Is Concierge Medicine Elusive for Most?

It’s easy to understand the lure of concierge medicine… 24/7 physician access, same day appointments and your physicians’ personal email and cell phone number. It all seems just too good to be true without raising ethical concerns.

Is Concierge Medicine Elusive for Most?

Concierge medicine, also referred to as retainer, boutique, platinum and membership medicine, has gained momentum over the last 5-10 years. There are different models with the same basic concept…. patients pay an additional fee for physician care with added benefits. Concierge physicians are typically in primary or internal medicine but may include some specialties. The cost depends on the age and health of the patient and the services that are provided

Limited Statistic

According to the Specialty Concierge Medicine Polling Data (2018), there are 5,000 to 6,000 practicing private medicine physicians. However, these numbers lack accuracy since there is no federal registry or national database to document physicians practicing under this care model. Statistically, concierge physicians:

  • See an average of 6 to 8 patients a day
  • Earn a salary range of $150.000 to $300,000 and more
  • Typically maintain a patient roster of fewer than 500 patients
  • Usually accept health insurance and charge an additional fee

Keep in mind, statistics on concierge services are limited, widely varied and lack reliability.

What is the Patient Draw?

It’s easy to understand the lure of concierge services, especially for those with chronic illnesses. Imagine having access to your doctor 24/7 with guaranteed same day appointments. Your physician may even give you a personal email or cell phone number. Common perks include:

  • Priority and longer appointments
  • House calls and hospital visits
  • Preventative and wellness care
  • No crowded waiting room and long wait times
  • Highly coordinated care with specialists
  • Assistance with insurance claims

Some concierge services offer premium or “executive” services. These may include unlimited appointments, all office services covered, transportation, covered diagnostic services and even spa type amenities (i.e. bathrobe, slippers).

Surrounding Ethical Issue

Concierge services have been controversial and often considered elitist. Let’s take a closer look at these ethical issues:

The Haves and the Have-Nots: Does concierge medicine promote a two-tiered health system that favors those who can afford extra services? One concern is further limiting the number of available physicians to care for those unable to afford premier services. According to a recent survey, Americans wait about 24 days to see a new doctor. This is a 30% wait time increase since 2014.

Abandonment: Consider a primary care physician with a patient load of 2,500 patients transitioning to concierge practice with only 500 clients. Patient downsizing raises 2 ethical issues of abandonment.

  • Patients can’t pay the retainer will no longer have access to their doctor.
  • Due to a national shortage of primary care physicians, finding a new one may be a challenge.

The American Medical Association (AMA) offers specific guidelines for ethical practices in retainer services. This includes ethical standards for the transferring of patients for continuity and the obligation to uphold access to care regardless of ability to pay.

Minorities and Cherry Picking: Critics argue minorities are poorly represented in concierge medicine. According to the CMT (2017) practice demographics are reported as 64% suburban clinics, 29% metropolitan and 7% rural practices. There is also concern physicians are “cherry picking” the healthiest patients and leaving sicker patients to be absorbed into traditional primary practices.

Ethical Obligation: The Graduate Medical Education Program (GME) financially supports training of physicians in hospital settings. Some argue use of taxpayer dollars in the GME program ethically obligates physicians to care for more patients than in concierge practices. Ethical concerns are also raised regarding physicians using concierge services to “cash out” early in their career. One viewpoint is individuals take spots from medical school applicants who may have practiced in areas benefiting more people.

Consumer Drawbacks

Patients need to consider the financial drawbacks before using a concierge service. Fees paid to these physicians are not tax deductible. The less expensive services may not use electronic records or other advanced technology. Therefore, patients may need to go elsewhere for some labs and diagnostic tests.

Conclusion

There are always going to be controversial ethical issues surrounding health insurance and healthcare. As physician and consumer frustration continues to build around the nation’s current health system, the use of concierge services will continue to rise.


Share your insight. What experience or ethical concerns do you have with concierge medicine? What is the likelihood you would someday move to this personalized model of care?

References:

The Future of Healthcare Could be in Concierge Medicine

Question: Is Concierge Medicine Ethical?

Retainer Practices- American Medical Association Code of Ethics

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J.Adderton

About J.Adderton, BSN, MSN

(Columnist)

I am a nurse with over 20 years experience and have had the privilege of working in a variety of settings. I love writing about what I encounter in my everyday nursing career.

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Specializes in School Nursing.

I see the Nurse Practitioner now that my primary physician is concierge and I don't have the finances to afford the retainer. I had a brief illness recently and the NP called me later that evening and said "while reviewing visits today with Dr. so-and-so, he mentioned that (medication) is also indicated for what you have, would you like me to call it in?"

When my mom's 6 month blood work for her Thyroid came back a bit off, the NP ordered follow-up labs and then the concierge doctor is the one who met with her to discuss that she had cancer and what the future would look like.

I hope others who are experiencing concierge changes at their office are having positive experiences like I am. I hate reading that people feel like they "lost" their doctor, mine is still there, just a bit removed by comparison.

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Specializes in Clinical Leadership, Staff Development, Education.

Thanks for sharing your experience. A great example how NPs can fill a need in today's healthcare.

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Specializes in Cardiology.

Meh, this has always been around. Those with more money get catered too. I guess the good thing for my area is that there are basically 3 major hospital systems and they bought out or forced physicians to join. The idea of independent practice by me is almost non-existent.

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Specializes in Dialysis.

I think we already have this in regular practice as well. Some MDs will not accept Medicaid or only take a small number of pts with Medicaid. In my area , this is governed by the hospital, who also owns the urgent cares, who do not take Medicaid either. There are 2 clinics in downtown Smalltownville who takes cash (sliding scale to income) and Medicaid. Appts are booked out 3 months, so if you have an acute incident, you suffer or go to ER.

Facilities will do backflips if you have a premium insurance or are wealthy private pay, so concierge medicine just falls in this line

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I am tired of reading how minorities suffer. And by "minority" is meant non-white, right?

There are plenty of non-minority poor or disadvantaged people who can't always get seen quickly or who see NP's instead of doctors. I am not saying that's bad, but some people think so.

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On 5/29/2019 at 1:28 PM, LikeTheDeadSea said:

I see the Nurse Practitioner now that my primary physician is concierge and I don't have the finances to afford the retainer. I had a brief illness recently and the NP called me later that evening and said "while reviewing visits today with Dr. so-and-so, he mentioned that (medication) is also indicated for what you have, would you like me to call it in?"

When my mom's 6 month blood work for her Thyroid came back a bit off, the NP ordered follow-up labs and then the concierge doctor is the one who met with her to discuss that she had cancer and what the future would look like.

I hope others who are experiencing concierge changes at their office are having positive experiences like I am. I hate reading that people feel like they "lost" their doctor, mine is still there, just a bit removed by comparison.

Did the NP not know that med was indicated?

Same question about your Mom's blood work.

Or did she know but not allowed to handle these matters without consulting with the doctor?

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Specializes in School Nursing.
On 6/1/2019 at 6:48 PM, Kooky Korky said:

Did the NP not know that med was indicated?

Same question about your Mom's blood work.

Or did she know but not allowed to handle these matters without consulting with the doctor?

The NP called me and said she forgot Lyrica was indicated for Shingles when I was in the office and that the doctor brought it up when reviewing their cases for the day. I was given Lidocaine patches for pain management initially, and I ended up never filling the Lyrica because it was managed fine without it. She said she rarely sees Shingles so it slipped her mind and apologized.

From my family's experience (4 adults, 2 with serious chronic illnesses) the NP is the main interaction/orders until something life threatening/altering comes along. Then both the doctor and NP come into the appointment for the information exchange. (ie: Telling my mom her blood work indicates she has leukemia).

Despite being concierge, the doctor makes an effort to meet every new patient at the practice, even if they are not part of the concierge because they consult with each other.

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Specializes in Nursing Professional Development.

I don't have any problem with people being allowed to purchase health care services of their choosing. Why should health care providers not be allowed to offer their services to the public for a fee?

The issues of accessibility to basic health services for people who have few financial resources is a different issue. I believe should support programs that help poor people get the services they need -- but that shouldn't stop someone who has money from buying a product/service that they want and can afford to pay for.

People without a lot of money by cheap cars, cheap houses, etc. -- that provide basic transportation and housing. Society should support programs that assure that the basic needs (safety, etc.) can be met by all. But people with lots of money are going to choose buy luxury cars and big, luxury houses, etc. Why should health care be all that different?

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Specializes in OB.
On 6/2/2019 at 12:44 AM, Kooky Korky said:

I am tired of reading how minorities suffer. And by "minority" is meant non-white, right?

There are plenty of non-minority poor or disadvantaged people who can't always get seen quickly or who see NP's instead of doctors. I am not saying that's bad, but some people think so.

Where is race mentioned in this article? I’ve looked twice but see no mention of it. But in general, just because you personally are “tired” of hearing about something doesn’t mean it isn’t a valid concern.

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