"An increasing number of physicians have turned to concierge medicine," explains Physicians News Digest, "also known as retainer or boutique medicine, to retain their individual practices."
In concierge medicine, patients pay their primary care physicians a retainer in return for basic services and augmented care. These flat fees are sometimes the physician's sole source of income; in other cases, doctors continue to take insurance and use their concierge patients' retainers as supplementary fees. For patients, the perquisites vary from practice to practice, but can include more personal attention, house calls and even the doctor's cell phone number for 24-hour access.
For David Woolfe, 57, whose primary care physician is a concierge doctor, one key perk is the comprehensive annual physical. "It's just a broader spectrum kind of assessment. They do a mental acuity thing, which had never been part of my physical previously, vision and hearing in a more determined sense, that sort of thing."
The enhanced exam is a two-step process: "You do the physical and the lab work, then come in to discuss." Woolfe also receives "a nice little CD" explaining his results.
For services like this, along with the ability to contact his doctor on her cell phone -- which he has done only once -- Woolfe pays $1,500 a year; his insurance covers regular visits. "It's costlier," Woolfe concedes, "and I don't know quite frankly if it's worth the additional expense. The physical is good, though, in the sense that it creates a real baseline: This is what things were when you were healthy, so you know when things start to change."
Woolfe didn't exactly come to concierge medicine of his own choosing. "I didn't switch so much as my doctor switched to a concierge model within her practice," he says. "So, in order to stay with her -- and I like her very much -- that was my primary motivation." And he's hardly a high-flying member of the wealthy elite: A resident of Long Island, he works as a religious educator and freelance writer.
"In terms of bang for the buck," Woolfe concludes, "other than having access to the doctor I want treating me on a regular basis, it's not worth it to me."
"But," he adds, "I don't really have any issues that require that kind of attention. Frankly, I don't think many people do. That's why it's called 'concierge.' It's just nice, it's not really necessary."
Jumping Off the Conveyor Belt
David Katzman is an internist in St. Louis who used to see five or six patients an hour -- 25 or 30 a day. "It was difficult to do," he says, "and really difficult to do well." But even churning through patients that fast, Katzman was finding it hard to make ends meet: "Expenses go up, whether it's postage, or malpractice insurance or rent, and you really don't have control over what you get for patient visits, what you can charge or what you receive. The only way you can make up your cost is taking on more patients." Other revenue-enhancing options -- doing lab tests, dispensing drugs, selling supplements, or opening a weight loss clinic in his office (or speaking for drug companies) -- didn't appeal to him.
His solution was to switch the concierge model. He made the transition in 2003.
Now, Katzman's patients are given an hour for every physical examination. They can call his office, request an appointment, and see him on the same day. They can text, email, or call him on his cell phone. And they can be confident that "their doctor knows them, and knows their medical history," Katzman explains, "because I don't have nearly as many patients."
His office has the time to schedule consults with specialists, and calls patients with lab results quickly. Katzman and his partner will visit their patients in the hospital, which many primary care doctors no longer do, and they can cover for each other relatively seamlessly, since they know many of each other's patients.
This deeper engagement has given Katzman the sense of professional satisfaction he lacked when he was engaged in what has been called "conveyer belt medicine."
Concierge medicine, he says, is "sort of like turning the clock back 40 or 50 years to a relationship between the doctor and the patient which is in many ways like a family relationship." Katzman even makes house calls a couple of times a month -- he did one just two days before speaking with DailyFinance.
Affordable, If You Make It a Priority
Katzman's practice is far from an exclusive haven for the most affluent. "I certainly have super-rich patients," he says, "but the majority of people are middle class or upper-middle class."
About 10% of Katzman's patients see him on scholarship, meaning he doesn't charge them at all. "These are patients who could obviously never afford this," he says. Many were in his practice before he became a concierge doctor, but some have been added since the switch. "Sometimes you're on call in the ER and patients get admitted that way," Katzman explains. "Usually, if I start with a patient I'll continue with them. Sometimes it's employees of people who are patients, like the housekeeper of a patient. Or there's somebody who knows someone who's having a problem and needs help."
For patients not on scholarship, Katzman charges an annual retainer of $1,800 for those over 50, and $1,200 for those younger. "The fee is relatively modest," he says, "compared to other fees in life. If somebody values being in a practice like this, they can do it in place of going out to dinner twice a month, or instead of the extended package on cable TV, or whatever. It's about picking and choosing what's important."
Ultimately, Woolfe agrees about the price, even if he sounds ambivalent about the value. "One would never say to someone who doesn't have $1500 that it's nothing -- it's a nice chunk of change. But in and of itself, it's not a reason to say you've got to be wealthy to do this."
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