Concierge Doctors: They're Not Just for the Super-Rich Anymore

concierge medicineReading certain media reports, one might think that concierge medical care is a service solely for the super-rich, an exclusive realm of $1 million in-home emergency rooms and $30,000 annual fees for round-the-clock access to physicians. But the concierge model actually encompasses a range of services, often costing significantly less than the stratospheric figures cited in stories about health care providers who cater to the 1%.

"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.

"I couldn't take care of patients the way I wanted to," Katzman says. "I had to have a panel of 3,000 to 4,000 patients. It wasn't very personally rewarding to me."

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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Thompson Aderinkomi

Concierge medicine is a great innovation but only takes half way. What we need are more low cost monthly memberships to primary care clinics that include wellness programs and chronic condition management. It was articles like these that inspired me to pivot my start-up

April 25 2012 at 11:45 PM Report abuse rate up rate down Reply

If Obama care survives and, as many forcast, there are not enough doctors, my prediction is this. The government will do everything it can to pull these concierge doctors back into the general physician pool, pehaps even forcing them to if they wish to keep their license. Afterall, healthcare is a right everyone is born with. How dare doctors try to make money of sick people, will be the justification.

April 09 2012 at 10:55 PM Report abuse -1 rate up rate down Reply

My stepdaughter is the survivor of a pediatric cancer. She has some odd health issues that are likely fall-out from the cancer and it's associated treatments. She has been through numerous physicians, including following up with the children's hospital where she was treated 30 years ago, and no one has been able to get to the bottom of her problems. Her dad, a physician, hand-picked a colleague to care for her, and even he didn't have time to figure out all of her issues. Finally, we found a concierge practice, and this doc spends a huge amount of time wading through her tests. Hopefully, he will be able to get her issues resolved soon, but he has tried a lot of new things that no one else has had the time to explore.

April 09 2012 at 1:33 PM Report abuse +1 rate up rate down Reply

They are equal oppurtunity wallet emptiers.

April 09 2012 at 12:10 PM Report abuse -1 rate up rate down Reply

Think you have it bad, Kenneth? I happen to be a physican in an urgent care setting in Brooklyn NY. I also own a very modest townhouse in Staten Island, and until recently, drove a 2003 Hyundai Santa fe. On one occasion, I was pulled over in New Jersey by a cop who wanted to see if the MD plates on that Hyundai were stolen. He could not believe that a doctor would be driving that P.O.S. car. At the present time, I have a 2011 Mercury Mariner, (a loaded out clone of the Ford Escape), upscale enough to be a believable "doctor's" car, but not enough to offend my mostly working class patient clientele

April 09 2012 at 11:44 AM Report abuse +6 rate up rate down Reply

One more thing. I am a family doctor. I am NOT rich. I drive a VW Jetta (and I have had people criticize me by saying that I must not be a very good doctor if I'm not rich). I have a modest home and no money in the bank. I have adopted two children that needed a home and it stressed us financially. I do what I do in order to help people. I see a lot of patients for free because they need help. The general public doesn't know that there are Medicare rules that state that I can't see patients for free and if I do, I face jail time for "Medicare fraud" because I charged Medicare more that I charged the indigent person. Look into this before judging or making comments. The governmental regulations regarding Medicare govern what insurance companies, hospitals, and doctors are allowed to do. Obamacare will make it WORSE for everyone....not better. The same common sense that had the military paying $200 for a hammer twenty years ago, now will be making life and death decisions for people.

April 09 2012 at 11:19 AM Report abuse +6 rate up rate down Reply
2 replies to Kenneth's comment

My husband is a doc and he drives a 12 year old Toyota and I drive a 10 year old Nissan. We don't own big screen TVs or numerous computer gadgets or the latest phones or laptops. Not all doctors are millionaires. Most are middle class. What Katzman says is true--pick and choose where you spend your money and weigh the importance of your needs.

April 09 2012 at 1:02 PM Report abuse rate up rate down Reply
1 reply to Adele's comment
Micah Price

I can empathize! I drive a Kia and don't have a smart phone. Most of my patients on disability that can never afford their copays have them but I don't. I always love how people assume that all doctors make millions of dollars. No figure.

April 10 2012 at 4:26 AM Report abuse rate up rate down

I am curious from a doctor''s standpoint what the bad issues are with Obamacare. It's so complicated that I really don't know what to conclude. I have a lot of health issues (6 spine surgeries) and have signed on for the Concierge program with my doctor of 20+ years. What is it about Obamacare that will make things worse?

April 09 2012 at 4:38 PM Report abuse +1 rate up rate down Reply
Mark Hotz

I have a concierge physician affiliated with MD-VIP. Although I am in very good health, I was sort of a hypochondriac, and I enjoy having the ability to see my doctor pronto when needed. We are on very friendly terms and I feel comfortable going to him. He is there in case something suddenly comes up, and will coordinate care. Recently I had a colonoscopy and was one of the very very few who aspirated during the procedure. As a result, I got aspiration pneumonia almost immediately. My MD-VIP doctor was on top of it as soon as he learned about it and made me feel much better. He even insisted that I call him on his cell phone twice per day on the weekend to let him know my status. MD-VIP was there for me when I needed it, and that is why I have it.

April 09 2012 at 11:18 AM Report abuse +2 rate up rate down Reply

One simple fact: you get what you pay for. Comprehensive office visits that take the doctor 20 or 30 minutes pay the doctor about $50. This is after two or three full-time employees fight insurance companies for 30-60 days. Those of us who can actually stay in business like this make less than plumbers or electricians. I have a friend who is a heart surgeon. He makes $800 for a six hour heart bypass. Good luck with Obamacare, which will further stress the medical practice by putting us under governmental oversight without increasing our pay. Smart people migrate to where the money is. Within ten years, your doctor might not have the intellectual ability to ask "do you want fries with that?" because anyone with an IQ of a nematode will know that they can make more money and have more autonomy in another field. Blame the insurance companies, blame the government, blame the lawyers.....don't blame the doctors. We are just looking for a way to make ends meet, just like you. The same thing that makes you irritated about having to pay for the services is what motivates us to charge for the services. The economy sucks and you and I are both looking for ways to keep the little bit of money that we have.

April 09 2012 at 11:12 AM Report abuse +4 rate up rate down Reply

This is the way physicians used to be able to care for their patients before the hospitals took over their practices. These docs can't even hire their own office staff, and must churn through a set number of patients per hour. Meanwhile, the administrative offices are packed with hundreds of pencil-pushers making new policies so that their jobs are justified as 'innovative, patient centered and cost conscious'. These thousands of policy makers have great salaries that have shoved the price of care skyward, and they have no contact with patients, and make the caregivers lives miserable.

April 09 2012 at 10:54 AM Report abuse +1 rate up rate down Reply

Concierge medicine? Gee, I remember the times that Concierges could only get you show tickets and recommend a good restaurant....My, have times changed....:)

April 09 2012 at 10:13 AM Report abuse +4 rate up rate down Reply