Top 9 Criticisms of Concierge Medicine

March 12, 2010 in Health Care "Reform" by RangelMD

Concierge medicine = A new primary care practice model whereby patients pay a flat rate per year in return for more and better services than are provided under the current system.

Many liberals have a knee-jerk reaction conniption fit when asked about concierge medicine: “Only the rich will be able to afford concierge care” and the end result will be that  “fewer doctors will see fewer patients”. These statements are true but ironically only for the current dysfunctional system which impairs quality by reducing actual patient care time and drives doctors away from a career in primary care.  Liberals are put into the uncomfortable position of admitting that the current insurance driven primary care system is underfunded and overburdened and likely gives poorer quality care than a concierge care system. The top 7 liberal conniptions about concierge medicine are as follows;

  1. “Seeing fewer patients will reduce access to primary care.” This concern is valid but only if applied to the current system which is designed to be like an assembly line a la the famous conveyor belt scene in I Love Lucy. If Lucy and Ethel don’t wrap enough candies then fewer will be made and available for kids and chocoholics. However,  medical care and the management of complex medical problems is not an assembly line style process and does not absolutely need to be done with an in-person visit. Many patient care encounters could be done over the phone (such as discussing lab results) or other modern electronic form of communication where the physician allowed to defer to his or her medical judgment as to whether the patient needs an in-office visit. For those patients who do belong to a concierge medical practice, access to care would actually be increased since many of these practices offer 24/7 direct access to an MD (some even provide their own cell phone number for concierge patients to call), the docs have more time to answer phone calls and email, and patients can usually get a same day appointment when needed.  If this practice model were much more widely accepted and initiated then the massive bleeding of physicians going into any other specialty than primary care might be slowed or even reversed thus improving access.
  2. “Physicians will have LESS incentive to see patients and perform care since they are paid up front.” Again, this concern might be valid for overworked and underpaid physicians on salary within a socialized government health care system but not for physicians in a concierge practice who have an ownership stake and the responsibility not only to ensure that their patients are well cared for but that they are satisfied enough with the care and service provided by the practice to sign up for another year. It’s called incentive and it is that little ingredient that has made capitalism such a successful economic system.
  3. “Only the ‘rich’ will be able to afford concierge care.” Though some concierge medical practices charge well over 2-3 thousand per year per member, many charge amounts that are comparable to the yearly cost of cable TV and currently 175 million Americans are able to afford this service. Put this in perspective. The cost of cable TV is about $3-4 per day while many Americans pay $8-16 per day for private medical insurance and they don’t get anything like the services of a concierge practice with 24/7 MD access, same day visits,and office visits of 45-60 minutes or more.  Perhaps Americans should start asking their insurance companies why concierge medical services are not covered given the amounts they pay. Additionally, concierge physicians are free to charge discounted fees to patients depending on their economic need and ability to pay in any way they want. Charging patients less than Medicare rates is actually ILLEGAL under current law for physicians who accept Medicare.
  4. “Concierge patients get better care.” Yes, this is an actual complaint of the concierge medical model that comes from people who are well aware that the current system severely underpays primary care providers and limits actual time spent on patient care. Actually there is no data, as of yet, that concierge medical care if of better quality and improves outcomes than the traditional model. But it can only be a matter of time since it is intuitive that a few minutes spent with a patient every few weeks or months cannot possibly be better or comparable to the much more comprehensive and personalize care afforded by the concierge model.
  5. “Concierge patients get better service.” This one is absolutely true and is the number one reason why patients sign up for concierge care. I’m not sure why it’s a complaint but it definitely comes from people who are aware of how the current system packs waiting rooms and physician’s schedules, leaves people waiting for weeks to months to get appointments, leaves people waiting hours for a rushed visit that lasts a few minutes, often gives little to no after-hours access, and generally treats patients like cattle and physicians like meat.
  6. “Concierge physicians just want to get rich.” Really? Is this why they actually and significantly REDUCE the number of patients that they care for in their panel? The vast majority of concierge physicians take an enormous financial risk to change to this practice model and do so out of desire to actually practice patient care and improve their lifestyle while MAINTAINING their income levels. Contrast this to some – not all – physicians in the current system who see 40 to 50 patients a day with a total patient panel of 5-8 thousand. Seeing this many patients a day leaves little time to do anything more than a cursory 60 second interview, a 15 second physical exam, and a few more minutes writing prescription refills, referral orders, and a laughingly inadequate chart notation. They then submit a “medium” office visit charge to Medicare or other private insurance which is not high enough to attract much unwanted attention to their bad documentation and poor medical care but enough at $30-50 dollars a visit to generate a substantial income for minimal effort. You do the math. It’s like having your own press to print money. Since patients entitled under the current system have come not to expect much in the way of comprehensive care, it is much easier for physicians to delve into the vast gray area of improper medical care and coding without being accountable to anyone. I’ve seen this more than I like to admit and it makes me sick every time.
  7. “Concierge medicine will increase health care costs.” Though the short term costs may be higher, concierge medicine can provide more comprehensive medical care and it is comprehensive primary care that has clearly been shown to reduce costs by providing care that is comparable to that of specialists and with better health care outcomes through a combination of preventive care, close management of chronic medical conditions, and counseling. Contrast this with the current  insurance driven model which pays only per visit and per test or procedure and essentially encourages over utilization without much regard for outcomes.
  8. Concierge Medicine amounts to patient abandonment. The reasoning is that by increasing their fees to levels that most patients are unable or unwilling to pay, physicians are effectively abandoning their patients. But this is not the legal definition of patient abandonment since under our current system a physician is not forced to work at a financial loss or in a system that they believe compromises patient care (in the same line of reasoning, is it also abandonment if the physician wants to retire or move?).
  9. Concierge Medicine is UNETHICAL. This one comes from jokers who believe that concierge medicine is elitist and exclusionary because it open only to people who can pay. As opposed to what . .  the current insurance based system that excludes 45 million Americans who can’t afford their inflated insurance rates and a Medicaid/Medicare system that makes it illegal for physicians to treat them at a discounted rate?
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