Medicine Health

A new drama on USA Network this summer has brought attention to a new trend in the practice of medicine. Royal Pains is the story of a concierge doctor in the Hamptons who treats the super rich in the privacy of their own homes.

But concierge medicine in not just for the super rich anymore. I became aware of one aspect of it recently in Orlando, Florida. Our daughter found a doctor that she liked. Despite having very comprehensive health insurance from a major carrier, her doctor advised her that in an effort to control the number of patients he would see, he was charging an annual fee for patients who wanted to continue to be treated by him. He was not accepting any new patients and current patients who pay a sliding scale annual fee would have more immediate access to him.

Anyone who has tried to make an appointment for their annual physical with a gynecologist has probably discovered that the wait to get an appointment is mind numbing. Shortages of practicing OB/GYNs has been well documented. I was made painfully aware that it is a growing problem recently when I got my card reminding me that my annual GYN physical was due. I called the next day and the first appointment they had was 6 months later. My gynecologist is a member of a large practice in a fairly large metropolitan area. I'm sure waiting times vary depending on geography but the trend is there.

Which brings us to the concept of concierge medicine. There was a time when doctors made house calls. Few of us remember those days but in the not too distant past doctors, especially family doctors, knew their patients and their history and often treated them at their own homes.

With managed care doctors moved away from this practice model. It is not unusual for a primary care physician to have a patient roster of 3000 or more and might see as many as 30 patients a day. Simple math shows that in an 8 hour day a doctor has 16 minutes per patient. Some doctors decided that was not the way they wanted to practice medicine. In 2003 a non-profit organization, the Society for Innovative Medical Practice Design (SIMPD) was formed. It is the trade organization for doctors who operate retainer driven practices.

It is estimated that over 5000 doctors now practice some form of concierge medicine.

The super rich have always known the value of a concierge doctor or as some call it a direct care physician. However, in the last few years more and more doctors and patients are finding value in hiring a personal physician. The promise of concierge medicine is appealing.

A physician on retainer agrees to provide direct care to the patient with convenient, unhurried appointments that start on time and go as long as necessary. The private physician focuses on prevention and keeping his patients healthy. In the event a patient does need the help of a specialist, the private physician coordinates with the specialist and assists with diagnostics and advocacy if necessary.

The patient has unprecedented access to the doctor. Each patient has the doctor's cell and beeper number and is encouraged to call if they feel the need. Limited practice size make next day appointments the norm. Test results are shared with the patient in a way that is understandable. A recent survey reported that 95% of patients renew their arrangement with the private physician year in and year out.

Concierge practices are growing in popularity. Most are located in urban areas and not surprisingly in areas with high average incomes. But hybrids of the concierge model are also springing up. Doctors are desperate to have more time with their patients but they recognize that they may not be able to move immediately to that model. A New York based company, Concierge Choice Physician (CCP) has helped more than 100 doctors in California, New York, Arizona, Florida and New Jersey to manage a hybrid model of concierge medicine.

No everyone is in favor a concierge medicine. Government agencies and insurance companies are opposed to the model. Some members of the medical community have voiced concerns about the ethical considerations.

The Society for Innovative Medical Practice Design (SIMPD) has published a Statement of Ethical Principles affirming ethical principles in line with those of the American Medical Association.

SIMPD has been asked to testify before the House Ways and Means Committee regarding Health Care Reform and has published a written statement of their position as it will be presented to Congress. Their testimony is scheduled in mid-June.

Whatever your opinion about the concept of concierge medicine it is a practice model for doctors that is growing. Patients, wealthy or otherwise, who want more and better access to their doctors continue to support the concept.