient had to pay an extra $1500 just to keep seeing their doctors.. the system would break, seniors would not be able to afford their primary doctors..
Consequently, this shift will have "unintended consequences" of the "better" doctors only treating the wealthy and the "non concierge" doctors will be treating the poorer patients. Poorer patients tend to be sicker so ironically the sicker patients will now be relying on the "non concierge" doctors. (in effect , the concierge medicine will naturally select or "cherry pick" the healthier, weathier or more motivated patients) . Now, the "non concierge" doctors will be overrun with more complicated patients, busier with poorer sicker patients, and now since these doctors will be much busier based on volume alone (since the "concierge" doctors can reduce their patient load dramatically because they financially can justify it...)the non concierge doctors will not have the time necessary to devote to sicker patients and thus the sicker patients will get sicker.
So, who do you recommend? Who should I recommend to these patients? The few remaining primary care doctors that have not established concierge practices in Boca are overwhelmed with patients now that the http://www.mdvip.com groups have dwindled their practices to the elite few. Patients wait for hours in the remaining overcrowded practices and weeks for an appointment. Many of these non concierge primary doctors are now closing their practice,understandably so because they just dont have the time to accept any more new patients.
Ultimately, the patients are forced to go to urgent care centers or emergency rooms for their care.. as they cannot find a primary care giver to manage their health. This is going to be huge inefficient burden on an already broken strained and over utilized emergency room system.
So, lets ask the bigger questions...Why are primary care doctors leaving their patients? Why is there a development towards concierge medicine? Perhaps if the primary care doctor made more money in their practice , they wouldnt feel the need to migrate to http://www.mdvip.com ... and if , perhaps, they did make more money, this symptom, ie movement toward "elite" concierge care would not have been created. So, all of us are too blame as we wanted our insurance companies and HMO's to tell doctors what they could earn. After 20 years of managed care medicine, such as HMO's http://en.wikipedia.org/wiki/Health_maintenance_organization doctors have reacted.
These are hard working http://www.sgim.org/ internal medicine doctors, but, I believe this is a much grander problem than the individual doctor needing more money... I believe this is a symptom, a manifestation, of a broken health care system.. with consequences affecting all doctors and all patients, across the board... on the one hand, I completely understand their position..ie medicine is a business , no different from any other, and we do, thankfully, live in a society that enables free choice with medicine and business and products and services (medicine is one of these)... And, though, in theory, capitalistic forces should correct the demand for more care by creating more doctors willing to step in and fill the void and "make the money" .. but, the problem is that doctors are limited on how much they can charge by insurance and third party payors as it is now a highly regulated industry and.. true capitalistic forces are not in play...if doctors feel they dont earn enough for their time... then , they will not continue to practice.
The problem is... our grandparents and parents.. cannot afford to pay for a concierge doctor..and they feel deserted by their primary doctor... Unfortunately everyone, patients , doctors and society loses.. society loses because an institution of trust for the health care provider is severed and the institution of caring doctors regardless of payment (whether theoretical or not) , the institution of trusting your doctors motives of being better for your health not the bottomline is gone .The patients that are jilted have lost faith in their doctor.. for even if they pay.. and feel that they are getting "more attention" (which is very controversial..because "more attention" in a concierge plan is really just being a "good doctor" , it is what we learned in medical school to do ie watching your patient and treating them , knowing their family, understanding their psychosocial issues and responding 24/7 to their needs.. ). I dont remember medical school teaching us or Hippocrates instructing us.. that we will get "extra" or more money if we are available to our patients "on call" or if we help them "prevent" disease rather than just "treat" disease. I dont remember this because as doctors we dont learn this..we learn that part of being a doctor is responding on call to a patient when they need us, it is helping to prevent illness with wellness planning, diet plans and advice, taking phone calls after hours, listening to family members...it is a shame now that all the things concierge medicine says it does for the patient are "a la carte" services , "Not Included".services that you must "pay to play" are the very services that made us unique as physicians, caring as humanitarians, and isolated from the motivations that corrupt our society. I know , i am living in a dream world....
So, it is sad for everyone... for patients, for doctors and for society... and for the loss of the innocence in belief that doctors are motivated differently than every other business person... ultimately, we are all human and we are all responsible for these societal shifts ..Everyone one of us, me included, is guilty and responsible and now we must own up to it.
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