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.
So should you consider concierge care?
Assess your current medical care. If you like your doctor, can get an appointment when you need one and don't feel rushed in the examining room, there's no reason to change to a concierge practice and pay extra money.
Consider your health. If all you need is an annual flu shot and a consultation for the sniffles, concierge medicine is probably not worth the cost. But if you have a chronic condition such as diabetes or heart disease and see several specialists in addition to your primary care doc, concierge care may pay greater health dividends in terms of coordination of care and longer and more frequent visits.
Consider the location. Most practices are heavily concentrated in urban areas such as New York, Washington, Los Angeles and Miami. If there's not a practice within easy reach, it probably doesn't make sense for you.
Weigh the cost. Ask yourself whether the money you're paying out of pocket will provide a return in terms of a better relationship with a doctor and better health.
If, after weighing these factors, you think a concierge doctor might make sense for you, be sure you have answers to the following questions before signing on the dotted line. Remember: There is no standard definition of concierge care, so before signing up you must be crystal clear on what you'll get for the money.
- Do you take insurance and will you file claims for me?
- What services does the fee include?
- Do you offer preventive care?
- Do you admit your patients to the hospital yourself or do you use a hospital-based doctor?
- Can I schedule same-day appointments?
- Can I contact you by email or phone with routine questions?
- Will you coordinate my care if I need one or more specialists?
- Do you make house calls?
And perhaps most important of all, make sure you click with the physician. "Set up an appointment to interview the doctor," advises David Fairchild, M.D., senior vice president for Clinical Integration at UMass Memorial Health Care and professor of medicine at UMass Medical School in Worcester. "This gives you a chance to talk about what you want in the relationship. For example, you may be interested in alternative therapies. Does the doctor agree they're worth a try? See how the fit feels between the two of you before you sign on."
To find the name of a doctor near you who practices concierge medicine, call the American Academy of Private Physicians toll-free at 877-746-7301 or email your request, including ZIP code, to Shelly Banyay.
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