En español l Crowded waiting rooms, jam-packed schedules, doctors too harried to really listen to their patients — such complaints abound whenever there's talk about medical care.
But what may come as a surprise to many health care consumers is that these criticisms are expressed not just by patients but by doctors as well, and many are seeking a solution in what's called "concierge medicine."
In this type of medical practice (also called boutique medicine, retainer-based medicine or direct care), doctors — mainly in primary care — see fewer patients so they can spend more time with ones they do see.
For their part, patients pay an out-of-pocket fee that typically ranges from several hundred dollars to $15,000 annually. In addition to longer visits, patients receive a comprehensive annual physical examination, a commitment to shorter waits and, in many cases, the doctor's cellphone number and email address so they can get in touch quickly.
Concierge medicine is not a substitute for health insurance. The retainer, no matter how steep, does not cover out-of-office visits to specialists, emergency room care, hospitalization, major surgery or high-tech diagnostic tests, such as CT scans and MRIs. The fee is not reimbursed by either private health insurance or Medicare, although patients' health savings accounts may cover some of the cost.
Concierge medicine comes in nearly as many flavors as does ice cream. In some practices, patients pay an annual fee and also pay for office visits; in others the annual fee pays for all in-office care. In what's called a hybrid practice, the doctor continues to see all patients but sets aside a few hours each day for patients who pay an extra fee. Some practices bill for insurance reimbursement; others have gone off the insurance grid.
Doctors who switch to concierge care say they do so because they're frustrated with ever-rising overhead costs and flat or reduced insurance reimbursements. They also say the only way to keep afloat these days is to see more patients and spend less time with each one, what some doctors call "assembly line medicine."
Critics of concierge medicine say they're concerned that if many doctors choose this type of medical practice, the result will be fewer doctors to go around, leaving it increasingly difficult for patients, especially lower-income ones, to find a doctor.
Some critics also worry about the impact on patients' health. "We know that concierge medicine works on the convenience side," says cardiologist Harlan Krumholz, professor of medicine at Yale University. "But we don't know if it's a good model on the science side. Getting more care doesn't actually mean getting better care." It's possible that concierge care could lead to overtreatment and overtesting, neither of which benefits the patient.
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