Medicine' - Take It or Leave It
February 2, 2009
More primary care physicians are embracing "concierge medicine," where patients pay an annual fee to guarantee access to their doctor, and giving their patients an ultimatum, pay to stay or find another doctor.
Some doctors switch to this kind of practice on their own while others join a concierge doctor network, such as MDVIP.
MDVIP-affiliated doctors limit their practices to a maximum of 600 patients. In exchange for $1,800 annual fees, patients receive 24/7 access to their doctor, a thorough annual physical, and express scheduling and office visits.
Some opponents of concierge medicine view the business model as an extra level of bureaucracy atop managed care medical insurance. Dr. Bill Anderson, who runs the Sleepy Hollow urgent care facility downtown, wrote recently in a weekly ad, "if you have a real doctor in a private practice and not a managed care medical plan, you get the same service, minus the frills. Your doctor or an associate is available by phone 24/7 and they coordinate emergency and hospital care when you need it. So what's the big deal?"
Jane, a seven-year
Their doctor conceded he was "terrified" that patients were not receiving the care they needed because of time constraints imposed by a large practice. Under the concierge model, he cut his roster to 300 patients, who pay $2,000 a year.
Jane considers the expense well worth it. She and her husband have already benefited from expedited services. When a routine exam revealed a questionable growth, her doctor was able to schedule an MRI within two days. The doctor called her on a Saturday to give her the results.
When her husband's physical revealed plaque in his arteries, their doctor argued with their medical insurer for tests not typically covered. He also provided a detailed roadmap for suggested lifestyle changes.
"I think if you have the privilege to do
this," explained Jane, who is 62 and a senior analyst for a
The annual premium for an employer health plan covering a family of four averaged $12,700 and $4,700 for single coverage last year, estimated the National Coalition on Health Care.
Dr. Bernard Kaminetsky, MDVIP's medical
Rose uses a 30-minute office visit to learn what's going on in his patients' lives, a mirror into their physical wellbeing. He can learn details not possible in the five to eight minutes required to keep up with an insurance-driven clientele.
"For me, I didn't sign up to practice medicine like this," he says. "Unfortunately I started practicing 25 years ago when it was different. I have seen the change, and it's very disheartening."
His 2,100 patient load will eventually be reduced to 450 or 500. He figures he will work just as hard but spend more time on each patient.
Rodriguez regrets that concierge medicine only helps a limited number of people. Ideally, he'd like to see a national healthcare system that embraces the concept of preventive medicine.
In the meantime, Rodriguez has chosen to help those he can under the current system, including himself.
John, a 20-year