I fear that my primary physician is trying to push me and many of his patients out of his practice. Of course, given the state of our health care system, who can blame him and his partners at the practice?
Primary care doctors are at the bottom of the insurance/Medicare food chain, receiving the lowest reimbursement rates compared to their “specialist” colleagues. So they have to focus their professional energy into creating a patient-mill, seeing patients at a rate of one very ten minutes so that they can meet the expenses of their practice AND obtain a similar income level of their “specialist” colleagues. No doubt this takes a real physical and mental toll that leads to professional burnout.
This is but one problem in the ever-complex health care dilemma our society wrestles with. Without reforms and solutions, the “market” is attempting address this problem for some primary care physicians and the results will have horrendous implications for society as a whole. Creating a system of primary care “have” patients and primary care “have nots”.
Basically there is a movement to “thin the herd” of primary-care patients by offering highly individualized treatment for a much smaller group of patients who can afford to pay additional out-of-pocket costs of as much as $5,000 a year-over and above normal health insurance costs. The doctor will have fewer patients…and less stress…but make the same and even more money. Their (paying) patients will, theoretically, will get better medical care. As for the current patients who can not afford the additional $1,500 to $5,000 a year in additional/optional medial fees…hmm, none of the marketing information I’ve read pushing these services seems to mention them. I guess they don’t matter…because they are no longer patients.
The concept is called “Concierge Healthcare” in which doctors charge additional monthly or annual fees for more individual attention-Doctors may even make a house call (if the price is right) like the fabled “good old days”. There are several companies marketing this concept to primary care physicians and now they are getting a toe-hold in Massachusetts. Two leading companies are: MDVIP and Concierge Choice Physicians
Here are a few Massachusetts doctors currently implementing this concept. Note the communities in which their practices are located-Brookline, Newton (OK…Chestnut Hill…maybe they are on the Brookline side) and Cambridge. It should be no surprise that that these practices are located in high-income areas. So in a time that we are struggling to provide basic health care affordable for the moderate to low income people within our communities, forces are at work to widen this gap. With the result of possibly thrusting middle income families into the quagmire of finding adequate medical care because their primary care physicians abandon them so they can see fewer patients that can afford to pay more for their services.
Of course this is not how it’s presented in the marketing brochures and puff-piece media stories that I’ve found. The pitch is how wonderful this is for the Doctor and their (remaining) patients. But they seem to gloss over a certain fact:
For a price, Dr. Barber’s patients can call on him just about any time, from anywhere in the world, if the need arises.
Getting in to see him isn’t difficult either. His practice, which once included 1,300 patients, today is limited to just 592, so getting an appointment is easy. “We like to say we have a non-waiting waiting room,” Dr. Barber said.
Having fewer patients not only means fewer scheduling conflicts, it means that Dr. Barber can spend more time with each patient, a critical factor in his ability to deliver proper preventive medical care-”as opposed to merely treating illnesses,” he said.
Gee, that’s great! A reduction of 57% of his patients…great for the 43% that decided to pay the extra money (over and above the $1,000 or so per month a family medical insurance plan costs). But no mention of what happens to the other 708 patients that lost their primary care doctor.
If this trend takes hold in Massachusetts, it will only compound the unintended consequences of our health care “reform” initiative.
For me, this is not theoretical. My doctor is moving to this model. Now I have a decision to make: pay more to keep my doctor…replace my windows to save on oil next winter…drive less…reduce my retirement savings to afford keep my doctor…or take a chance finding a new doctor.
And “they” say I’m middle class?
PS) If anyone wants to learn more, here are some more links (most of it is warm and fuzzy BS):