Is My Doctor Going to Fire Me?

(FrankSkeffington's in a tough position. Read on.

And without a serious increase in family docs/primary care, we're going to see a lot more of this. - promoted by Charley on the MTA)

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):………

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8 Comments . Leave a comment below.
  1. Excellent take

    on the second evolution of health care for the elite.  A part of that filtration process is already underway in the massive effort to datamine for "pre-existing" conditions.  Then can get  your genetic tendency markers or know the particular brand of cigarettes you smoked, it all goes into your credit rating don't you know.  Being just a peasant I was thinking I should fire my doctor simply because his database goes directly into NSA HQ and I know those cretins will use that info against me.

  2. Newton, Brookline & Cambridge. Gee what are those communities famous for? Oh yes---90% democratic/ well to do/ progressives.

    I have been beating this drum re healthcare providers---buy no one wants to listen to a middle of the roader.

    I went to a CEU class last night at a restaurant---a freebie---paid for by a drug manufacturer. My waitress was a woman I had worked with. A nurse who was burned out in three years. She works two jobs now, but less hassle and zero liability issues ( read lawyers suing your ass off for doing you job). BTW---the average age there was easily 45-50. One nurse at my table looked around and said, "who is going to take care of us?"

    Healthcare providers are bailing out. Why? Burnout, piss poor compensation, mountains of paperwork to CYA and placate medicare/medicaid (requiring additional administrative staff---increasing the overhead), malpractice insurance, mind numbing regulation, 24/7 schedules, physical assaults,the list goes on and on.

    I see med students, and I always ask, "Do you know what you are getting into?" Most are fresh faced, enthustiastic, want to save the world, forget compensation. Five years out of med school, they are shipwrecks. I talked a 30 year old M.D. (woman) out of quitting medicine three years ago. She finally threw in the towel about four months ago. She now works for an insurance company, 40 hrs a week, 8-5, and didn't take that big of a hit $$$ when you look at the bottom line.

    This is a societal issue that will only get worse. We have to stop this insane litigation. Reduce liability and malpractice costs, reduce working hours for healthcare providers (the American entitlement for immediate medical attention is often not reasonable). Increase compensation for lower paid healthcare providers ie MD's and RN/LPN who  are not employed by major medical facilities. Unfortunately there is the issue that most Americans are not in love with hard work and being an MD or an RN is HARD WORK. The onus is not entirely on those seeking service. Healthcare workers, and those going into the healthcare fields must realize that there is considerable sacrifice.

    The answer is increasing the number of COMPETENT nurses and MD's. It's hard, sometimes grisly, emotionally exhausting , physical work. If you can get bright young hard charging men and women into the service to face death on a battle field, then you can find those same people for healthcare. They must be adequately compensated. And the American public must come to terms with the fact that healthcare workers make mistakes, and they should not be professionally executed for a mistake. Medical mistakes are often horrendous as a consequence, but must everyone in USA be ultimately punished by driving the healthcare workers we have elsewhere, and discouraging young people from entering? No matter what, if we started tomorrow, we wouldn't see dramatic change for at least ten years. Medicine is something that generally takes considerable time to be GOOD at.  

    But what do I know?  

    • Are we increasing the rate of supply?

      We all want people to have access to health care -- and to do that, we need more doctors and nurses.  As the boomers retire, they'll consume medical care at higher rates -- and again, we'll need more doctors and nurses.

      My question: are medical training institutes for these professionals expanding?  Are new ones being created?  If we don't increase the number of doctors and nurses graduating every year by a substantial percentage, than how can we expect to have adequate personnel in the future, given that the amount of health care the average person will be consuming is going up, both because we're expanding health care coverage and because the demographics will result in more seniors?

      And hey, increasing the supply of this labor will increase competition, helping to keep wages [and hours worked] down, which both keeps cost down and helps reduce burnout, right?

  3. Point of information

    Frank - they have them on Cape Cod, too, but those aren't on your list or site.

  4. Many doctors will no longer take on any more medicare/medicaid pt.'s for the obvious reason---they don't get paid. paid in a timely fashion/paid at the going rate.

    • Dentists too

      MassHealth recipients are entitled to dental care and the Legislature made a big deal when it expanded coverage a couple of years ago.  Trouble is now that hardly any dentists takes MassHealth Patients.

      I think also, that many GPs are starting to turn patients away as the new Universal coverage is coming online because already it's simply a matter of the demand is outstripping the supply.  

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Thu 30 Mar 8:34 PM